Introduction & module overview

Shingles (herpes zoster) is a viral infection that affects sensory nerves and the skin surface served by those nerves (dermatomes).

It can be a challenge to diagnose shingles as the pain can precede the rash by several days. Once the rash has appeared, it does usually have a vesicular appearance and often patients will attend the pharmacy already suspecting they have shingles.

Treatment timetables are important when dealing with shingles. The sooner that antivirals are supplied to eligible patients, the less likely it is that they will suffer from post-herpetic neuralgia. This means, in general, treating all those over the age of 50 years with antivirals.

The risk of developing shingles increases as a person gets older and it predominantly affects those over 70 years of age, although it is sometimes seen in young people and children. Shingles is a reactivation of a previous chickenpox (varicella-zoster) infection, sometimes from decades ago.

Post-herpetic neuralgia (PHN) occurs in up to a third of people with shingles, causing severe and debilitating pain, which can be long-lasting. It is defined as pain persisting for more than 90 days after rash onset and is more common, and tends to be more severe, in older people.

An estimated 200,000 people in the UK have shingles every year. The overall annual incidence is estimated to be 1.85-3.9 cases per 1,000 population, increasing with age from less than two cases per 1,000 in people younger than 50 years to 11 cases per 1,000 in people aged 80 years or older. The lifetime risk of developing shingles is 20-30 per cent and this increases with age.

The provision of antiviral medication (aciclovir and valaciclovir) from community pharmacies via the Pharmacy First service has the potential to improve access to treatment within the crucial three-day period after the shingles rash appears. This early intervention can then help to reduce both the severity and duration of disease.

There is also very good evidence that shingles vaccine can prevent the disease in older people.