How Stress Triggers Shingles and Affects Recovery

Shingles is a viral infection that causes a painful rash typically appearing on one side of the body. It is caused by a reactivation of the virus that causes chickenpox years or even decades after having a chickenpox infection. Although the reason why this virus reactivates years later is unknown, some researchers think a weakened immune system could be the cause^[1].

Stress increases an individual’s risk for a life-threatening infection, and research has found that stress has some part to play in almost every infection^[2]. Because stress affects the immune system so significantly, many researchers believe that stress may be a trigger for shingles^[3].

In this article, we will explore the link between stress and shingles, how stress affects the immune system, risk factors and symptoms of shingles, and how shingles is treated.

What Is Shingles?

Shingles (herpes zoster) is an infection caused by the varicella-zoster virus, which causes a painful rash on one side of the body. The same virus also causes chickenpox (varicella). A person who has not had chickenpox before can get chickenpox through exposure to someone with shingles^[4].

Shingles can occur in anyone who has had chickenpox before. According to one study, three to five people out of every 1,000 globally will get shingles each year^[5]. People who have not received the Shingles vaccine or are older than 85 have a 50% chance of developing Shingles in their lifetime^[4].

Shingles typically affects the torso, although symptoms can also occur on the face and internal organs. Shingles infects a single sensory nerve near the spinal cord, causing the symptoms to appear across a specific area of the body rather than all over it. The pain individuals infected with shingles experience is caused by nerve involvement, not by the rash itself, which can be severe^[6].

Are Stress and Shingles Connected?

It is often assumed that stress is associated with a greater risk of developing shingles, and many studies have found that there may be a link. One study showed acute and chronic stress is associated with decreased antibody activity. When the immune system is depressed, there is an increased likelihood of reactivation of latent infections, such as the varicella-zoster virus (VZV), which causes shingles^[7]. Another study found that perceived mental stress, less sense of purpose, and adverse life events may contribute to developing shingles, specifically in persons over age 50^[8].

However, while many researchers have found a link between stress and shingles, many others have found that stress levels do not affect an individual’s risk of developing shingles. While it has always been assumed that stress can trigger shingles, few studies have investigated this directly. One study used case-only methods to investigate whether stress and shingles are connected and found no evidence that stress triggers shingles^[9].

This conflicting research places focus on the complex relationship between stress and shingles and shows that additional factors, such as individual differences in stress perception, coping mechanisms, and overall health, may influence the risk.

How Does Stress Affect the Immune System?

Long-term (chronic) stress is typically considered detrimental to overall well-being, but it is important to understand that short-term (acute) stress plays a protective role in the fight-or-flight response. While long-term stress is associated with adverse and immune-destroying effects, short-term stress helps the body protect itself.

Two main pathways in the brain are responsible for stress regulation. These pathways (the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system) connect stress to immunity. Stress triggers the release of stress hormones, which control the movement of immune cells. Research has found that an acutely stressful event may temporarily strengthen immunity and promote protection during infection; conversely, chronic stress dysregulates and inhibits immune function. Chronic stress causes an increase in levels of cortisol (a stress hormone) through the HPA axis, suppressing immune response^[10].

While stress can be protective in acute situations because it enhances immunity and helps the body respond to threats, prolonged stress can have the opposite effect. Chronic stress and its impact on the HPA axis and cortisol levels undermine immune function, leaving the body more vulnerable to infections. The two sides of stress show how it can be both helpful and harmful and demonstrate the importance of effective stress management strategies to support long-term immune health and overall well-being.

Risk Factors for Shingles

Although it is often believed that shingles is caused by stress, a weakened immune system is the primary risk in its development. Here are some other factors that may place individuals at risk of developing shingles in their lifetime:

• Age: An individual’s risk of developing shingles increases with age, occurring more frequently in individuals older than age 50^[11].
• Weakened immune system: 30% of those hospitalized with shingles have a suppressed immune system^[11].
• Medications: Medications, such as steroids or others used to suppress the immune system, may place an individual at risk for developing shingles^[12].
• Chronic conditions: Conditions such as chronic obstructive pulmonary disease, asthma, diabetes mellitus, ischemic heart disease, and cancer may increase the risk for the development of shingles^[13].
• Chickenpox vaccine: According to research, individuals who have received the live chickenpox vaccine may be at risk of developing shingles. However, this risk is lower than in those who contracted the virus through exposure^[14].

Symptoms of Shingles

Shingles typically presents as:

Early Symptoms

• Pain, tingling, or burning on one side of the body
• Fever
• Headache
• Chills
• Upset stomach

Rash

The rash comprises blisters that usually scab over in 7 to 10 days. The rash is usually only one-sided and typically has a band or belt-like appearance.

• The rash starts as small red spots.
• The red spots form blisters that break and form sores.
• The sores dry and form crusts.
• The crusts fall off in 2 to 3 weeks.
• In addition to the torso, the rash may also appear on the face, eyes, mouth, and ears if the infection is near these places.

Other symptoms may include temporary joint pain and stiffness, photophobia, tender and painful skin, and eye and ear pain if the rash occurs near these organs.

Consulting a healthcare provider as soon as possible may reduce the length and severity of shingles, but it is vital to seek immediate care in certain situations: when a rash involves the eye, there is difficulty hearing, the rash is widespread, there is weakness or drooping of one side of the face, or if one’s immune system is compromised, such as in cancer or HIV/AIDS.

Treating and Managing Stress-Induced Shingles

Shingles can be treated with antivirals, pain relief, and medications to address the pain, itching, and infection. Antivirals may include acyclovir, famciclovir, or valacyclovir, and they work best when taken within 3 days of the rash appearing^[15]. Pain relievers may consist of over-the-counter medications, like acetaminophen and non-steroidal anti-inflammatories, as well as narcotic pain relievers (which require a prescription)^[16]. Individuals with shingles may also use creams for itching, cool compresses for discomfort, and non-stick dressings to help cover the rash and avoid spreading the virus^[6].

Although stress may not directly cause shingles, some stress management strategies can be employed to keep the immune system at peak functionality and reduce the risk of contracting infectious diseases. These include regular exercise, a balanced diet, adequate sleep, and spending time on hobbies or socializing^[17].

Treating shingles is relatively simple, but prevention is better than cure. Chickenpox and shingles are vaccine-preventable diseases. The shingles vaccination is over 90% effective at preventing shingles in adults 50 years and older with healthy immune systems. Immunization can prevent future disease occurrences for individuals who have had shingles^[18].

Conclusion

While stress may not directly cause shingles, a weakened immune system does. Stress is a significant contributing factor to a weakened immune system, so stress may play an indirect role in the reactivation of the chickenpox virus.

Shingles often presents as a painful band-like rash on one side of the body. It may also cause additional symptoms, like muscle aches, pains, and fever in the early stages. These symptoms can be treated with antivirals, pain medications, and other comfort measures. While this disease is treatable, it is also preventable with the shingles vaccination.

For individuals to prevent infection by the herpes zoster virus, they should keep their immune system strong by managing chronic stress through exercise, a balanced diet, good sleep, and engaging in activities they enjoy.