Shingles

Shingles is an infection that causes a painful rash. People with suspected shingles should get advice from their community pharmacist / GP or 111 as soon as possible if they think they have it. A rash will usually appear a few days later. In rare cases shingles can cause pain without a rash. Usually you get the shingles rash on your chest and tummy, but it can appear anywhere on your body including on your face, eyes and genitals. The rash appears as blotches on your skin, on one side of your body only. A rash on both the left and right of your body is unlikely to be shingles.

The first signs of shingles can be:

• A tingling or painful feeling in an area of skin
• A headache or feeling generally unwell
• A rash or blotches which become itchy blisters that ooze fluid. A few days later, the blisters dry out and scab.
• The rash can be red, but this can be harder to see on brown and black skin
• The rash can form a cluster that only appears on 1 side of your body. The skin remains painful until after the rash has gone.
• The rash may also be in and around your eye, making it sore and red. It can affect your sight or hearing and make it hard to move one side of your face.

Treatment for shingles depends on how severe your symptoms are and whether you're at risk of complications. Although with a mild rash you may not need any treatment a community pharmacist is an ideal place to go to for support and therapy such as the anti viral medications Aciclovir and Valaciclovir work best if you start taking it within 3 days of the shingles rash appearing.

Some examples of patients who may be offered medicine (antiviral tablets) to help speed up their recovery from shingles are:

• Thosed with  a weakened immune system
• Those whose pain or rash is moderate or severe
• Those whose rash is affecting other areas of their body apart from their chest, tummy and back

Other treatments for shingles can also include medicines to help relieve pain, such as painkillers e.g Ibuprofen and Paracetamol steroid tablets e.g. Prednisolone or medicines that help with nerve pain.e.g. Amitriptyline

The pharmacist will also offer lots of guidance to manage the condition for example:

• Take anagesia for the pain
• Keep the rash clean and dry to reduce the risk of infection
• Wear loose-fitting clothing
• Use a cool compress (a bag of ice cubes or frozen vegetables wrapped in a towel, or a wet cloth) a few times a day
• Do not let dressings or plasters stick to the rash
• Do not wear clothes with rough fibres that can irritate your skin
• A reminder it can take up to 4 weeks for the shingles rash to heal
• A reminder your skin can be painful for weeks after the rash has gone, but it usually gets better over time.
• To avoid anyone who is pregnant and has not had chickenpox before
• To avoid people with a weakened immune system – like someone having chemotherapy
• To avoid babies less than 1 month old

According to NHS UK NHS Shingles there is also a Shingles vaccine available on the NHS for:

• People who turned 65 on or after 1 September 2023
• People aged 70 to 79 who have not yet been vaccinated
• People aged 50 and over with a severely weakened immune system

The vaccine helps reduce your risk of getting shingles and even if you get shingles after being vaccinated, the symptoms can be much milder. You can get shingles more than once, so it's important to get vaccinated even if you've had shingles before. if you fall into this category the pharmacist will probably recommend vaccination.

You cannot get shingles from someone with shingles or chickenpox but you can get chickenpox from someone with shingles if you have not had chickenpox before.When people get chickenpox, the virus stays in the body. It can be reactivated later and cause shingles if someone's immune system is weakened e.g. because of stress, certain conditions, or treatments like chemotherapy.

Under the Pharmacy 1st scheme if Shingles is confirmed, and dependant on the patient themselves, the pharmacist may prescribe oral antivirals Aciclovir or Valaciclovir if certain criteria are met e.g.

• The patient falls into the correct age bracket for the prescribing
• The patient has the correct signs and symptoms to meet the prescribing criteria
• They do not fall into the excluded categories
• The registered healthcare professional should also have evidence of competence in the clinical skills and knowledge covered in the Centre for Pharmacy Postgraduate Education (CPPE) Pharmacy First Service self-assessment framework. This evidence can be found at the following link CPPE Pharmacy First. Numarknet has partnered with CIG our training provider and a downloadable document with links to the CIG website and enroling on the external CIG training can all be found at the following link ECG Pharmacy First . The document is called ECG Pharmacy First Training Booking Guide.

With support and treatment most people recover from shingles without any problems. But it can sometimes cause long term complications, such as:

• Post-Herpetiic neuralgia where pain lasts for several months after the shingles rash has gone
• The rash becoming infected, which may need to be treated with antibiotics
• Scarring or changes in skin colour after the rash has healed
• Muscle weakness
• Eye problems, which can lead to sight loss
• "Ramsay Hunt syndrome", a rare condition where shingles affects your facial nerve, causing weakness on one side of your face and sometimes hearing problems