Shingles: When Immunity Weakens, a Dormant Virus Wakes Up
A Silent Guest from Our Childhood
Lately there is a sentence I hear more often from my patients and those around me: “I have shingles (herpes zoster).”
First comes a burning sensation. Sometimes on one side of the chest, sometimes on the back, the lower back, the neck or the face. Then redness and small fluid-filled blisters appear. When the skin heals, in some patients the story does not end. The rash disappears but the pain remains; a pain that keeps you awake at night and makes even clothing touching the skin unbearable.
Its medical name is herpes zoster; in everyday language, shingles. Shingles tells us not only about a virus but also about the memory of the body. Because most of the time we are not facing a new virus from outside. The varicella-zoster virus, the agent of the chickenpox we had in childhood, is not completely abandoned by the organism after the illness passes. It can remain silently in the sensory nerve ganglia. For years. Sometimes for decades.
As long as the immune system keeps it under control, we do not feel its presence. Then the balance shifts. Age advances, cellular immunity weakens, a severe illness is endured or a treatment that suppresses immunity is given. A virus that has been silent for years can become active again.
That is what shingles is. For this reason, I find it incomplete to look at shingles merely as a disease that appears on the skin. The rash we see on the skin is the outward face of a much deeper biological process between the nervous system and the immune system.
Immunity Is Not Simply “Strong” or “Weak”
In daily life we like to say, “My immunity has dropped.” Yet the immune system is not a simple switch that turns on and off. I think of it more as a complex defense and communication system that needs to be managed well.
Being strong is not enough on its own. It must respond at the right time, in the right place and as much as needed. Too little a response can cause problems; so can an excessive and misdirected one.
For this reason, for me the key concept is not “strengthening immunity” but the regulation of immunity.
Shingles is one of the instructive examples of this. The virus has been there for years. What changes is most often not the presence of the virus but the organism's capacity to keep it under control.
Aging is one of the most important causes of this change. The risk of shingles rises markedly especially after age 50; one important reason for this is that cellular immunity, which keeps the varicella-zoster virus suppressed, declines with age. Cancers, some immune system diseases, organ transplants and immunosuppressive treatments can also increase the risk.
But a person is not made up only of diagnoses. How we live is not outside our biology either.
Sleep is decreasing. Movement is decreasing. Nutrition is deteriorating. Chronic stress is lasting longer. Sometimes a person sleeps 8 hours but does not wake up rested. Metabolic problems are multiplying, and the organism is trying to live under a high load for a long time.
It would not be scientifically correct to say that each of these “causes shingles.” But to think that the immune system, the autonomic nervous system, hormonal responses, metabolism and lifestyle are entirely independent of one another would be to oversimplify human biology more than necessary.
Stress Is Not Just Feeling Sad
When we say stress, most people think of emotional distress. Yet from the organism's perspective, stress is a broader concept.
Sleeplessness is also a burden. So is long-term pain. Overwork, chronic illness, constant anxiety, the loss of a loved one, and physical and emotional exhaustion also demand a response from the organism's adaptive systems.
The body does not respond to these with a single organ. The autonomic nervous system, the hypothalamic-pituitary-adrenal axis, the immune system and metabolic processes influence one another within the same life.
Short-term stress is a part of life, and the organism can usually cope with it. The problem is the burden becoming chronic and the space left for recovery steadily narrowing.
A car whose gas pedal is pressed constantly but whose brake is hardly touched can travel for a while. But not forever.
The human body was not made only to struggle. It needs recovery, sleep, movement, nutrition and rest. What I call regulation is partly the ability to move between these two directions: to be able to respond when necessary, and to calm down again once the danger has passed.
Shingles Sometimes Speaks Before the Skin Does
Shingles does not always begin with blisters. Sometimes the first symptom is burning, stinging, itching or an unexplained skin sensitivity.
The patient comes and says, “Doctor, my skin is burning but nothing is visible.”
A few days later a typical rash may appear. It is usually one-sided and follows a specific nerve distribution.
This is where time matters.
Shingles is not a disease to be left waiting with the thought “it will pass anyway.” Starting antiviral treatment early in a suitable patient is important for the course of the disease and for complications. For this reason, if shingles is suspected, early medical evaluation is needed.
Shingles involving the area around the eye or the face in particular should not be delayed. Because eye involvement can lead to complications that may threaten vision, rapid evaluation is important.
The Skin Heals; the Nerve Sometimes Does Not Forget
This is one of the aspects of shingles that makes me think most as a physician.
The blisters dry. The scabs fall off. Seen from the outside, the skin has healed. But in some patients the pain continues.
We call this postherpetic neuralgia.
Because shingles does not affect only the skin; it can also cause damage and changes in sensitivity in the sensory nerves and the related nerve pathways. Sometimes the patient cannot tolerate even their shirt touching their skin. They describe the pain as burning, electric shocks, stabbing or as if in contact with fire.
It can last weeks, months and sometimes longer. The risk increases with advanced age.
What I call the memory of the body we feel here in a figurative sense too: The mark on the skin has faded, but the nervous system carries the trace of the event a while longer.
For this reason, shingles treatment should not be seen merely as drying the blisters. Besides managing the acute phase correctly, it is also important to evaluate the pain and to treat appropriately the patient who develops chronic neuropathic pain.
Related article: What Is the Role of Neural Therapy in Shingles?
You can find neural therapy and Hüseyin Nazlıkul's other treatment methods here.