Shingles, or herpes zoster, is a painful, blistering rash that occurs on one side of the body or face when the chickenpox virus (varicella-zoster virus) reactivates in nerve cells.  

Shingles rates are increasing in the US, even among younger adults. It is estimated that about 1-in-3 Americans will develop shingles at some point. Women are more likely to be affected than men, and aging is a risk factor.

The painful rash of shingles usually resolves within several days to weeks. However, a dreaded complication of shingles is postherpetic neuralgia (PHN), which is ongoing pain that persists for months to years after the rash is completely resolved. This pain can significantly affect the quality of life.

Conventional treatment for shingles consists of an antiviral (e.g., valacyclovir), a pain medication (e.g., NSAID or mild narcotic), and a nerve pain medication (e.g., gabapentin). More evidence is needed to determine if the use of antivirals reduces the likelihood of developing PHN.  

Medications often have undesirable side effects, and some, like NSAIDs, have FDA black box warnings. Also, there is controversy about the effectiveness of conventional treatments in preventing complications like PHN. With that knowledge, you may ask: “Can I prevent shingles naturally? Can I use evidence-based supplements, herbs, or acupuncture to shorten the duration of a shingles outbreak and lessen the likelihood of developing PHN?” Keep reading to learn more about a functional medicine approach to shingles.

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What Causes Shingles

Shingles, or herpes zoster, is caused by the varicella-zoster virus (VZV), the same virus that causes varicella or “chickenpox.” When VZV is first encountered, usually as a child, the rash and blister-like lesions that form are called chickenpox.  

It’s thought that the virus in the chickenpox blisters moves backward from the skin, along the nerves, and into a cluster of neurons near the spinal cord, where it can remain dormant for the entire life of the person.

Things to Know About Shingles

Sometimes, VZV reactivates, leading to a painful, blistering rash called shingles.

You cannot get infected with shingles from a person who has it. However, if you have never had chickenpox or have not received the varicella vaccine, you can get infected with chickenpox if you come into close contact with a shingles rash that has not yet crusted over.

The shingles rash should always be covered until it crusts over, and contact with vulnerable people (immunocompromised, pregnant women, premature babies) should be avoided.

Risk Factors for Shingles

Aging and female sex, which are non-modifiable, put you at a higher risk for developing shingles.

A modifiable risk factor that increases the risk for shingles is psychological stress due to suppression of the immune system (decreased numbers of cytotoxic lymphocytes).

A case-control study found those with diabetes, hypertension, and cancer were more likely to develop shingles. Conditions like HIV or medications that suppress the immune system are also risk factors for shingles.

A large cohort study found that typical modifiable factors like alcohol consumption, smoking, BMI, and physical activity levels were not associated with developing shingles.

Complications From Shingles

The most common complication of shingles, occurring in up to 18% of afflicted patients, is postherpetic neuralgia (PHN). PHN is a long-term nerve pain in the location where the rash was. The likelihood of developing PHN increases with age.

Other complications include:

• Secondary bacterial infection
• Vision loss
• Hearing loss
• Brain inflammation
• Death

Shingles "The Great Mimicker"

Although not a complication per se, the pain of shingles can be mistaken for other conditions like carpal tunnel syndrome, arthritis, trigeminal neuralgia, abdominal pain, or a heart attack. This diagnostic confusion can lead to unnecessary blood tests, investigations, or inappropriate medications. It can also delay the treatment of shingles.

Another issue with shingles is the pain can be so severe that even when there is a classic rash, it is overlooked or missed by healthcare providers because the focus is on ruling out life-threatening causes of pain.  

Shingles Signs & Symptoms

Three stages commonly occur with shingles: prodrome, pain, and rash. There can be an overlap between these stages.

Prodrome

During the prodrome phase, there may be symptoms typical of a viral infection, like headache, fatigue, fever, and body aches. This stage can last for 1-2 days.

Pain

The next stage is prickling, tingling, or burning pain in a localized area. The pain can range from mild to excruciating. It is usually felt 2-3 days before the rash appears.

Rash

The shingles rash is commonly only on one side of the body and is grouped along a narrow band of nerve distribution (a dermatomal distribution). The rash usually affects the trunk (thorax) but can affect the neck, face, and eye.

The shingles lesions start as blisters (vesicles), and over the next few days, the blisters become cloudy (pustular). After about 7-10 days, the lesions crust over and are no longer contagious. Within a month, the crusts fall off, and the lesions disappear. Long-term scarring and pigment changes can occur.

Can You Prevent Shingles?

