Is Shingles Contagious to Kids?

Medical Review By: Ted Schiff, MD

Shingles is miserable. The painful, fluid-filled blisters can last weeks before they crust over and disappear, and in some people, nerve pain lasts even longer. If you have shingles, you probably wouldn’t wish it on anyone. While you’re waiting for the outbreak to end, if you have children or grandchildren you may be asking yourself, "Is shingles contagious to kids and babies?"

The answer is no, you can’t give them — or other adults — shingles. But that doesn’t mean there is no risk in exposing them. Kids can be vulnerable for another, surprising reason. Here’s what you need to know about shingles transmission.

The relationship between shingles and chickenpox

Shingles is caused by the varicella-zoster virus (VZV), a member of the herpes family of viruses. What many people don’t realize is that this same virus also causes chickenpox. If you had chickenpox as a child, you’re vulnerable to shingles as an adult.

Here’s how it works: When you recover from chickenpox, the virus retreats to nerve tissues near the spinal cord, where it typically remains dormant (inactive). But it can be reactivated later in life, possibly by stress, illness, a weakened immune system or physical injury. When that happens, it moves along the nerves to the skin and causes an outbreak of shingles.

Once you’ve had chickenpox, you become vulnerable to shingles for the rest of your life.

How to avoid spreading the VZV virus

While kids can’t catch shingles from you, they could catch chickenpox if they’ve never had it or were never fully vaccinated against it (with both doses of the chickenpox vaccine). Once they develop chickenpox, they will also be vulnerable to shingles later in life.

For someone to catch chickenpox from a case of shingles, shingles has to be in the active phase, when the blisters are oozing fluid. There’s no risk of transmission before blisters appear or after they have dried and crusted over. Passing it on requires direct contact with the blister fluid — say, when you cuddle your grandson and his skin touches your rash. Fortunately, the VZV virus is less contagious when an adult has shingles than when a child has chickenpox.

Preventing the spread of VZV when you have shingles is relatively simple: Cover your blisters during the oozing phase with nonstick sterile bandages. Hydrocolloid adhesive pads, available at many drugstores, are a smart choice. Avoid scratching the blisters.

While you’re contagious, avoid contact with people for whom chickenpox poses an increased risk, including:

• Pregnant women who’ve never had chickenpox or the chickenpox vaccine
• Premature or low-birth weight infants
• Anyone with a weakened immune system, including people undergoing chemotherapy or taking immunosuppressive drugs and people with HIV

Preventing shingles and chickenpox

Children who haven’t had chickenpox can avoid falling sick by getting both doses of the chickenpox vaccine. The Centers for Disease Control and Prevention (CDC) recommends getting the first dose at 12 to 15 months old and the second dose between the ages of 4 and 6.

Teenagers and adults who’ve never had chickenpox may also benefit from getting the vaccine.

The CDC recommends older adults get a shingles vaccine since the risk of shingles and the long-term nerve pain that sometimes follows (known as post-herpetic neuralgia) increases with age. The Shingrix vaccine, which has been in use since 2017, is the preferred shingles vaccine for adults age 50 and over. It has been shown to be 97% effective in preventing shingles in adults ages 50 to 69 who received two doses. An older shingles vaccine, Zostavax, is being phased out.

Shingles treatment tips

Shingles usually lasts two to four weeks and generally doesn’t recur. If you can get a diagnosis from your doctor within the first three days — not always easy, since your only symptoms may be a burning/tingling/itching sensation on one area of the skin — an oral antiviral medication may shorten the duration and the severity of the outbreak.

An over-the-counter or prescription pain medication can help ease the pain. For the itching, try cool compresses, calamine lotion and lukewarm baths with store-bought or homemade colloidal oatmeal (oats ground into a fine powder) sprinkled in.

Article Written By: Jennifer L. Cook, an award-winning editor and writer whose work has appeared in Good Housekeeping, Prevention, Consumer Reports on Health, and Woman’s Day and on Investopedia.com and Bottomlineinc.com.

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Telogen Effluvium: Stress-Related Hair Loss Is Real

Suddenly, out of the blue, your hair starts falling out, maybe by the fistful. It could be  telogen effluvium — temporary hair loss often caused by prolonged, intense stress, an infection or physical trauma, such as from a car accident or surgery.

