Recurrent Shingles: How It Happens and Who’s at Risk

If you ever had chickenpox as a child, you probably know that there’s the possibility of it popping back up again later in life as shingles. And if it does come back, it’s painful, itchy and irritating. But it usually goes away within three to five weeks with the help of treatment.

Still, there’s always the risk shingles could return a second or third time, says infectious disease expert Kruti Yagnik, DO. It all depends on the strength of your immune system.

Can you have shingles more than once?

Most people only get shingles one time, but anywhere from 1.2% to 9.6% of people may experience shingles more than once. In most of these cases, shingles resurfaces because a weakened immune system allows the varicella-zoster virus (the same virus that causes chickenpox) to get reactivated. And once you’ve had this virus a single time, it continues to stay dormant (or asleep) inside your body’s nerve tissues.

“It’s not that it’s not treatable,” says Dr. Yagnik. “It’s that, over time, it’s going to reactivate again because your immune system can’t keep it in check.”

Symptoms of shingles and shingles recurrence

Shingles often start with pain, burning or tingling on the affected area, followed by fluid-filled blisters that break open and crust over within a matter of days. It typically happens only on one side of your body and can come with other symptoms like:

• Extreme sensitivity to touch
• Sensitivity to light
• A red, itchy rash in the affected area
• Fever
• Fatigue
• Headache

“Most people say the first time they have shingles is the worst and it’s not as bad the second or third time, but every person is different and it depends on your immune system, the medications you’re taking and how healthy you are,” notes Dr. Yagnik.

Over time, especially if you’ve had shingles more than once, you can also experience chronic nerve pain, called postherpetic neuralgia, from your nerves being irritated by the virus. And whether it’s your first or second time, you’re contagious with shingles until the rash itself is dried and crusted over.

What causes recurrent shingles outbreaks?

Having shingles once increases your chance of future outbreaks, but not everyone experiences it a second time. Recurrent shingles usually occurs as a result of a weakened immune system. Our immune systems tend to weaken naturally as we age, but we can also become immunocompromised as a result of various other medications or medical conditions like:

• Diabetes
• Cancer
• Human immunodeficiency virus (HIV)
• Stress
• Steroids
• Chemotherapy
• Immunosuppressants for organ transplants

“The virus that causes shingles stays in your body,” reiterates Dr. Yagnik. “Anything that weakens your immune system can cause it to resurface.”

Treatment

Whether it’s the first, second or third time, shingles treatment typically involves antiviral medications like acyclovir or valacyclovir until the shingles subside within three to five weeks. During that time, you can relieve your pain and reduce the severity of your symptoms with the help of:

• Over-the-counter pain medications
• Topical lotions like lidocaine cream or capsaicin cream

During treatment, you want to:

• Keep the affected area clean and bandaged to prevent secondary bacterial infections and to limit the spread of the varicella-zoster virus
• Avoid pools or raw water (rivers, lakes, ponds, oceans) to avoid further irritation or infection

Prevention

You can’t really prevent a shingles outbreak from happening, but you can get the shingles vaccine to reduce the likelihood of it popping up again, even if you have a weakened immune system. Other than that, you want to do whatever you can to improve and maintain the health of your immune system, as this will help stave off recurring infections. That means:

• Maintaining healthy nutrition
• Exercising daily
• Improving your sleep schedule
• Boosting your body’s natural defenses

“All of these things help more in the long term than you may think,” advises Dr. Yagnik. “Anything that can keep your immune system healthy is a good thing.”