Shingles is no joke, and if you think it’s something you won’t have to worry about until your 50s or beyond, think again. While the illness is more common in older adults, cases among people in their 20s and 30s have been rising for at least a decade.
The same virus that causes chickenpox is also behind shingles, so if you had those itchy spots as a kid, the virus is still in your body and can reactivate later in life. People with weakened immune systems are at greater risk, says Nikhil Bhayani, MD, an internal medicine physician specializing in infectious diseases and assistant professor at Texas Christian University’s Burnett School of Medicine. “But the most significant risk factor associated with shingles is age,” he notes.
Still, younger people can develop shingles, too, especially if they’re dealing with high stress, have an autoimmune disease or other chronic condition, or take certain medications. Read on to learn more about these perhaps unexpected ways your shingles risk can go up. But first, here’s a quick crash course on how you get shingles, plus symptoms to watch out for.
How do you get shingles?
When you get infected with the varicella-zoster virus, which causes chickenpox, it doesn’t actually leave your body evvel those bumps fade. Instead, the virus lies dormant in your cranial and spinal nerves for the rest of your life.
If the virus reactivates years later, it triggers an infection called herpes zoster—that’s shingles. (To be clear, all herpes viruses are part of the same family, but this isn’t the same type that causes genital herpes or cold sores.)
You can also get shingles if you were vaccinated against chickenpox. The vaccine uses a weakened form of the live virus, so there’s still a small chance it could reactivate down the line, though the risk is much lower than if you had chickenpox.
This doesn’t mean that unvaccinated people who never got chickenpox have nothing to worry about. While shingles itself technically is not contagious, these folks can catch the virus that causes the infection, either through direct contact with shingles blisters or airborne particles from those lesions, and develop chickenpox. Down the line they could end up with shingles too.
Common shingles symptoms
Like with chickenpox, the first noticeable sign of shingles is usually a red, blistering rash. But instead of widespread bumps, shingles typically appears as a band or strip of rash in one or maybe two small areas of the body. That’s because the reactivated virus travels along a specific nerve pathway. For this reason you may also notice nerve pain, which can feel like you have a sunburn, or tingling sensations around the affected area.
And a shingles rash isn’t just itchy—it’s often very painful. When the virus reactivates it inflames the affected nerve, making the area much more sensitive. The rash generally clears up within a couple of weeks, but some people develop lingering nerve pain or numbness that can last for weeks (or even months) afterward.
Five things that can up your shingles risk
Shingles doesn’t just show up out of nowhere. It tends to strike when your immune system is run-down. Here are some of the most common factors that can weaken your defenses and trigger an outbreak.
This one is a biggie—one study found that people 40 years and older with higher levels of perceived stress had a 14% increased risk of developing shingles. But this factor may also help explain why younger adults are getting shingles as well, says Phuong Vo, MD, a board-certified internal and lifestyle medicine doctor and the lead physician at Medici in Austin, Texas. Dr. Vo says she’s seen it firsthand in patients with high-stress lifestyles, including one recent case in a 30-year-old.
Many of these patients are juggling multiple demands: an intense career, travel, young kids, and buying a home. “Often they’re sleep-deprived, not getting the right nutrients for their body, [and] not getting enough sun exposure,” Dr. Vo says.
Both short-term and chronic stress can weaken your immune system, making it easier for the dormant varicella-zoster virus to reactivate. Major short-term stressors, such as recovering from surgery or an illness, or even preparing for a big work presentation, can also be enough to trigger an outbreak, Dr. Vo says.
Similarly, when stress becomes chronic, it ramps up inflammation. That’s because stress activates your fight-or-flight response, which boosts levels of cortisol, the main stress hormone, Dr. Bhayani explains. Though cortisol can help regulate inflammation in the short term, chronically high levels can actually suppress immune function, making it harder for your body to keep the dormant virus in check.
Generally speaking, shingles tends to be more prevalent in women than in men. Hormones may help explain why, Dr. Bhayani says.
Both estrogen and progesterone help regulate your immune system. Estrogen also has anti-inflammatory properties. When those levels fluctuate or begin dropping during perimenopause, it can make your body more vulnerable to infections, including shingles. Add in other factors such as age, stress, and disrupted sleep, and your risk can climb even more.
