An unwanted encore of dormant chickenpox virus causes shingles

FARGO - Laura Eidem thought shingles was something that only elderly people had to worry about.

Then the skin on the left side of her face started to feel tingly and sensitive and a rash appeared on her chin.

At only 25, Eidem went to the emergency room when the rash got worse and returned home with a treatment for the suspected culprit, the common skin infection impetigo.

But that didn't work, and as the pain intensified and the rash on her chin became unbearable, she got the real diagnosis - shingles, an unwanted encore of disease caused by the same virus that had given her chickenpox as a kid.

Even after she started taking antiviral medications, Eidem missed a week of work and suffered from a scar on her chin that took years to heal.

"It wasn't horrible, but you could see the red part of it," she said. "I'm still weird about my chin."

Now 34 and living in Fargo, Eidem is a medical rarity - while it's uncommon for people to have shingles more than once, with only 1 to 4 percent having a second brush with the disease, she has dealt with more than 15 outbreaks in nine years.

She also doesn't fit the standard profile of a shingles sufferer because of her young age and lack of the risk factors that most often threaten a return from the dormant varicella zoster virus.

A common concern

About one in three Americans will suffer from shingles during their lifetime, according to the Centers for Disease Control and Prevention, and an estimated 1 million will have an outbreak each year. About half of all cases strike people 60 or older.

The reason for the virus' unwanted reactivation from its dormant state in the nerves is still not completely understood.

But there are several factors that put former chickenpox sufferers at a higher risk, said Dr. Sathya Machani, an internal medicine physician with Sanford Health in Fargo.

"For one reason or another over a period of time, most commonly in people who get sick or immune-suppressed or stressed or have any other infections, this virus which is already in the system starts to activate and causes shingles," he said.

Machani said chickenpox typically affects the entire body. But shingles is different, usually only forming one strip of lesions on one side of the body that will scab over in seven to 12 days as long as the skin doesn't become infected.

Initially, symptoms can be hard to diagnose, first appearing as itching or burning hypersensitive skin. A day or two later, a rash usually appears.

But the worst part isn't visible, Machani said.

"It causes inflammation of the nerves at whatever nerve root it affects," he said. "People who will get shingles tend to have this pain, which is more debilitating and lasts for long periods of time."

The pain is difficult to control, Machani said, and long after the rash clears up, some will suffer from potentially debilitating postherpetic neuralgia for years to come.

The skin might be slightly lighter or darker than normal for months, and scarring is possible.

But some can also lose their vision if the shingles virus flares up in the nerves of the middle eye, and according to the CDC, shingles can very rarely cause pneumonia, hearing problems, brain inflammation or death.

Age is the main risk factor, Machani said, and among people 85 or older, half will get shingles.

But he said the big red flag is a weakened immune system - something that happens naturally as we age, which is why older people are at a higher risk, or something that can be caused by certain cancers, HIV or other conditions that suppress the immune system.

As bad as childbirth

Corrine Haussler got a surprise for her 75th birthday four years ago, but not one that she wants again. At first, she was having bad earaches, and then she thought she was getting a cold.

But a few days later, Haussler woke up on her birthday to a quarter-sized blister on her forehead.

She went to a doctor when her eyes became swollen shut, and she was given an antiviral medication. Even with this help, the scab took more than six months to heal, and she still has a scar.

But she didn't get the rash that most shingles sufferers have.

"The scab was enough, believe me," she said.

Sue Evans had seen commercials on TV about the shingles vaccine, but thought she didn't have to worry about it - she's only 50. She didn't feel well in early October and assumed it was her multiple sclerosis until she developed a rash across her back.

By the time Evans was diagnosed, it was too late to try the anti-viral medications. She just has to wait for the shingles to run its course.

Evans was prescribed a double dosage of gabapentin, an anti-seizure drug she takes for her MS, to help with the pain.

The flare-up meant she had to drop out as a candidate for IV infusions to deal with her MS - the infusions could ignite the shingles again - so now she's "in limbo" and will soon make a major life change.

"I'm going to end up moving from Minot to Fargo so that I can see if there's another form of treatment for the MS," she said.

High levels of stress can increase the risk of getting shingles, and that's exactly what happened to 31-year-old Erica Miller.

In the spring of 2012, Miller was working two jobs, dealing with the death of her grandfather, preparing to be a bridesmaid in her brother's wedding and selling her house to move to Bemidji, Minn.

"I think it was just like a perfect storm of events where it was just too much for me," she said.

Then 30 years old, Miller developed a rash along her bra line and up her spine but assumed it must be related to the other big stressor in her life - she was 33 weeks pregnant with her second child.

After about a week, she started to feel "awful," but tried to work through it. On a Monday morning as she led a work meeting, she went into labor.

Doctors were able to stop the early labor and realized the rash was actually shingles. They determined stress caused by the shingles had sent her into labor.

Miller gave birth to a healthy boy several weeks later. After going through childbirth and shingles in just a matter of weeks, she said the two completely different experiences were equally painful.

"It's a weird pain," she said. "Childbirth is very intense, and shingles is enough to where if something would touch the rash, it just made you shake it hurt so bad."

The painful, sometimes debilitating complications that can come from this disease are precisely why everyone over the age of 60 is encouraged to get the shingles vaccine, which is 30 to 40 percent effective in preventing shingles, Machani said.

"To an extent, it can prevent getting an episode of shingles," he said. "But when it comes to preventing the pain which comes from the shingles, it's close to 70 percent effective."

The vaccine is often covered by insurance plans or Medicare for patients older than 60. While the U.S. Food and Drug Administration has approved its use for anyone 50 or older, many will have to pay out of pocket to get it early - and it could run $300 or more without insurance.

Still, Miller said she told her dad that the vaccine is a small price to pay for protection against shingles.

"If you can possibly vaccinate yourself against one of the most painful things you could go through, I would do it," she said. "It's not even worth the risk that you could end up with that with stressors in your life that could possibly bring that out. If you could somehow prevent that, I would do it instantly."