Prevention of shingles is a challenging topic because very few known modifiable factors change susceptibility.  

A two-dose vaccine, Shingrix, can be administered to those aged 50 and older. The reported effectiveness is up to 97% in preventing shingles in 50-69-year-olds and up to 91% in the 70+ age group. According to the CDC, if you currently have shingles, have a moderate or severe illness, or are pregnant, you should wait to receive the vaccine. All pharmaceutical interventions have risks and benefits, requiring an informed decision based on your personal health considerations.

Household exposure to a child with chickenpox decreased the likelihood of developing shingles by 33% in the two years following exposure and 27% in the 10-20 years following exposure.

The below table summarizes what is known about shingles prevention and susceptibility:

Functional Medicine Labs to Test for Root Cause of Shingles

Varicella Zoster Antibody IgM

The prodromal and pain stages of a shingles outbreak usually occur before the classic rash occurs. Less commonly, the rash is atypical and can lead to diagnostic confusion. Varicella zoster antibody IgM levels can be assessed to provide evidence that the prodromal, pain, or skin lesion symptoms are consistent with an acute shingles reactivation. IgM is not always elevated during shingles, so if the antibody value is lower than expected, use your best clinical judgment to assist with diagnosis, don’t rely solely on the antibody level.

Glucose Metabolism

Diabetes is a risk factor for developing shingles. Labs to evaluate glucose metabolism, such as fasting insulin, fasting glucose, and hemoglobin A1c, can help manage this risk factor.

Immune function

Immunosuppression is a risk factor for developing shingles. Evaluating immune function, especially cytotoxic T lymphocytes, helps identify your immune status. You can then work with your functional medicine practitioner to further evaluate lifestyle, nutrition, chronic illnesses, medications, and environmental factors that may be suppressing your immune system.

Vitamin C & D Levels

Vitamins C & D are two test that should be assessed due to their contribution to the development of PHN.

• Inadequate vitamin C is associated with an increased incidence of PHN pain.
• Suboptimal vitamin D is associated with the development and severity of PHN.

4 Natural Treatment Options for Shingles and Postherpetic Neuralgia

1. Increase Vitamin C & D

Vitamin C is essential for immune function, synthesis of natural pain chemicals like endorphins, and neuron protection. Intravenous vitamin C has been shown to decrease PHN pain. Increasing the intake of fruits and vegetables can boost vitamin C levels.

Vitamin D is involved in reducing inflammation of neurons as well as inflammatory chemicals in the body. Including a vitamin D supplement can boost levels into the optimal range.

2. Herbs & Supplements

Although more extensive case studies are needed over extended periods, functional medicine practitioners commonly use these topical botanicals with great success:

• ‍Melissa officinalis (lemon balm): Has antiviral properties‍
• Hypericum perforatum (St. John’s wort): Aids in skin healing‍
• Eleutherococcus senticosus (Siberian ginseng): Has antiviral properties‍
• Glycyrrhiza glabra (licorice root): Has antiviral properties‍
• Lavandula officinalis (lavender): Aids in skin healing ‍
• Sarracenia purpurea (purple pitcher plant): Has antiviral properties

3. Lifestyle Changes

Psychological stress and catastrophizing increase the risk of developing shingles and pain intensity. Lifestyle modifications, including mindfulness, meditation, physical activity, or yoga, have been shown to help reduce stress and inflammation.

4. Other Treatments

Topical Ozone

A study of 60 patients evaluated topical ozone therapy versus a control. Patients receiving ozone therapy had significantly less pain on days 3, 7, and 14 compared to the control group.

Topical Capsaicin

Capsaicin provides pain relief in acute shingles and PHN.

B12 Injection

Patients receiving B12 injection around the rash site had significantly reduced pain and improved quality of life compared to the control groups.

Intravenous Magnesium

A small double-blind placebo-controlled study demonstrated that intravenous magnesium sulfate significantly reduced pain scores compared to the control group.

Acupuncture

A recent meta-analysis found significantly positive results using acupuncture, herbs, and cupping to reduce PHN pain and prevent PHN when employed during a shingles outbreak.

Summary

Shingles can be an exceedingly painful disorder with complications including ongoing, debilitating pain (PHN), vision and hearing loss, brain inflammation, and death. Conventional medications appear to reduce the duration of a shingles episode but provide unclear benefits in preventing PHN.

Functional medicine prevention strategies for shingles include diabetes management, a healthy immune system, and stress management.

Functional medicine treatment strategies for an acute shingles outbreak include nutrition, topical herbs, intravenous supplementation, and other modalities like vitamin B12 injections and acupuncture.