Shingles cases among people aged 30 to 49 more than doubled between 1998 and 2017, US research reported. Yet the first warning can be as slight as a small bump or nagging ache, easy to dismiss.

Shingles can affect younger adults, even though the risk rises with age. Early symptoms may appear before the rash, making the infection easy to mistake for something less serious.

How the Virus Reawakens

Shingles, also called herpes zoster, is caused by the varicella-zoster virus, which causes chickenpox. Dr Shibani Mukerji of Massachusetts General Hospital said the virus retreats into nerve tissue and can lie dormant for decades.

Mukerji said the virus can reactivate when immunity becomes less robust because of age, stress, illness or certain medications. It then travels along nerves to the skin, causing the painful rash.

A Small Bump and Aching Ribs

Claire Trageser, 43, noticed a small bump on her stomach and an aching pain in her ribs. She said she felt like she was going crazy, and though online searches pointed to shingles, she was certain it was nothing.

Her doctor confirmed shingles after one look and said it was not a mild case. The doctor said she needed to slow down during marathon training.

Trageser said she was shocked, as she believed she still had years before worrying about shingles. She left in tears, dreading what the next week would bring as the rash grew worse.

Her symptoms, a bump and pain on the torso, echo the early signs experts describe. The CDC says the earliest sign is a tingling, itchy or painful feeling on the skin, even before a rash is visible.

A rash often follows a few days later, typically as a stripe or band on one side of the body, often on the face, neck or torso, Mukerji said. It then turns into painful blisters.

Dr Richard Dupee of Tufts Medical Center said shingles is a nerve inflammation first and a rash second. The pain can feel burning, stabbing or electric, and may start before any rash appears.

Consultant dermatologist Dr Adil Sheraz said shingles can be missed before a rash appears, and younger patients can be overlooked. Some cases never display a rash at all.

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Why Younger Adults Get Shingles

Trageser said that when she told friends, mostly women in their 30s and 40s, almost all had a story. The 2019 paper found the rise outpaced that in older groups, although older adults still had more cases overall.

Women also appear to have a higher risk of shingles than men. Research has found this difference, although the reasons are not fully understood and may involve differences in immune responses.

Jennifer Moffat of the State University of New York Upstate Medical University said a small gap in immune function is enough to let the virus emerge. Stress, diabetes and steroid treatment can all be associated with an outbreak.

Why Early Treatment Matters

Antivirals such as acyclovir, valacyclovir and famciclovir can shorten an outbreak and reduce the risk of lingering symptoms, the CDC says. They work best when treatment begins within 72 hours of symptom onset.

Some people develop postherpetic neuralgia, nerve pain that can linger for months or even years after the rash clears, Mukerji said. Dupee said shingles on the face can threaten vision if the virus reaches the eye.

For younger people, general wellbeing may help support immune health, Moffat said. Anyone who suspects shingles should see a doctor without delay.

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