Celebrities get shingles, too

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Perhaps you heard the news recently that Lin-Manuel Miranda has shingles. Headlines announced this in a variety of ways:

• Hamilton creator Lin-Manuel Miranda is suffering from shingles (NY DailyNews)
• Lin-Manuel Miranda has shingles; must be quarantined from his baby (today.com)
• Lin-Manuel Miranda has shingles, regrets joke about blurred vision (CBS News).

Without more information, these headlines might leave you wondering: is this a serious condition? Is it dangerous for children? Can it lead to blindness?

What is shingles?

The term "shingles" refers to a painful rash caused by infection with the varicella-zoster virus (VZV), a member of the herpes family of viruses. The typical rash usually leads to a quick diagnosis — there are groups of tiny fluid-filled "bubbles" or blisters limited to a single patch of skin. However, the rash may be preceded by burning pain over the skin, fever, fatigue, or headache. Miranda reportedly thought he was experiencing a migraine when it started.

VZV is the same virus that causes chickenpox. Anyone who has had chickenpox (usually as a child) can have the virus hidden in nerves beneath the skin. Years later it can erupt onto the skin as shingles. The name comes from the Latin cingulum, which means belt. The rash of shingles often spreads over a patch of skin in a pattern that resembles a belt.

Shingles is quite common. According to the CDC, almost one in three people will develop shingles in their lifetime. But the risk is not random. It's more common in people over age 50 and those who have a weakened immune system. Other celebrities reported to have suffered with shingles include Roseanne Barr, Richard Nixon, and Robin Williams.

Is it contagious?

Shingles is contagious. A person who has not had chickenpox in the past and has not been fully vaccinated against chickenpox can develop chickenpox if they have close contact with someone who has shingles. The two doses of the chickenpox vaccine are recommended for children between the ages of 12 and 15 months and between the ages of 4 and 6 years old. That's why Miranda was "quarantined" from his 8-week-old son, who has (presumably) not had chickenpox and is too young to have received the vaccination. Once the rash scabs over, usually within seven to 10 days, shingles is considered much less contagious.

Complications of shingles

Complications occur in about one in 10 people who have shingles. These include:

• continued pain (called postherpetic neuralgia) in the area of the rash, even after the rash has disappeared
• eye infection and inflammation which, although rare, can lead to vision loss
• ear inflammation and pain
• meningitis (inflammation of the lining of the brain)
• bacterial skin infection

Concern about vision loss for Miranda was real after he'd tweeted that he had blurry vision. He later clarified that it was because he'd had his pupils dilated for an eye examination, not due to the infection.

Preventing and treating shingles

Shingles can be prevented. The shingles vaccine is currently recommended for people ages 50 and older; those with weakened immune systems should not receive it. It is not 100% effective, but those who develop shingles despite the vaccine tend to have a slightly shorter duration of rash and a lower incidence of complications (especially postherpetic neuralgia).

In addition, if enough people receive the vaccination for chickenpox, the frequency of shingles may decline. Proof that this is the case may not be available for many years, since the interval between chickenpox and shingles can be several decades and the chickenpox vaccine only became widely available in the mid-1990s.

Treatment of shingles includes an antiviral medication (such as acyclovir, famciclovir, or valacyclovir) and pain medications (such as a nonsteroidal anti-inflammatory medication, tramadol, or oxycodone).

The bottom line

Shingles is a common disease that may become less frequent due to recently developed vaccinations. For most people, it's a painful but temporary problem; when complications develop, it can be much more troublesome. Check with your doctor about vaccinations for chickenpox and shingles, any unexplained rash, or if you're exposed to someone with shingles. Hopefully we'll soon learn that Miranda has recovered quickly and completely.