Shingles

This is the first in a new series of CPD modules which cover conditions included in the Pharmacy First service in England and equivalent schemes in other parts of the UK.

Shingles (herpes zoster) is a viral infection that affects sensory nerves and the skin surface served by those nerves (the dermatomes). The risk of developing shingles increases as a person gets older and the disease predominantly affects those over 70 years of age. Shingles is a reactivation of a previous chickenpox (varicella zoster) infection, sometimes from decades ago.

The provision of aciclovir treatment on the NHS from community pharmacies has the potential to improve access to treatment within the crucial three-day period after the shingles rash appears. This early intervention can help reduce the severity and duration of shingles. There is also good evidence that a shingles vaccine can prevent shingles in older people.

There are several myths about the relationship between chickenpox and shingles. Pharmacy teams have a role in explaining that:

• People do not “catch” shingles – it only happens to people who have previously been infected with chickenpox
• Those who have not had chickenpox cannot get shingles because there is no dormant infection to be reactivated
• Most adults will have had chickenpox – many will have had it during childhood so do not remember or were not aware of the diagnosis
• Shingles can cause chickenpox in people who have not had it. Healthy people who have already had chickenpox will not be at risk.

Patients with suspected shingles should be advised to:

• Avoid contact with people who have not had chickenpox, particularly pregnant women, immunocompromised people (e.g., those on chemotherapy or corticosteroids) and babies younger than one month of age
• Avoid sharing clothes and towels
• Wash their hands often.