https://cna.st/affiliate-link/AF4hZrJoZxC7r4YmRKZiFdFFiQSrW23AYDJJNVYTCc2ACWBbuGMCfenu1BNft98ZjSEEjVnTMfmx3goayYZsg5fDsozGoekmocSv9dfSaAD2rYwbSdfUuJdZ1fKhbjMxWvwbJRSCQDhFPhykPgB4BGNLQKristen Pipps was visiting her parents for the Thanksgiving holiday in 2019 when she first noticed a red, blotchy rash on the side of her torso. At first she thought the itchy patches were just a reaction to their laundry detergent, but then her skin started to hurt. “A simple brush of my shirt would send lightning bolts of fire up my sides,” she says.
A couple of days later, with the rash still not getting any better, Pipps asked her mom if she thought it could be shingles, something that never would have crossed her mind if her dad hadn’t just gotten the viral infection 10 months prior. “You can’t get shingles in your 20s,” her mom told her. Still, Pipps went to her dad for a second opinion. “My dad took one look and said, ‘That’s definitely shingles,’” she recalls. Later that day her primary deva doctor confirmed it.
Pipps was 26 at the time.
“I’m not müddet I even really knew what shingles were beyond ‘something old people get,’ let alone what they look and feel like,” she says of the surprising diagnosis. She wondered how she could end up with the same health issue as her then nearly 60-year-old father—an infection with a risk level that gets higher as you get older. It’s not uncommon for younger people to dismiss their shingles symptoms, thinking something else is going on. But brushing off symptoms can lead to delayed treatment, worsening skin lesions, and long-lasting complications like postherpetic neuralgia (PHN).
Pipps is among those who’ve experienced persistent nerve pain from PHN, which can cause a burning, sharp, tingling sensation long after the shingles rash clears. Most people find that irksome shingles symptoms slowly subside in a few weeks, but PHN can last months or even years.
Pipps was just 26 years old when she got shingles.
Kristen Pipps
“With shingles the most important thing is catching it early,” says board-certified dermatologist Mona Foad, MD, founder and CEO of Mona Dermatology in Cincinnati.
The sooner you take action, the sooner you can get treatment to halt the infection’s progression, she explains. Antivirals are doctors’ first-line defense against shingles, as they can reduce symptom duration and nerve pain intensity, says Laraine Washer, MD, the medical director of infection prevention and epidemiology at University of Michigan Health.
But the misconception that shingles is an older person’s disease doesn’t just plague patients. Providers also can fall victim to inadvertent bias, assuming a young, otherwise healthy patient must be dealing with something other than shingles. The result could be you ending up in a situation similar to the one Amanda Chatel found herself in back in 2006.
“I had just turned 26 a few months prior when I broke out in a blistering rash on the right side of my mouth and the right side of my chest,” Chatel recalls. A health deva provider at a clinic in New York City diagnosed her with oral herpes.
Chatel’s sister had gotten shingles herself a few years earlier and experienced similar symptoms, so Chatel sought a second opinion. After swabbing both areas Chatel’s family doctor in her hometown told her the original provider had gotten it wrong: She didn’t have oral herpes; she had shingles. “If it weren’t for my sister, I would have just assumed [the clinic] was right in their initial diagnosis,” she says.
One possible explanation for Chatel’s original misdiagnosis lies in the family of viruses to which shingles belongs. Shingles, also known as herpes zoster, is caused by a reactivation of the varicella-zoster virus, which is also behind chickenpox. The varicella-zoster virus is one of eight viruses in the herpes family known to infect humans, Dr. Washer explains. While not all herpes viruses cause blistering (e.g., Epstein-Barr virus), several are accompanied by their own brand of painful rash, including herpes simplex 1, which typically causes cold sores in or around the mouth; herpes simplex 2, which generally leads to genital lesions; and shingles.
An early misdiagnosis delayed Chatel’s access to the deva she needed.
Amanda Chatel
By the time Chatel got the appropriate diagnosis a couple of days later, both areas were blistering and she had developed other widespread symptoms. “I also had a fever, chills, and my body felt like someone had beaten me with a bag of bricks,” she says. “The blisters hurt like hell, with this horrible burning sensation that actually throbbed.” Though Chatel was prescribed an antiviral, it took a few weeks for the rash to clear completely and for her body to “feel right again,” she says.
That could be because antivirals work best when taken within 72 hours of symptom onset, according to Dr. Washer. As a result some providers may be reluctant to prescribe antivirals if it’s been more than three days since you first noticed symptoms, she explains. Still, immunocompromised patients, those developing active lesions in new areas, or anyone with shingles on their face may be treated with antivirals regardless of the timing, Dr. Washer adds.
