Q: I’m a 48-year-old male with a history of chickenpox as a child and a minor case of shingles at age 40. My question/concern is since the shingles case, on two occasions I have had episodes of what I would call a “shingles like” rash and small blisters without the pain – just an incredible itch. Both episodes seemed to occur when my stress (work level) was high and nutrition (usually outstanding) low.

Is there such a thing as a muted form of shingles, or could this be something else? And since I have already had shingles, would I be a candidate (and perhaps this would help prevent these episodes) for the shingles vaccine?

A. As you are aware, having chickenpox as a child can lead to shingles as an adult. Generally speaking, shingles causes an extremely painful rash caused by the varicella zoster virus. The pain is so severe a sufferer will be disinclined to scratch the blisters that are present. Did you visit your health care professional the two times the rash was present on your body or did you have such a mild case you didn’t feel it was necessary? Where was the rash? Without these answers, I cannot make an educated guess if your rash was indeed shingles or the result of an unrelated condition. Take the time to think back to where the rash was. You can essentially draw an imaginary line from your head down to your feet. It may have been on the front and back of the torso, for example, but if it appeared on the left and right sides of the body, it wasn’t shingles. The pain isn’t always debilitating but the location of the rash is telltale.

The good news is that you cannot catch shingles from someone else who has it; however, there is a small chance a person with shingles can spread the virus to another person who never had chickenpox as a child or who didn’t get the chickenpox vaccine. In answer to your question, a person can get shingles more than once; up to 4% of individuals will experience a second episode of herpes zoster, although this is more common in those who have a compromised immune system.

Symptoms may begin with a headache or light sensitivity. The individual may feel as though he or she has the flu or is coming down with something. Several days later a rash may appear and blister. The blisters crust over and may or may not leave scars. There are instances in which severe pain will present in the area where the rash will appear within a few days. Visual changes may be present and a physician should be consulted – particularly when there is a question of diagnosis. In the case of shingles, an anti-viral medication and perhaps one for pain may be prescribed.

Zostivax, the shingles vaccine, is available to reduce the risk of shingles in people 60 and older. At this stage, even the Centers for Disease Control (CDC) does not have a recommendation for individuals between the ages of 50 and 59 (or younger) – only because individuals in this age bracket have never been part of a test study. However, the Food and Drug Administration (FDA) has approved Zostivax for individuals in the 50-59 age group. So, in answer to your question and because you are very close to the “acceptable” age, you should pursue this with your personal physician. He or she has access to your medical records and history of conditions. There is no specific waiting period following an outbreak of shingles but you should be assured the rash has disappeared prior to being immunized. It is not recommended for individuals with HIV/AIDS or others with a weakened immune system, those on chemotherapy or radiation treatment, have cancer, leukemia or lymphoma, or have a severe allergic reaction to any component of the vaccine.

A possible cause for your rash may be stress that can have a powerful effect on a person’s skin. It can worsen psoriasis and eczema, cause hives, contact dermatitis from poison ivy/oak or sumac, lead to oral mouth blisters (herpes simplex), and still more. Is there a possibility you ate a specific food (albeit twice) such as an Asian dish with MSG, are allergic to nuts and a nut oil was in a restaurant dish, and had an allergic reaction?

Visual examination is critical for a correct diagnosis. With or without pain, be sure to see your health care professional if you have another outbreak.