What is Shingles?
Shingles is a disease that occurs when the chickenpox (varicella) virus, which lay dormant in the body since childhood, reactivates when immunity is weakened. Approximately one in three Japanese people will experience shingles at least once in their lifetime, and it is said that about one in three people will experience it by the age of 80.
It is characterized by pain and a rash that appear on only one side of the body, in a band-like pattern along the nerve pathways. If left untreated, it can progress to prolonged nerve pain (postherpetic neuralgia or PHN), making it extremely important to start treatment within 72 hours of the rash appearing.
Early consultation is the best prevention
Even if you only feel a "tingling pain," that's fine. If a rash starts to appear, please see a doctor within 72 hours at the latest. The sooner treatment begins, the more you can significantly reduce the risk of sequelae.
Symptoms and Progression of Shingles
Typical Progression
| Period | Symptoms |
|---|---|
| Prodromal phase (a few days to 1 week before) | Tingling or pricking pain, discomfort, itching (no rash yet) |
| Acute phase (rash appearance to 1 week) | Redness → vesicles → pustules, pain intensifies |
| Crusting phase (1 to 2 weeks) | Vesicles rupture and form scabs |
| Healing phase (2 to 4 weeks) | Scabs peel off, sometimes leaving pigmentation or scars |
| PHN transition phase (1 month onwards) | Pain continues after the rash heals (postherpetic neuralgia) |
Characteristics of the Rash
- Appears only on one side of the body (does not cross the midline)
- Distributed in a band-like pattern along the nerve pathways
- Common sites are the chest, abdomen, back, face, and neck
- Changes from red spots → small vesicles → pustules → scabs
- Vesicles are numerous clusters arranged in a band
Characteristics of the Pain
- Tingling, throbbing, or burning pain
- Pain when clothing touches the skin (allodynia)
- Often intensifies at night
- Tends to be more severe and prolonged in older individuals
Triggers for Onset (Factors Weakening Immunity)
- Aging (especially after age 50)
- Severe stress / overwork
- Lack of sleep
- Other illnesses (influenza, cancer, post-surgery)
- Use of immunosuppressants, steroids, or anticancer drugs
- Chronic diseases such as diabetes
- Immunodeficiency states such as HIV infection
- Excessive dieting / malnutrition
Serious Cases That Should Not Be Overlooked
The following symptoms indicate high urgency
Symptoms in these areas carry a risk of severe sequelae such as vision impairment, hearing loss, or paralysis. Immediate medical attention is recommended.
- Rash around the eyes or on the tip of the nose (herpes zoster ophthalmicus, risk of vision impairment)
- Rash inside the ear or on the face (Ramsay Hunt syndrome, facial paralysis, hearing loss)
- Rash is widespread or bilateral (disseminated herpes zoster, suggesting immunodeficiency)
- Accompanied by high fever or severe headache (complication of meningitis or encephalitis)
- Accompanied by difficulty urinating or defecating (involvement of sacral nerves)
- Difficulty breathing or altered consciousness
Principles of Treatment
Antiviral Drugs (Important to Start Within 72 Hours)
Antiviral drugs suppress virus proliferation, accelerate healing, reduce the severity and duration of pain, and prevent PHN.
| Drug | Dosage | Characteristics |
|---|---|---|
| Valacyclovir (Valtrex) | 3 times a day × 7 days | Most common, adjusted according to renal function |
| Famciclovir (Famvir) | 3 times a day × 7 days | Equivalent efficacy to valacyclovir |
| Amenamevir (Amenalief) | Once a day × 7 days | No adjustment needed for renal function, fewer interactions |
| Acyclovir IV drip | IV drip 3 times a day × 7 days | For severe cases or when oral intake is difficult, inpatient treatment |
Pain Control
| Severity | Management |
|---|---|
| Mild | Acetaminophen, NSAIDs |
| Moderate | NSAIDs + pregabalin (Lyrica), mirogabalin (Tarlige) |
| Severe | Combination with weak opioids (tramadol), tricyclic antidepressants (amitriptyline) |
| Intractable | Nerve block (referral to pain clinic) |
Topical Therapy
- Vidarabine ointment: Promotes healing of vesicles
- Antibiotic topical agents: Prevents secondary infection
- Protective dressing: Protects ruptured vesicles
About Postherpetic Neuralgia (PHN)
Pain lasting for 3 months or more is called PHN
This is nerve pain that continues even after the rash has healed. It is said to occur in about 20% of people over 50 and about 30% of people over 80. The pain can last for several months to several years, and significantly reduces quality of life, so early treatment is paramount.
Prevention and Treatment of PHN
- Prevention: Sufficient antiviral drugs from the acute phase + early use of neuropathic pain medications
- Drug treatment: Pregabalin, mirogabalin, tricyclic antidepressants, SNRI (duloxetine)
- Topical: Lidocaine patches (Noritren), capsaicin topical application
- Nerve block: Referral to a pain clinic for intractable cases
Shingles Vaccine
Shingles is a disease that can be prevented by vaccination. It is recommended for people aged 50 and older, and not only prevents the onset of the disease but also reduces PHN if the disease does occur.
| Vaccine | Type | Doses | Efficacy against onset | Estimated Cost |
|---|---|---|---|---|
| Shingrix | Inactivated (recombinant subunit) | 2 doses (2-6 months apart) | Approx. 97% (50s) / 88% (70s) | Approx. ¥22,000 per dose × 2 |
| Live attenuated vaccine (Biken, etc.) | Live vaccine | 1 dose | Approx. 50-70% | Approx. ¥8,000 |
* Some municipalities may offer subsidies for vaccination for people aged 50 and older. Please check with your local government for subsidy programs.
Shingrix is particularly recommended for:
- Individuals aged 50 and older (especially those over 60)
- Individuals who have had shingles in the past (to prevent recurrence)
- Individuals using immunosuppressants
- Individuals with chronic diseases (diabetes, chronic renal failure, etc.)
About Human Transmission
Shingles itself does not transmit to others, but the virus can spread
Shingles does not transmit "as shingles" to others. However, there is a possibility that people who have never had chickenpox (especially children and pregnant women) can become infected with chickenpox. Cover the blistered area with clean gauze and avoid contact. Once scabs form, the infection is no longer transmissible.
Precautions in Daily Life
Skincare and Hygiene
- Keep the affected area clean (wash gently with soap)
- Bathing in lukewarm water is OK (avoid water that is too hot or prolonged bathing)
- Do not burst or scratch the blisters
- Use a dedicated towel and separate it from family members' towels
- Wear soft, non-irritating clothing
Rest and Recuperation
- Get enough sleep and nutrition (for immune recovery)
- Limit alcohol consumption
- Slow down work and household chores without overdoing it
- Consult a doctor if pain prevents sleep
Features of Our Clinic's Shingles Treatment
- Immediate examination and antiviral drug prescription possible after rash appearance (walk-ins welcome)
- Supports easy-to-take antiviral drugs such as amenamevir (once a day)
- Prevents PHN with neuropathic pain medications such as pregabalin and mirogabalin
- For severe cases involving the eyes, face, or ears, prompt referral to an ophthalmologist or ENT specialist
- Referral system to pain clinics for intractable pain
- Supports vaccination with Shingrix and live attenuated vaccines
- Walk-ins welcome / Open 9 AM - 9 PM daily / 1 minute walk from Jujo Station
Consult us immediately if you feel a tingling sensation
Even if you think it's "just nerve pain" or "just fatigue," it could be shingles. Even before a rash appears, if you suspect it, please see a doctor. Early treatment is the key to preventing sequelae.
