Introduction and module overview

This module covers the diagnosis, treatment and prevention of shingles. After completing it you will be able to:

• Assess patients’ symptoms to decide whether or not shingles is likely and differentiate between those eligible for pharmacy supply of aciclovir and when referral is necessary 
•  Describe the current NHS eligibility criteria for the shingles vaccine and how pharmacies can improve uptake.

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

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 provision of aciclovir treatment on the NHS from community pharmacies has the potential to improve access to treatment within the crucial three-day period after the shingles rash appears. This early intervention can help reduce the severity and duration of shingles.

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