“It occurs after a person has undergone a stressful life event that shocks the body, such as battling a virus,” said Dr. Alissa O’Brien, a board-certified dermatologist with Water’s Edge Dermatology.

COVID-19 appears to have triggered a rash of new cases, whether from the infection, the treatment (including being on a ventilator), emotional stress related to the pandemic or some combination.

Dr. O’Brien said the new cases aren’t surprising, since post-infection hair loss is a well-known phenomenon. “Approximately three months after a ‘stressful’ event, the hair sheds much more than normal. Up to 50% of the hair can be temporarily lost due to telogen effluvium.”

While emotional stress can trigger hair shedding, “in my experience, the worst cases usually follow major physical stressors, such as infection with COVID-19, ICU hospitalization, being on a ventilator or temporary dialysis,” said Dr. O’Brien.

Certain medical conditions, such as liver, kidney and thyroid disease, and some medicines can also trigger telogen effluvium, as can extreme weight loss from crash dieting. Mild telogen effluvium is common after pregnancy.

How the hair loss happens

Hair naturally goes through periods of growing and shedding. At any given time, 85 percent of your hair is in the growth (anagen) phase; the remaining 15 percent is in the resting (telogen) phase. After about three months in the telogen phase, hair falls out.

When a stressor or trauma disrupts this cycle, many of the hairs that were in the growth phase abruptly enter the resting phase. Three months later, the hair becomes thinner — sometimes dramatically so.

“Up to 70% of the hairs that were in the anagen phase may be affected. It can seem like your hair is coming out in handfuls,” said Dr. O’Brien. The hair loss can come as shock. “Looking in the mirror can be quite distressing when you notice up to half your hair has fallen out,” Dr. O’Brien added.

People experiencing telogen effluvium may also develop horizontal indentations in the fingernails and toenails known as Beau’s lines.

Telogen effluvium treatment

The good news is that telogen effluvium is temporary. Hair will grow back, though it may not fill in completely, and the strands may be thinner. Unfortunately, there’s no way to speed this process along.

“Many patients want a magic pill, shampoo, serum or vitamin to take, but the only treatment is time,” said Dr. O’Brien. “The hair will return to its normal growth and resting cycle, but it takes anywhere from six to 12 months to fully recover.”

For people with severe hair loss, that span can feel like eternity. Hair extensions or hair pieces can bridge the gap.

Watching your hair fall out may be demoralizing, but unlike with certain other types of hair loss, if you have telogen effluvium, you’ll eventually notice new strands coming in on their own — and see that reassuring head of hair in the mirror again.

Article Written By: Jessica Brown, a health and science writer/editor based in Brooklyn, New York. Her work has appeared in Prevention, Johnson & Johnson, the Breast Cancer Research Foundation, and many more.

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6 Skin Symptoms to Never Ignore, Even During COVID-19

Most doctor's offices are still open — and in fact never closed — during the coronavirus pandemic. But some people have been avoiding seeing the doctor for fear of catching COVID-19. If you have a health condition that needs medical attention, however, that strategy can backfire. Left untreated, some conditions, including certain skin conditions, can pose serious threats.

See a dermatologist or other skin care provider, either via an in-office visit or a teledermatology (telemedicine) visit, if you experience any of these symptoms.

1. A bad, worsening or spreading rash

Some rashes, like poison ivy rash, typically resolve on their own and don’t usually require a doctor’s care. Other rashes need to be taken more seriously. For example, a rash that’s painful or gets worse quickly could stem from a serious infection. A rash all over the body could also indicate an infection, or an allergic reaction. If you have a rash combined with a fever or breathing difficulty, get to the emergency room. If you have a rash near your eye or on your genitals, especially if it blisters, see a doctor right away.

An infected rash is another reason to see a doctor. Infected rashes may be painful or warm to the touch and may crust or leak yellow or green fluid. Red streaks may appear on the skin near the rash.

2. A suspicious mole or other growth

If you notice an unusual new bump or growth on your skin or a suspicious mole — one that has changed in shape, size or color — don’t put off seeing a dermatologist, especially if you’ve had skin cancer in the past or you have a family history of skin cancer.

