Stress a factor in shingles for people younger than age 50

A red mark seemed like a bug bite two summers ago, so Kendra Jones dismissed the painful spot on her back. When it spread and the pain worsened, a doctor’s diagnosis surprised Jones, then 35. She had shingles.

“I went through this feeling of shock and disbelief because I was under the impression that was something that people who are older experienced,” said Jones. “I also asked a lot of questions about how it happened, and it came down to stress.”

At the time, she was planning an international trip, working more and putting in extra hours for a nonprofit. “I keep myself really busy. Even though I like my life to be like that, I think sometimes my body doesn’t.”

Shingles is caused by the varicella-zoster virus, which also causes chickenpox. Shingles symptoms include pain, itching or tingling of the skin, followed by a painful rash of blister-like sores. The condition occurs more commonly in people much older because the body’s immune system weakens with age.

If you’ve had chickenpox, the virus lies inactive in nerve tissue. Many years later, the virus can reactivate as shingles, which happens for about 1 in 3 people in the U.S. A newer shingles vaccine is recommended only for people at ages 50 and older.

A family medicine doctor at MultiCare Rockwood Quail Run Clinic, Dr. Gretchen LaSalle said she sees shingles in patients younger than 50. Rates in that population have risen since the 1940s, she said. Doctors have a few theories about why.

“Stress is thought to be a pretty big contributor,” LaSalle said, with either physical or emotional stress on the body – along with rising levels of the stress hormone cortisol – that can cause our immune system to weaken, she added.

“Our world is stressful, our jobs are stressful, and many of us don’t get enough sleep. We are glued to our technology. We’re missing out on that human connection and positive relationships that increase our well-being and decrease stress.”

Other factors include smoking, heavy alcohol consumption and not eating right, she said. Another theory is that people are living longer with cancer, HIV and other conditions that suppress the immune system, and they’re diagnosed younger. They are at higher risk for shingles.

LaSalle wrote a newly published book that is a clinicians’ guide to vaccines and vaccine hesitancy. She said another theory about shingles in younger people considers possible effects since chickenpox vaccinations started in 1996.

“For people who had chickenpox, it’s thought that adults get some benefit from being re-exposed to kids who have chickenpox,” she said. “It’s sort of a little immune booster.”

“The theory is now that we vaccinate and kids aren’t getting chickenpox, the adults aren’t getting that little boost in their immune system, but that doesn’t account for the rise we’ve seen since the ’40s because the chickenpox vaccine wasn’t out until 1996.”

The Centers for Disease Control and Prevention cites more cases of shingles for people ages 50 to 59 and some rise in the 30-49 category. “This trend continues among younger and middle-aged adults,” the agency says.

What to look for

Usually before the rash, symptoms can be anything from tingling and itching to burning, LaSalle said. It’s usually along a nerve root and on half the body, so on one side of the face, abdomen or down one leg.

Several days later, a rash appears as a cluster of blisters usually in a linear pattern. Look for a stripe across the belly, down a leg or an arm, LaSalle said, and don’t delay seeing a doctor. If shingles occurs, patients are given anti-viral medicines that are best to start as soon as possible after the rash appears, LaSalle said.

“The thing we really worry about is not so much the rash. That will go away,” she said. “About 10%-18% of people who get shingles will have nerve pain that comes with shingles that will linger for years or for the rest of their lives. It’s called postherpetic neuralgia.”

“We want to prevent that lingering nerve pain from happening, so if you start the anti-virals early, then it shortens the course and decreases the chance that you’ll have that lingering pain.”

It’s rare, but some people don’t develop the rash, LaSalle said. That happened for Holly Elmer, 52. She had a painful bump in January 2018 that spread on one side of her head. It was repeatedly misdiagnosed until she heard about shingles without an outbreak.

Elmer thinks stress was a factor. “I’m normally a healthy person, but I happened to wear myself out restoring two houses,” said Elmer, adding that she has lingering nerve problems and tinnitus.

Strategies

If you’re 50 or older, LaSalle recommends getting the Shingrix shingles vaccine, a two-shot series. After its approval in fall 2017, the manufacturer didn’t anticipate the high demand during 2018, and supplies were used up.

“Shingrix is still hard to find,” LaSalle said. “It’s kind of been on back order ever since. I think some of the pharmacies because they have national buying power are having some better luck getting it than the local clinics.”

You can get Shingrix even if you don’t remember having chickenpox. Studies show more than 99% of Americans ages 40 and older have had chickenpox even if they don’t remember.

Some patients mistakenly think because they’ve had shingles, they don’t need the vaccine. That’s not true, LaSalle said, because shingles can reoccur.

People need to go back for the second Shingrix shot two to six months after the first for maximum protection. After the two shots, Shingrix provides more than 90% protection against shingles. That protection stays above 85% for at least the first four years after you get vaccinated, the CDC says.

Most people get a sore arm with some pain after getting vaccinated. About 1 in 6 people have a strong reaction to this vaccine, LaSalle said, such as fever and aches for two to three days that prevent regular activities, then symptoms go away. If you’re younger than 50, then what?

“Other than clean, healthy living and trying to minimize stress in our world, I think just try to be healthy and do things that are stress-relieving and health-promoting,” she said.

Try for adequate sleep, regular exercise and outside time for fresh air and walks. Being in nature relieves stress, LaSalle added. For Jones, she improved after a doctor prescribed anti-viral medications, but she ended up with shingles a second time.

A few months after her first outbreak, a tingling returned to the same area. Her doctor’s office said because shingles affects the nerves, she’d likely have those sensations for up to a year.

“Then a year later, I felt that pain again, and it was real,” Jones said. “It’s incredibly frustrating because the (shingles) vaccine is not covered for people who are under 50.”

But Jones has made lifestyle changes to reduce stress. She joined the YMCA and does yoga.

“I joined a leadership development program, so I’ve learned a lot of tools about how to re-steer my train of thought if I’m kind of tending toward negative thoughts. And I reserve one night a week for myself to do whatever I want to do.

“Just those few small changes have really helped with my stress level. I’m really hoping that makes an impact in my life as far as stress and shingles.”