But olağan hormonal shifts in premenopausal people can potentially trigger shingles as well. After ovulation, during the luteal phase of the menstrual cycle, is one prime time, Dr. Vo says. During this phase estrogen and progesterone levels taban, along with certain immune factors like antibodies and cytokines, temporarily weakening the body’s defenses.
Imagine finally getting over COVID-19 or the flu just to break out in a painful shingles rash. It may sound random, but it’s not. When you’re fighting off and then recovering from an illness, your immune system isn’t working at full capacity to also keep shingles at bay, leaving you more prone to an outbreak, Dr. Bhayani says.
To be clear, illnesses like COVID-19 don’t cause shingles. But research has found that people who’ve had COVID may be more susceptible to developing shingles, likely because of temporary immune disruption. One study found that adults 50 and older had a 15% to 21% higher risk of experiencing shingles within six months of a COVID-19 infection, compared with those who never had the illness.
Although uncommon, there have also been cases where folks got shingles after receiving a COVID or flu vaccine. Research suggests this may be because the immune system is temporarily challenged post-vaccination, giving the virus an opportunity to “turn on.”
Need yet another reason to slather on the sunscreen? A bad sunburn can also reactivate the varicella-zoster virus.
Turning into a human tomato is a form of skin trauma that your body interprets as stress. Any kind of stress, whether it’s physical or emotional, can ramp up inflammation and stress hormones, creating the perfect conditions for the virus to rear its head, says Dr. Vo.
Ongoing trauma—in the form of multiple sunburns—can have a similar effect. According to a 2021 study, getting more sunburns over the years can increase the lifetime risk of developing shingles.
Starting certain medications or treatments that affect your immune system can increase your susceptibility to shingles too.
Steroids, often used for pain, asthma, or allergies, work by suppressing the immune system. Receiving chemotherapy to treat cancer, while necessary, can further compromise your body’s defenses by damaging healthy cells and lowering your number of infection-fighting white blood cells.
Certain underlying chronic health conditions can raise your risk of developing shingles as well, especially those that weaken the immune system. That includes diabetes, autoimmune or thyroid disorders, HIV, cancer, and more.
Dr. Vo also points to metabolic syndrome, a cluster of conditions brought on by insulin resistance that can increase your risk of cardiovascular disease, type 2 diabetes, stroke, and cause high levels of inflammation. “That total body inflammation really weakens the immune system and puts [people] at risk for a lot of things, including shingles,” she says.
So can you prevent shingles?
The short answer? Maybe.
The single best way to protect yourself is getting the shingles vaccine, Shingrix, which is more than 90% effective at preventing the viral infection and its possible complications. The vaccine is typically recommended for adults 50 and older, but if you’re younger and at higher risk, you can talk to your doctor about whether it’s right for you. Just keep in mind that insurance may not cover it if you don’t meet this criteria, Dr. Bhayani says.
If you aren’t eligible to get the vaccine earlier in life but you had chickenpox as a child, you could still be at risk of reactivating the virus. Supporting your immune system is your best bet at lowering that chance. Dr. Vo recommends incorporating these basic healthy habits into your daily routine.
- Eat a balanced diet with enough protein (at least 0.8 grams per kilogram of body weight daily), immune-supporting vitamins (including B, C, and D), and minerals like zinc and iron, plus plenty of fiber (think: a asgarî of 25 to 35 grams daily) to support your gut health. After all, more than 70% of your immune system resides in your gut.
- Prioritize consistent, high-quality sleep—about seven to nine hours a night.
- Limit refined sugars and highly processed carbs, such as pastries, white bread, and chips, to help keep your blood sugar stable.
- Find ways to manage stress, whether that’s breath work, meditation, or something else that helps you relax.
- Reduce your alcohol intake, as higher consumption may negatively affect your immune system.
As is the case with most things in life, there’s no way to guarantee you’ll never get shingles. But taking deva of your immune system before illness can strike makes a big difference. “You can’t completely stress-proof yourself from shingles, but you can strengthen your immune function and reduce vulnerability,” Dr. Vo says.