The provider may examine your growth or mole via a telederm visit, but if there’s any concern about skin cancer, you’ll need to be seen in person and possibly undergo a skin biopsy.

Whether or not you notice any suspicious growths, you’ll also want to keep up your annual skin cancer screenings, especially if you have a history of melanoma.

3. A sore that doesn’t heal

An open sore that won’t heal, or one that heals and then returns, could be a sign of basal cell carcinoma. It could also indicate a skin ulcer caused by diabetes, leg swelling or physical pressure from being bed- or wheelchair-bound. Whatever the cause, it needs medical attention.

4. Raised, scaly, itchy patches

Plaque psoriasis is a serious medical condition caused by an immune system glitch that makes skin cells grow too fast. Raised red patches with silvery scales form, often on the elbows, knees or lower back. Psoriasis tends to go through cycles of flaring and subsiding. Proper treatment can help tame flares.

People with psoriasis face an increased risk of cardiovascular disease, diabetes and psoriatic arthritis, an inflammatory joint disease, which makes getting an accurate diagnosis especially important.

5. Purple discolorations on the hands or feet

A strange symptom appearing in some COVID-19 patients is purple spots on the hands or feet, especially the toes. So-called COVID toes are thought to stem from blockages or tiny clots in small blood vessels. They sometimes appear in children who have no other signs of the coronavirus — a helpful tipoff to the disease. The spots may eventually scab over. COVID-19 may also cause rashes in some people. See photos here.

A provider can examine any purples spots or rashes via a telederm visit. You should be able to send a photo in advance. If there’s a suspicion of COVID-19, you’ll want to get tested.

6. A painful red rash on one side of the body

If you’ve ever had chicken pox, you’re at risk for developing shingles later in life, especially after age 50. You might feel burning, itching, tingling or extreme skin sensitivity (usually in an area on just one side of the body). Next comes a painful red rash in the same area. The rash soon becomes groups of blisters, which are clear at first but then turn yellow or bloody before they crust over and disappear.

The pain may be bad enough that you need prescription painkillers, but that’s not the only reason to see a doctor right away. When shingles is diagnosed within 72 hours, oral antiviral medication can be prescribed to treat the shingles and also help prevent post-herpetic neuralgia, a long-lasting condition that involves burning pain.

Article Written By: Marianne Wait, an award-winning health and wellness writer based in New Jersey.
Medical Review By: Ted Schiff, MD

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Easy Three-Step Morning Skin Care Routine

When you wake up in the morning, what do you do? Make coffee, brush your teeth, get dressed? Shave or put on makeup? If that's all, you're missing a few things.

No matter your gender or skin type, it's important to wash your face in the morning, smooth on some moisturizer and apply sunscreen — the three critical steps in any morning skin care routine, according to Julie Forero, DO, a board-certified dermatologist with Water’s Edge Dermatology. She explains why and provides tips for each step, including her top skin care products.

Step 1: Wash your face

If you don't normally wash your face in the morning, it's time to start. Washing removes oil that accumulates overnight, but that’s not all. "Our skin is constantly replacing itself, so we develop dead skin cells on surface. Sometimes they need a little assistance to come off," said Dr. Forero. "Washing with an exfoliating cleanser reveals a more radiant complexion and promotes a clean palette for applying makeup," she added.

Tips for washing your face

1. Choose an exfoliating cleanser. A cleanser with salicylic acid and/or glycolic acid will chemically exfoliate dead skin cells. Try wederm Exfoliating Cleaner, which comes in two versions: one with 2 percent salicylic acid and 2 percent glycolic acid, and one with 2 percent salicylic acid and 5 percent glycolic acid (which is better for oily skin). Other good options are Oil-Free Acne Wash from Neutrogena, which contains 2 percent salicylic acid (and no, it’s not just for acne), and Effaclar Medicated Acne Face Wash from La Roche-Posay, which contains 2 percent salicylic acid as well as gentle-on-the-skin lipohydroxy acid.
2. Skip the salicylic acid. If you have very sensitive skin, rosacea or atopic dermatitis, or if you’re pregnant, you should use a glycolic acid product instead of one with salicylic acid. One to try is Glytone Mild Gel Cleanser. If it bothers your skin, try a non-exfoliating cleanser such as ZO Gentle Cleanser or CeraVe Hydrating Facial Cleanser.
3. Gently massage in the cleanser, making small circles with your finger pads. “Massaging promotes circulation and helps very gently exfoliate your skin cells,” said Dr. Forero. It also promotes lymphatic drainage, which may make your face look less puffy.
4. Rinse well and gently pat dry. “You want your face to still have a little bit of water on it when you apply moisturizer,” said Dr. Forero. Damp skin absorbs product more readily and gives the moisturizer the chance to lock in the hydration.

