Patient Perspective: Shingles
When 17-year-old Gracie arrived home from a sleepover at her cousin’s house with a neck full of what appeared to be bug bites, her mother wasn’t happy.
Gracie told her they must be flea bites. The spare bed she’d slept in wasn’t the cleanest, she reported, and the family pets slept there often.
The bites covered her neck and they looked to be single red marks that scattered up into her hair, where they were hard to see.
Thinking nothing much of it, and assuming they’d go away, the family went about their lives.
A few days later, Gracie started complaining that one of the bites felt swollen and sore. Concerned, her mother decided to call their family doctor’s after-hours clinic.
Gracie had a phone consultation with the doctor on call, who told her to pick up some Benadryl. He advised that he didn’t think she had flea bites as they were usually found on the ankles.
He speculated that the bites may have come from bed bugs and told them to get in touch if they didn’t calm down in a week or so.
Following her appointment, Gracie and her sister went off to the pharmacy to pick up some Benadryl, and Gracie took some before bed.
The next morning Gracie woke up in even worse pain; the Benadryl hadn’t helped. Her mother called their family doctor and he asked for pictures of Gracie’s bites.
As her mother was taking pictures, Gracie told her she had a big patch of bites on her chest right below her collar. Gracie’s mum hadn’t seen the patch until now. She decided to take a photo of it to include with the images that she’s sending to their family doctor.
Less than an hour later the doctor called, advising that he thought it looked like shingles. Gracie’s family was in shock! Her mum had heard of shingles before, but she’d never seen it and had always heard it was only a concern for the over-60 crowd.
The doctor prescribed Valacyclovir as an antiviral medication and Gabapentin for pain.
The issue, he explained, was that the medications were most effective when taken as soon as shingles appeared.
Gracie began treatment, but it was almost three weeks before she began to feel better. Luckily, there appeared to be no lasting complications.
What Patients Should Know About Shingles
Shingles affects up to 130,000 people in Canada each year. While it’s generally thought of as an issue for older adults, cases have also been rising in younger people.
In fact, over the past couple of decades cases in adults within the 30-50 age group, have seen a steady rise.
What Is Shingles?
Shingles is a painful rash caused by the chickenpox virus, also called the varicella-zoster virus (VZV). Anyone who has suffered chickenpox is at risk, with the VZV virus lying dormant in the system once the chickenpox appears to have healed.
Although it can lay dormant after the initial infection, the virus can be activated by triggers such as stress as it greatly impacts the immune system.
Shingles usually appears as a patch of blisters on one side of the face or body. The shingles virus is also known as herpes zoster (HZ) and can be contagious.
While not life-threatening, shingles can lead to a hospital stay, as well as a host of nasty long-term side effects if not treated properly.
Shingles Treatment
Antiviral meds are a go-to treatment for shingles as they halt the progress of the virus. It’s important to administer treatment fast, within 72 hours of the rash appearing, if possible.
Without prompt treatment, there can be fatal complications such as bacterial infections, or stroke. Not to mention the acute, ongoing pain and discomfort caused by the disease.
Some potential complications of shingles can be:
- Bacterial infections.
- Ophthalmic issues which may cause blindness.
- Postherpetic neuralgia (PHN).
- Ramsay Hunt syndrome and other palsies.
Who Is At Risk For Shingles
Anyone who has had chickenpox is at risk for shingles, regardless of age. And even though younger people are getting it more over time, the risk also increases with age.
Likewise, the older the patient the higher the risk of complications.
Patients with immunosuppressive illnesses such as HIV or lymphoma are also at risk. When your immune system is weakened, the risk of contracting shingles increases.
How to Identify Shingles
Shingles is usually easy to spot as it shows up as a distinctive rash down one side of the face or body. In some cases, it may show up in several areas at once.
Often, shingles first presents itself as moderate to severe pain, tingling or an itching feeling on the skin. These symptoms may be present anywhere from 1-5 days before the rash appears.
How Long Does Shingles Last
In most cases, the shingles rash can last anywhere from 3-5 weeks.
It begins to blister around Day 4 and generally scabs over anywhere from the seventh to the tenth day. Different patients tend to experience different sensations from the virus. While some describe it as itching or burning, others get a throbbing or even stabbing pain at the site.
Other symptoms may include:
- Chills
- Fever
- Headache
- Nausea
- Malaise
How Pharmacists Can Help Treat Shingles
Once a patient has shingles, antiviral treatment should start within 72 hours. Generally, Acyclovir, Famciclovir or Valacyclovir are the most used in Canada.
These medications stop the progress of the virus and can lessen the duration of the illness. They can also reduce the chances of developing complications.
Aside from these meds, there are several other treatments pharmacists may recommend. While not cures, they may help ease discomfort.
These include:
Over the Counter Medications:
There are several over-the-counter options to ease symptoms and relieve pain.
For pain relief, pharmacists may recommend:
And the following may be helpful to soothe the skin:
- Calamine lotion
- Oatmeal baths
- Witch hazel
One of the best ways pharmacists can help treat the illness is by educating patients. Recommending helpful over-the-counter treatments can assist patients in improving faster.
Important Note: Shingles is most likely to spread during the blister phase. During this phase, proper care is important to prevent the spreading of the infection. Educating patients regarding this is an important part of treatment and prevention.
As well, having prescriptions delivered to them can help in preventing the spread of the virus. By offering a delivery service, you can aid your patients with their recovery!
Pharmacists and Shingles Prevention
As with treatment, education plays an important role in Shingles prevention.
Who Should Get The Shingles Vaccine
In Canada, it’s recommended that anyone over 50 get the shingles vaccine. It’s not usually given to younger patients, yet the growing number of cases in the 30-50 age group may change this.
Patients who have had Shingles should still get the vaccine as you can get shingles more than once.
Currently, the recommended vaccine in Canada is Shingrix. This vaccine consists of two doses with a 2-6 months gap between doses. Two doses of this vaccine provide protection not only against Shingles but against postherpetic neuralgia (PHN) as well, one of the most common complications of shingles.
If you don’t offer Shingles vaccinations in your pharmacy, you may want to consider doing so. Pharmacists can play a much-needed role in educating patients on both prevention and proper treatment of the illness.
As trusted frontline figures in our healthcare system, pharmacists have the power to help prevent and ease this painful illness.
Interest in reading more about the impact pharmacists have on the lives of their patients? Check out our blog, Trust and The Human Brain: 3 Ways to Build Patient Trust.
