When Fabian Prahl notices a small, red spot on his forehead in the mirror, he thinks nothing of it. A few days later he received the diagnosis: shingles. The disease is anything but harmless. His family doctor speaks of possible blindness and an increased risk of a heart attack.
Suddenly there is this little red spot. Top left in the receding hairline corner. Fabian Prahl discovered it on a Wednesday in November 2023 when he looked in the mirror in the morning. He doesn’t think much of it. The next day the spot got bigger. Prahl is still not worried. But over the weekend, purulent pustules spread from the hairline to the left eye. The lymph glands behind his ear swell and Prahl gets a fever.
He doesn’t feel any pain, nor does it itch. Fabian Prahl starts Googling his symptoms. The search results worry him, but he can’t find the actual cause. He finally goes to the doctor on Monday morning, five days after the first spot appeared. He remembers: “The doctor came in and before even saying hello he said straight away: ‘Ah, shingles’.”
Fabian Prahl was 54 years old at the time and a manager at a credit card comparison portal. Shingles, that’s something for pensioners, was his first thought. He had heard of the disease before, several years before. A former colleague had contracted shingles and had a rash in the belt area, as the name suggests. Prahl had not expected that even a small spot on the forehead could be a first warning signal.
Shingles is caused by herpes viruses and is therefore called herpes zoster by experts. A rash on one side of the body, often the trunk, is characteristic. The viruses can also affect the skin on the head, arms or legs. Certain symptoms can appear before redness or pustules appear:
It is important that those affected go to the doctor as quickly as possible if they suspect shingles. Because the disease can be treated better the earlier intervention takes place.
Prahl only went to the doctor five days after the small red spot appeared. Relatively late, he comments and prescribes his patient “thumb-sized” tablets and a cream. Prahl should take or apply both five times a day for a week.
“He said that I should be careful that the shingles doesn’t get into the eye because it could make you blind,” Prahl remembers in an interview with FOCUS online. “That was a blatant statement. The rash was as ugly as night, but since nothing else hurt me, I didn’t expect there to be anything serious behind it.”
Because he can work from home, Prahl does not take sick leave. In order to protect his wife and two children from a smear infection, he will now disinfect his hands more often, especially if he has previously touched his face. He takes no further precautions.
The next day his fever rose, his left eye swollen shut and was covered in pustules. Prahl tries to make an appointment with an ophthalmologist. It is now the beginning of December. Most people reject him on the phone, he says, because they no longer have any free appointments. He is finally examined in an eye clinic. The attending doctor can reassure him that his eye is not yet damaged. He is also prescribed eye drops.
When he’s out and about, Fabian Prahl now wears a hat pulled low over his face. “With the pustules, I felt like a leper, people were looking and taking a step to the side,” he remembers.
Luckily, the medication works quickly. Within a week, the pus pustules slowly turn into scabs and crusts. What remains are brown spots. Even in April 2024, the skin still doesn’t look like it used to. Outsiders would no longer see that Prahl had shingles. He himself can still see a few small areas where the skin is still darker.
According to studies by the Robert Koch Institute, more than 300,000 people in Germany develop shingles every year. It can affect anyone who has ever had chickenpox. Because shingles (herpes zoster) is a reactivation of chickenpox pathogens, the varicella-zoster viruses. After the chickenpox infection, they have retreated into nerve nodes in the spine and cranial nerves, so they remain latent in the spinal cord.
The disease is usually triggered by a weakened immune system that can no longer keep the viruses under control. The pathogens become active and migrate from the nerve node back to the skin surface. An immune deficiency can be caused by stress, a serious illness such as cancer or an HIV infection. But age also plays a role. The older we get, the weaker our immune system usually becomes.
In Fabian Prahl’s case, stress was probably the trigger, he suspects in retrospect. “My mother became more and more of a need for care,” he says. Prahl, who lives only 500 meters away from her, was called more and more often to quickly pick up packages at the post office or bring in the newspaper. Every call left him stressed and worried that something had happened to his mother. If she didn’t get in touch for a while, the worries were there too.
Prahl has now become aware of this stressful situation. He has handed over tasks to a nursing service. He also tries to live a healthier and more conscious life, for example by not drinking alcohol anymore. He wants to prevent it because studies have shown that an outbreak of the herpes zoster virus can increase the risk of a heart attack in the following six months.
Fabian Prahl is now due to be vaccinated against shingles. Because the disease can recur. The vaccination serum is an inactivated vaccine that contains a specific surface protein of the virus. It stimulates the immune system to develop and maintain special antibodies. According to statistics, 33 out of 100 adults will develop shingles in the course of their lives – with vaccination this figure is only three out of 100. In Germany, the vaccination is approved for people aged 50 and over, and the Standing Vaccination Commission recommends it from 60.