Originating from the same virus that is responsible for giving you chickenpox, shingles is a viral infection that results in a painful rash on your body. Also known as herpes zoster, shingles is not life-threatening, but may be very painful.
It happens due to the reactivation of the varicella-zoster virus, which remains dormant in your nerve roots after you’ve had chickenpox. Hence, anyone who has had chickenpox is at risk of developing shingles later in life.
In Singapore, it is estimated that 80 to 85% of adults would have had chickenpox, and from this group, 20% would then later develop shingles. Experts estimate that up to 30,000 people in Singapore are diagnosed with shingles every year, with a higher incidence rate in adults aged over 50.
We sit down with general practitioner Dr. Irene Gay and infectious disease specialist Dr. Loh Jiashen to learn more about this painful condition, its signs and symptoms, and how it can be managed and prevented.
One of the first symptoms observed in patients suffering from shingles is a stripe of painful blisters, typically across the side of your torso, although the blisters have been known to appear in other parts of the body. This includes your arms, back, or even face.
Dr. Loh warns that certain locations, such as over the eye, may cause complications such as blindness if not treated promptly.
According to Dr. Irene, the fluid in the blisters contains the chickenpox virus and can cause a chickenpox infection in someone who has never had it.
“Caregivers should ensure that the blisters are covered, and be careful not to touch the exposed blisters if they are still not crusted,” states Dr. Irene. “They must also ensure to wash their hands well after caring for the patient.”
In 2023, Singaporean actor Nick Shen shared his experience battling shingles, citing the pain from his rashes as being “beyond description.” It was so bad it compelled him to pause his work, cancel events, and withdraw from public appearances. He suffered from not just painful rashes across his skin, but also facial paralysis due to the virus affecting the facial nerves.
“The shingles scars are still on my face. I really hope that no one will experience this,” said Shen in an interview with Stop Shingles.
Although shingles only affects those who have a history of chickenpox, Dr. Irene cautions those who think they may be free from the virus, as chickenpox is a very common infection, and some may have suffered a mild chickenpox infection during their childhood and not recall it.
“More than 99% of adults above the age of 50 carry the chickenpox virus. Therefore, someone who does not think he/she has had chicken pox before, might very likely already be carrying the virus,” she adds.
Unfortunately, it is possible for someone to get shingles more than once.
“Although, shingles does not get worse with each time you get it,” explains Dr. Loh. “The incidence of post-shingles pain, or post-herpetic neuralgia, increases with age. This means that your second episode of shingles can result in post-herpetic neuralgia while your first episode, acquired when younger, does not.”
Other symptoms of shingles include:
Unfortunately, there is no cure for shingles, and you’ll have to let the condition run its course over a period of three to five weeks. However, there are steps you can take to manage your symptoms. You can approach your family’s general practitioner for medicine to manage the pain from your blisters.
“Patients who present within 72 hours of the onset of shingles rash can be prescribed oral antivirals, which may help to reduce the severity and duration of symptoms. Pain relief medications are usually prescribed to help alleviate the pain,” explains Dr. Irene. She also advises patients to keep their rashes dry and covered, as they are infectious. If your rashes affect your eyes, an ophthalmologist will often be involved in your care to reduce the risk of long-term complications such as blindness.
Some shingles patients may experience complications. One such complication is post-herpetic neuralgia, where patients still experience persistent nerve pain even after their shingles have recovered. This happens when damaged nerve fibers get confused and send messages of exaggerated pain from your skin to your brain. There are currently no cures for it, but treatment options are available to ease symptoms, and for most people, post-herpetic neuralgia gets better over time.
“Post-herpetic neuralgia can be treated with stronger medication like Gabapentin and stronger painkillers,” explains Dr. Irene. “However, in spite of this, patients often do not get full relief from their pain.”
Dr. Loh adds, “There is also some association with heart attack and stroke for a few months after a shingles episode.”
The best way to prevent shingles is to get vaccinated.
If you are a healthy teenager or adult who has never had chickenpox, you may consider the varicella vaccine, which protects against chickenpox, and subsequently shingles. Otherwise, if you have suffered from chickenpox before, there are shingles vaccines available, such as Zostavax and Shingrix.
Shingrix is recommended in clinics around Singapore as it has an effectiveness of over 97% as compared to Zostavax with an effectiveness of 51%. According to Dr. Irene, Zostavax is a live vaccine that is contraindicated in patients who are immune compromised or immune suppressed, while Shingrix is a non-live, recombinant, adjuvanted vaccine. Zostavax has been removed from sales in the US in 2020, and those who had gotten the Zostavax vaccine are recommended to also get vaccinated with Shingrix. Current data shows that the vaccine remains effective for more than 10 years.
The Shingrix vaccine is recommended for adults above the age of 50, as well as those 18 years and older with weakened immune systems.
The full course of the Shingrix vaccine, which consists of two doses, will cost you around $900.
To ensure the Shingrix vaccine is accessible to Singaporeans and permanent residents who may require it, the Singapore government will start subsidizing the cost of the Shingrix vaccine from September 2025. Eligible seniors above 60 years old, and younger patients with a weakened immune system may be eligible for the subsidies. The subsidy is means tested. With the subsidies, the cost of two doses of the vaccine will be more affordable and accessible.
Some common side effects you may experience from the Shingrix vaccine include pain, redness and swelling at the injection site, fever, chills, lethargy, or stomach upset.
Severe side effects from an allergic reaction include a swollen face, eyes, lips, or tongue, difficulty in breathing, or an itchy skin rash over your body. If you experience any of these symptoms, you should seek prompt medical evaluation.
If you notice you or your loved ones experiencing symptoms of shingles, do see a doctor early. If you have had chickenpox, you are advised to get vaccinated with Shingrix to lower your chances of developing shingles.