That last scenario—having a shingles rash on your face—doesn’t just get doctors’ attention because it can be unsightly. “If somebody has a facial rash either across their forehead or, particularly, if they have lesions on their nose, those patients really should see their physicians, they should get started on antivirals, and they probably should see an ophthalmologist,” Dr. Washer says.
The seriousness lies in which nerve may be affected, Dr. Foad says. The shingles virus lurks silently within sensory nerve cells and, evvel reactivated, pops up along dermatomes. Each of these patches of skin corresponds to a specific nerve that feeds sensory information—e.g., pain, temperature, and itchiness—to and from the spinal cord.
For example, the same nerve that serves the tip of the nose also serves the eye. So if you have a shingles infection on your nose, it could actually travel along the nerve and impact your vision. “You don’t want to get shingles in your eye because then that could lead to blindness,” Dr. Foad says. “Cosmetically, you don’t necessarily want to have shingles on your face, but the bigger thing is that you definitely don’t want it to be in the nerve that goes to the eye.”
When Jamie Smith*, then 28, felt a slight tingle at the tip of her nose, she thought it was just the start of a “weird pimple,” but after a rash developed on the left side of her nose, an urgent-care provider diagnosed her with shingles. It wasn’t long before the rash spread to her eye, and before she knew it she had seen a slew of physicians: a primary deva doctor, a dermatologist, an ophthalmologist, and even an otolaryngologist (an ear, nose, and throat specialist).
At the time Smith was a new mom attempting to juggle her return to work in an emotionally demanding career, a round-the-clock schedule of breastfeeding and pumping, marital strain, and her grandmother’s cancer diagnosis. “The whole experience was extremely traumatic and life-changing,” she says. “Shingles was my wake-up call that all the emotions and stress I was dealing with would catch up to me and manifest physically.”
Like other viruses, varicella-zoster is an “invader” that preys on a weakened defense, i.e., a compromised immune system. While another physical illness or injury can impact how susceptible you are to shingles, mental stress often seems to be associated with the virus getting reactivated, particularly among younger patients, both experts say.
“We live in a world that has so much stress, and I think that younger people are under more stress,” Dr. Foad says of the high-demand lifestyle many young adults are trying to maintain. “Shingles is a disease that can be activated when somebody’s immune system is a little bit down, and we know that stress is a big factor in that. [So] it doesn’t surprise me that you can find younger people who are starting to get reactivation of the disease.”
Stress was a common factor for many of the women we spoke to for this story, and Smith was not alone in coming down with shingles during a stressful period.
Last year Lynsey Buckelew had just turned 40 and was looking to recharge after wrapping up a particularly challenging work event. She headed to upstate New York to spend time in nature, only to return home with sores on the left side of her upper back and down her left arm from what she believed was poison ivy. Even after noticing that scabs were forming, she waited a week to be seen by a doctor, because “surely it wasn’t shingles,” she recalls thinking. She was wrong. A dermatologist diagnosed her with shingles and quickly prescribed medication, but the sores were already weeping, and soon after, the virus spread to her midline.
“It was the itchiest sensation,” Buckelew says. “Every night for weeks I woke up in the middle of the night to reapply calamine. I laid on ice packs—anything for some relief.” It took two rounds of antivirals and six weeks for the open sores to close, but “even then, I was experiencing a dull pain under the skin where the rash had been,” she says of the entire ordeal, which lasted nearly two months.
“I fully believe the stress of a gig that I had very little time to prep for…with a company that didn’t value my time…had me completely overwhelmed,” she says of the pressure she was under just before getting shingles. “Our mental health is far more connected to our physical health than I ever could have imagined.”
Protecting yourself against a viral infection like shingles comes down to the same advice you’ve heard again and again: Get good sleep, drink enough water, eat well, and slow down when your body tells you to chill, Dr. Foad says. “It’s that simple,” she says.
However, you can do all the “right” things and still get shingles. (It’s worth noting that the Shingrix vaccine can dramatically lower your risk. But it’s not FDA-approved for people under 50 years of age unless they’re immunocompromised.) A young, strong person who eats nutritiously and exercises regularly can still get shingles, whereas an older person who barely sleeps and eats one meal a day may never get it, notes Dr. Foad.
“Even though I had great boundaries with work, all it took was one week of extreme stress to take the next two months away from me,” says Buckelew.
Predicting what exactly will trigger reactivation of the virus is impossible, Dr. Foad says. For that reason she tells young people not to feel ashamed or guilty if they develop shingles.
It’s not your fault if you get shingles, she says plainly. “We can’t control everything. If something does happen, get it treated, go check it out, but know it’s not your fault. There’s help out there,” Dr. Foad says. “No matter what it is, listen to your body.”
*Name has been changed