Step 2: Apply moisturizer

Whether your skin is dry, oily or acne-prone, it's smart to use a moisturizer.

"Moisture is different from sebum, which is the oil in the skin," said Dr. Forero. "Moisturizer helps prevent trans-epidermal water loss, and this helps keep the skin barrier intact. The more whole your skin is, the less easily it will become irritated by the environment."

You don't have to spend a fortune on a moisturizer. In fact, price doesn't always correlate with quality. "Some wonderful products are very cheap," noted Dr. Forero.

Moisturizer tips

• Look for hyaluronic acid. Despite the "acid" in its name, it's very good for sensitive skin. "It's a molecule that has long arms like an octopus. Those arms attract and hold a lot of water, so they plump up like a big sponge," said Forero. The result: glowing, dewy skin. Dr. Forero likes Neutrogena's Hydro Boost line — the gel for oily skin and the gel-cream for drier skin. Another product she likes, which contains more hyaluronic acid, is wederm Pure Hydration hyaluronic acid serum. Use it as a moisturizer, use it before your moisturizer or add a drop or two into your moisturizer.
• If your skin is dry or sensitive, opt for a cream instead of a lotion. Creams are more moisturizing. They’re also potentially less irritating because they contain less water, which means less preservative is necessary. (Some lotions are an exception to the rule; Dr. Forero notes that some CeraVe lotions are as rich as a cream.)
• If you live in a hot climate like Florida, you may want a lotion instead of a cream. VaniCream Moisturizing Lotion is a good, light option.
• See a dermatologist if you can’t find a moisturizer your skin can tolerate. He or she can guide you through a more educated trial-and-error selection process.

Step 3: Apply sunscreen

"Rain or shine, whether you're going outside or not, everybody needs sunscreen every morning," said Dr. Forero. "Keep it by your toothpaste and get in the habit of putting it on your face. If you’re doing that once in the morning, that’s great. If you can reapply before lunch and before leaving the office in the afternoon, that’s phenomenal."

Even if you’re under the sun only while walking from your car to a building, that exposure adds up. "UVAs rays break down the elastin and collagen in the skin, and that makes you look aged over time," said Dr. Forero. "It's a very slow, gradual process. So, sunscreen is your best anti-aging product."

Remember that UVA rays can penetrate windows. These rays can cause wrinkles and also common forms of skin cancer, including basal cell carcinoma and squamous cell carcinoma. That’s why sunscreen is important even indoors.

Sunscreen tips

• Use a broad-spectrum sunscreen to protect against both UVB rays (responsible for sunburns) and UVA rays. Choose an SPF of 30 or more.
• Look for zinc oxide. "My favorite broad-spectrum ingredient is zinc oxide, and I like to see at least 7 percent. Zinc oxide covers more of the UVA wavelengths and lasts longer than avobenzone," said Dr. Forero. (Avobenzone is a UVA-absorbing ingredient in chemical sunscreens). "I use EltaMD UV Clear." It has 9 percent zinc oxide and an SPF of 46. "I like the product container because one pump gives you enough product to cover your face, neck and upper chest." Don’t worry, it goes on clear.
• Don’t like the feel of sunscreen? If your skin can tolerate fragrance, try Eryfotona Actinica from Isdin. "It has a special technology so it doesn’t feel like you’re wearing a cream as much," said Dr. Forero.
• Hit commonly missed spots. A lot of people forget their ears, neck, eyebrows, hairline and eyelids — all places skin cancer can develop.

A basic morning skin care routine takes only a couple of minutes, less time than you spend drinking your coffee. The payoff is clearer, more radiant skin, protection from sun-related skin aging and a lower risk of skin cancer.

Article Written By: Marianne Wait, an award-winning health and wellness writer based in New Jersey.
Medical Review By: Julie Forero, DO

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