Shingles
SHINGLES
ELIGIBILITY:1 Adults aged 18 years and over
EXCLUDE: Pregnant individuals
SHINGLES (HERPES ZOSTER) is a viral infection of a nerve and the skin surface. It develops due to the reactivation of the varicella-zoster virus that causes chicken pox, which typically occurs during childhood.12,13 The virus stays dormant in the body and can become active later on in life when the immune system is compromised. The lifetime risk of developing shingles is 20-30% and the risk increases with age. Treatment for shingles depends on how severe the symptoms are and whether the person is at risk of complications.13
Joe, a 70-year-old male, approaches the pharmacy counter and asks to purchase some paracetamol tablets for his headache. He also wants to buy some hydrocortisone cream for the painful, tingling rash on his tummy which has worsened over the past week. He thinks it’s eczema which he suffered from many years ago, however this feels much worse. He shows you a picture of his rash and you are concerned by its appearance as it looks like shingles.
Joe appears to have the following signs and symptoms of shingles:13
Rash on the chest and/or tummy – however it can appear anywhere on the body including the face, eyes and genitals
Rash appears in blotches on the skin, usually on one side of the body – a rash on both sides of the body is unlikely to be shingles
Tingling, burning or painful feeling in an area of skin
Headache or feeling generally unwell
Pain without a rash
Headache
Fever
Click the button to find out whether this customer is eligible for referral.
REFERRAL OUTCOME
Referred to the Pharmacy First service
You tell him:
"Your symptoms indicate that you may have shingles. Would you like the pharmacist to have another look? If you are eligible, they may be able to offer you treatment for this via the Pharmacy First service."
Joe agrees and enters the consultation room with the pharmacist, who provides him with some anti-viral medication to treat his shingles outbreak.
Joe is very grateful and wonders if there is anything he can do to take care of himself at home and protect others around him.
SELF-CARE ADVICE & PRODUCT RECOMMENDATIONS
You tell Joe that there are some things he can do to help manage the symptoms:12,13
Paracetamol alone or in a combination with codeine (co-codamol) or an a NSAID (ibuprofen) can help to manage the pain, depending on severity
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 wrapped in a towel or a wet cloth) a few times a day
Don’t let dressings or plasters stick to the rash
Don’t wear clothes with rough fibres that can irritate the skin
PREVENTING THE SPREAD
Shingles can’t be spread to others; however, people can catch chickenpox from those with shingles if they have not had it before or if they have not the chickenpox vaccine. The infection can be spread while the rash still oozes fluid so it is important to avoid contact with others until the last blister has dried and scabbed over.12,13
Vulnerable people to avoid include:12,13
Pregnant women
Babies less than 1 month old
People with a weakened immune system, e.g. those on chemotherapy
To prevent the spread of the virus, Joe should:12,13
Avoid sharing towels, clothes or flannels
Wash hands regularly
Avoid contact sports and swimming
Avoid contact with others if the rash is weeping and can’t be covered
Complete the care
You tell Joe that it can take up to 4 weeks for the rash to heal and the skin may still be painful for weeks after the rash has gone, however it will get better over time.13 It is possible to get shingles more than once, so Joe may want to consider a shingles vaccination after he has recovered if he has not already had it.
KEY LEARNING POINT
Customers will not always be able to articulate how they feel, so it’s important to encourage meaningful conversations, as potentially serious conditions like shingles could be misdiagnosed or left untreated otherwise. It’s important to follow the WWHAM framework and keep an eye out for signs and symptoms/red flags that could alert you to conditions like shingles.