Shingles

What is shingles?

Shingles (herpes zoster) is a common infection of the nerves. It is caused by a virus. Shingles set off a painful rash or small blisters on an area of skin. It can appear anywhere on the body, but it typically appears on only one side of the face or body. Burning or shooting pain and tingling or itching are early signs of the infection. After the rash is gone, the pain usually resolves. But it can continue for months, even years. This is called postherpetic neuralgia.

What causes shingles?

Shingles is caused when the chickenpox virus is reactivated. After you have had chickenpox, the virus lies dormant in certain nerves for the rest of your life. Shingles is more common in people with a weak immune system and in people over age 50. The risk goes up with each decade of life after that.

What are the symptoms of shingles?

Symptoms may include:

• Skin sensitivity, tingling, itching, or pain in the area of the skin before the rash appears

• Rash. The rash usually shows up 1 to 5 days after symptoms start. At first, the rash looks like small, red spots that turn into blisters. The rash often occurs in a single stripe on either the left or right side of the body. In some cases, it occurs on one side of the face. In people with weaken immune systems, the rash may be more widespread on the body and look like chickenpox.

• Blisters typically scab over in 7 to 10 days and clear up within 2 to 4 weeks.

Other early symptoms of shingles may include:

• Stomach upset

• Feeling ill

• Fever or chills

• Headache

The symptoms of shingles may look like other health conditions. Always talk with your healthcare provider for a diagnosis.

How is shingles diagnosed?

Your healthcare provider will do a complete physical exam and ask about your health history. Specifically, they will ask about whether you have ever had chickenpox.

Your healthcare provider will likely know right away that it is shingles based on the unique rash. The rash usually appears as a single stripe in one area on one side of the body or face. It appears as red spots, small, fluid- or pus-filled vesicles, or scabs.

The healthcare provider may also take skin scrapings for testing.

How is shingles treated?

Antiviral medicines may help ease some of the symptoms of shingles, shorten the course, and lessen the chance of nerve damage and postherpetic neuralgia. Other treatments focus on pain relief and preventing infection. Painkillers may help ease some of the pain. Other treatments may include:

• Creams or lotions to help ease itching

• Cool compresses put on affected skin areas

• Antibiotics for the skin (topical) or taken by mouth (oral) or IV (intravenous) if there are signs of bacterial infection in the involved area

• Steroids

• Antidepressants for nerve pain

• Anticonvulsants for nerve pain

What are possible complications of shingles?

Symptoms of shingles usually don't last longer than 3 to 5 weeks. But complications can happen. The main complications that can result from shingles include:

• Postherpetic neuralgia (PHN). This is the most common complication of shingles. This continuous, chronic pain lasts even after the skin sores have healed. The pain may be severe in the area where the blisters were present. The affected skin may be very sensitive to heat and cold. If you had severe pain during the active rash or have impaired senses, you are at increased risk for PHN. Elderly adults are also at greater risk. Early treatment of shingles may prevent PHN. Pain relievers and steroid treatment may be used to treat the pain and inflammation. Other treatments include antiviral medicines, antidepressants, anticonvulsants, and medicines for the skin.

• Bacterial infection. A bacterial infection of the skin where the rash happens is another complication. Rarely, infections can lead to more problems, such as tissue death and scarring.

• Vision problems. When an infection happens near or on the eyes, a corneal infection can happen. This can lead to temporary or permanent blindness.

How can I help prevent shingles?

The recombinant zoster vaccine (RZV) vaccine is available to prevent shingles or make it less painful.

Experts recommend the vaccine for all adults 50 and older, even if you've had shingles before. Two doses of the RZV vaccine are recommended. You should get the second RZV dose 2 to 6 months after the first. The vaccine makes it less likely that you will develop shingles. If you do develop shingles, your symptoms will likely be milder than if you hadn’t been vaccinated. RZV is also advised even if you had the older shingles vaccine (zoster live vaccine, ZVL) in the past. That's because the RZV vaccine works better and protects you from shingles longer.

Talk with your healthcare provider about the best time for you to get vaccinated, along with the benefits and side effects. 

When should I call my healthcare provider?

To reduce the severity and shorten the length of the illness, treatment must be started as soon as possible. If you think you have shingles, call your healthcare provider as soon as possible.

Key points about shingles

• Shingles is a common viral infection of the nerves. It causes a painful rash or small blisters on an area of skin.

• Shingles is caused when the chickenpox virus is reactivated.

• It is more common in people with a weak immune system and in people over the age of 50.

• Shingles starts with skin sensitivity, tingling, itching, or pain, followed by a rash that looks like small, red spots that turn into blisters.

• The rash typically affects just one area on one side of the body or face.

• Starting treatment as soon as possible helps reduce the severity of the disease.

Next steps

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are and when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.