Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Charles Hare

Charles Hare, MD

Infectious Diseases

As your doctor, I believe that empowering you with information will allow you to be more proactive in our partnership in maintaining your health. MyDoctorOnline will enable us to communicate better. You can e-mail me, check your lab results, make an appointment, access our many online programs or get information about a particular health topic - any time that's convenient for you.

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San Francisco Medical Center
Appt/Advice: 415-833-2200

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Overview

Shingles is a painful rash caused by the virus known as varicella-zoster, which is the same virus that causes chickenpox. Once you’ve had chickenpox, the virus remains inactive (dormant) forever in your body’s nervous system. If the virus becomes active again in one of the nerve branches of your body, shingles is the result.

It is not exactly clear what triggers the previous chickenpox infection to become shingles, but it becomes more common as you age, especially over the age of 65. Anyone who has previously had chickenpox can get shingles. Since shingles develops when the dormant virus becomes activated in your body, you cannot catch it from someone else. If you (or your child) have not already had chickenpox or the chickenpox vaccine, and you are exposed to someone with shingles, you may develop chickenpox.

The blistering shingles rash usually appears as a band around one side of your waist area to your back, although it can occur anywhere on your body. You will likely feel a burning sensation or pain in the area before the rash appears.

A vaccine is available to reduce the risk of getting shingles. Since there is no cure for shingles, treatment focuses on symptom management and shortening the course of the illness.

Shingles usually clears up within 2 to 3 weeks and does not typically recur. If the virus affects your nerves, additional treatment may be needed, and it may take longer to fully recover.

Additional References:

Symptoms

The first symptom of shingles is usually mild to significant burning or shooting pain, itching, or tingling in one area of your body. For example, you may feel pain on one side of your waist but not the other. Not everyone who gets shingles experiences this pain, however.

Within 1 to 3 days, a red rash appears in the same location as the pain. You might also have a fever or headache. The rash turns into small, fluid-filled blisters that look like chickenpox blisters. Within 1 to 14 days, the blisters will break, leaving small scabs. The scabs eventually fall off and do not usually leave a scar. However, in some people, pain or other discomfort may continue for weeks, months, or even years after the blisters heal (known as sensory symptoms).

While the shingles rash often occurs as a band around the waistline to the back (dermatome) on only one side of the body, it can appear anywhere on your body and may involve your eyes, nose, and mouth. The second most common area affected by shingles is on one side of the face, around the eye and forehead. If shingles appears on your face, it could affect your hearing or vision.

Shingles may cause many blisters or just a few. In some people, the rash looks more like a severe burn. Some people may only develop a few blisters and do not have other symptoms, such as pain. Shingles usually clears up within 2 to 3 weeks and does not usually recur. However, it may return in people who have a weakened immune system.

In addition to pain, rash, and blisters, you might also experience a number of other symptoms, such as fever, chills, headache, and upset stomach. Some people develop joint pain, swollen glands, or blisters on the genitals. If shingles develops on your face, you may also experience one or more of the following symptoms:

  • Drooping eyelid
  • Hearing or vision loss
  • Loss of eye movement
  • Loss of taste

Risk Factors

You might be at greater risk of developing shingles if you had chickenpox before the age of 1 year, if you are older than 60 years, or if you have a weakened immune system due to HIV, cancer chemotherapy, or organ transplantation. Your risk of developing shingles increases with age. Most people who develop shingles are over age 40.

People who use immunosuppressant medications (such as prednisone) are also at higher risk of developing shingles and for recurring shingles. 

If a woman is pregnant and develops chickenpox late in the pregnancy, the baby is at increased risk for developing shingles during childhood (pediatric shingles).

Contagiousness

When you have shingles, you can pass the varicella-zoster virus on to people who have not already had chickenpox or the chickenpox vaccine. The virus is transferred by direct contact with the open blisters on your skin. A person cannot pass the illness called "shingles" on to another person, only the virus that causes chickenpox.  Rarely, if shingles causes infection in large areas of the skin, involves the lungs, or other areas in the body, it can be transmitted through the air.

Diagnosis

We will diagnose your shingles after looking at your blistering rash and talking about your other symptoms. If the diagnosis is not clear, a culture, scraping, or biopsy may be done to determine if it is shingles.

If we suspect that your blistering skin is infected with bacteria, we may take a sample to confirm the infection so that we can prescribe the appropriate antibacterial medication to help ease symptoms.

Prevention

If you have never had chickenpox, avoid touching the blistering rash of a person who has shingles.

A shingles vaccine (Zostavax) is available, which is different from the chickenpox vaccine. We may recommend this vaccine for people 60 years or older. While it may not prevent shingles in everyone, it can reduce your risk for shingles complications and shorten the duration of the outbreak.

Treatments

Shingles often clears up on its own without medical treatment. If we determine treatment is needed, we may prescribe an antiviral medication, such as acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir). A medication is most effective when taken within 1 to 2 days after localized pain and rash occur.

Early treatment with an antiviral medication may reduce the length or severity of shingles. Antiviral medicines may also reduce the pain associated with shingles.

Home treatment

Apply wet compresses to relieve itching and swelling. Calamine lotion, colloidal oatmeal baths, and antihistamines (such as loratidine or cetirizine) might also reduce itching, pain, and swelling. Nonprescription pain medicines, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), might help for mild pain and fever.

Keep the infected skin clean and do not leave used tissues or washcloths lying around. Pregnant women or those who have never had chickenpox are advised to stay away from any noncovered shingle wounds.

Complications

In rare instances, shingles can lead to some serious complications, particularly among the elderly or anyone with a weakened immune system. These more serious complications may include:

  • Ramsay Hunt syndrome. This occurs when shingles affects a nerve in your head, leading to weakened facial muscles, along with a rash near your ear, tongue, and inside your ear canal. This condition can lead to hearing loss, difficulty closing one eye, difficulty eating, and paralysis on the side of your head affected by the shingles virus.
  • Postherpetic neuralgia. When the nerves are damaged from shingles, the localized pain may continue for days, weeks, months, or even years after the blisters heal (postherpetic neuralgia). The pain can range from mild to severe and debilitating. This condition is more likely to occur in people over the age of 60 or people with a suppressed immune system due to medications or illness.

Shingles can also lead to blindness, deafness, encephalitis (a form of brain infection), blood infection (sepsis), and bacterial skin infections that may be difficult to treat.

For Caregivers

A person with shingles cannot pass shingles to another person. The person can only pass on the virus that causes chickenpox.

If you are pregnant or have not had chickenpox previously, talk to your doctor before being near a person who has shingles or chickenpox.

If you are caring for someone with shingles, it is important to help them control symptoms such as pain, itching, and fever. Make sure they take all medications as prescribed.

The person may benefit from cold wet compresses or a cool colloidal oatmeal bath, which can reduce itching and discomfort. Unless otherwise indicated, the person can take ibuprofen or naproxen to relieve fever and pain. An antihistamine may reduce itching and swelling.

If you are experiencing an emergency, like the rash occurs on the person’s head or face, or if you get shortness of breath while with a shingles rash, call 911 immediately or go to the nearest emergency room.

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours per day, 7 days per week.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages.
  • Manage your prescriptions.
  • View your past visits and test results.
  • View your preventive services to see whether you are due for a routine screening or updated immunization.
Learn more about your condition
  • Read about causes, symptoms, treatments, and procedures.
  • Find interactive health tools, videos, and podcasts to help you manage your condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
  • Locate health education classes and support groups offered at every medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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