Shingles recurrence: What to know

Shingles typically appears as a single stripe of blisters. Doctors call it recurrent shingles when a person develops this infection more than once.

If a person develops shingles repeatedly, they may have an underlying health condition that affects their immune system. A doctor may recommend undergoing additional tests to assess it.

Several treatment options are available for shingles, along with a vaccine, which can help prevent recurrent shingles.

What causes shingles to come back?

You can develop shingles only if you have already had chickenpox. The varicella-zoster virus (VZV) can cause both shingles and chickenpox. Chickenpox, also known as varicella, is more common in children, while shingles typically occurs in adulthood, more frequently in older adults.

After you recover from chickenpox, the VZV remains inactive in your nervous system. External factors and other medical conditions can trigger VZV and make it active again. When this happens, shingles occurs. About 1 in 3 people in the United States develop shingles at some point.

Causes that may trigger shingles may include:

• taking medications that suppress the immune system (immunosuppressants)
• emotional stress
• undergoing chemotherapy or radiation therapy
• re-exposure to the virus
• having underlying health conditions, such as HIV
• fatigue or exhaustion
• presence of malignancy, such as leukemia and lymphoma
• inadequate nutrition

Recurrent shingles is rare. One 2020 study found that the recurrence rate in people who didn’t receive a Zostavax vaccine was 2 in 660 participants, and 1 in 321 people who did receive it. Zostavax is an older version of the vaccine that has now been replaced with Shingrix.

To help prevent infection and transmission of shingles, keep your skin rash and blisters dry and clean. When the blister turns into crusts, the virus is no longer transmissible.

Symptoms to look out for

If you have shingles, you may develop a strip of blisters that can cause a painful burning sensation in the area involved. The most common part of the body where shingles develops is the torso. However, shingles can occur elsewhere.

Other symptoms of shingles may include:

• headaches
• muscle aches
• fever
• stomach pain
• vomiting

You may also experience a burning sensation for 1 or 2 days before the rash appears. Once the shingles starts clearing and the blisters crack open, you may experience some bleeding, and scabs may develop.

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Treatments

The treatment for shingles typically includes taking antiviral medications and pain relief medications. Antivirals help improve the symptoms and reduce the risk of complications that shingles can cause.

Antiviral medications are likely to include:

• famciclovir (Famvir) 500 milligrams (mg), three times daily for 7 days
• acyclovir (Zovirax, Sitavig) 800 mg, five times daily for 5 days
• valacyclovir (Valtrex) 1 gram, three times daily for 5 days

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If you experience severe pain, doctors may recommend over-the-counter pain medications and analgesics like topical lidocaine or prescribe opioid medications.

If you develop persistent pain (neuropathy) after the shingles clears, doctors may recommend topical capsaicin and Emla cream after the lesions turn into crusts.

Vaccination

Doctors recommend the shingles vaccine — Shingrix — to people over 50 years. This vaccine lowers the risk of developing painful shingles and is more than 90% effective in preventing shingles development.

The vaccine is given in 2 doses, 2–6 months apart. You only need to get it once.

People can receive a dose of the Shingrix vaccine even if they had shingles before. It is safe and can give you protection from developing shingles again in the future, stopping recurrent shingles.

It’s important to remember that this vaccine does not cure active shingles infection or its symptoms and does not treat or reduce the pain you may develop after the shingles is gone.

The vaccine may not be suitable if you:

• currently have shingles
• are breastfeeding or chestfeeding
• are pregnant
• have had a severe allergic reaction to any of the components of the Shingrix vaccine

You may also have to reschedule your vaccination if you have a fever or are ill. You will be able to receive the vaccine when you feel better.

If you have any concerns about whether the shingles vaccine is safe or suitable for your health conditions, a doctor can advise you.

Summary

Shingles can only occur after chickenpox, as both viral infections result from exposure to the VZV. A person typically gets shingles only once, but some people may develop shingles repeatedly. Doctors refer to this condition as recurrent shingles.

Recurrent shingles risk factors may include having an underlying condition that involves your immune system, such as HIV, taking immunosuppressant medications, or stress. Shingles is more common during adulthood, and doctors typically recommend the Shingrix vaccine to people over 50 years of age to help prevent it.

When shingles occurs, people typically develop a rash and blisters on their body, usually on their torso. Shingles can cause severe pain and a burning sensation. After the shingles clears, you may experience nerve pain in the area where shingles developed.

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