Shingles is a viral infection that results from the varicella-zoster virus (VZV), the same virus that causes chickenpox. It typically affects a single sensory nerve ganglion and the skin surface that the nerve supplies.
Both shingles and chickenpox are caused by the varicella-zoster virus. You can’t get shingles unless you’ve already had chickenpox. There’s no cure for shingles, but there are treatments to manage its symptoms. Vaccines are available to help prevent shingles and the long-lasting nerve pain that sometimes develops.
Shingles isn’t a life-threatening condition, but it can be very painful. Vaccines can help reduce the risk of shingles. Early treatment can help shorten a shingles infection and lessen the chance of complications. The most common complication is postherpetic neuralgia, which causes shingles pain for a long time after your blisters have cleared.
What Is Shingles?
Shingle is a disease characterized by a painful, blistering skin rash that affects one side of the body, typically the face or torso. This condition may also be referred to as herpes zoster, zoster, or zona. The word shingles come from the Latin word cingulum, which means belt. There are approximately 1 million estimated new cases per year in the U.S., with almost one out of every three people developing shingles at some point in their lifetime. Though most people who develop shingles will only have a single episode, there are some who develop recurrent cases of shingles. Shingles are more common in older individuals and in those with weakened immune systems.
The characteristic rash of shingles typically appears after an initial period of burning, tingling, itching, or stinging in the affected area. After a few days, the rash then appears in a stripe or band-like pattern along a nerve path (called a dermatome), affecting only one side of the body without crossing the midline. The rash erupts as clusters of small red patches that develop into blisters, which may appear similar to chickenpox. The blisters then break open and slowly begin to dry and eventually crust over.
Symptoms
Shingles usually affects one side of the body. This is most often the waist, chest, abdomen, or back. Symptoms can also appear on the face and in the eyes, mouth, ears. The virus can also affect some internal organs.
Shingles typically affects a single sensory nerve ganglion near the spinal cord, called a dorsal root ganglion. This is why the symptoms occur in specific areas of the body, rather than all over it. The pain results from nerve involvement, rather than the rash itself.
In fact, some people have pain but no rash. Others, meanwhile, may have a rash with pain that is accompanied by other symptoms, such as fever, chills, or headache.
Symptoms can vary in nature, depending on where on the body they appear.
Common Symptoms
Some of the most common symptoms of shingles include:Trusted Source
a constant dull, burning, or gnawing pain, or a sharp, stabbing pain that comes and goes
a skin rash that resembles a chickenpox rash but only affects certain areas
fluid-filled blisters that develop as part of the rash
Symptoms on The Body
A blistering skin rash may appear in one or more distinct bands with sensory nerves of the skin, called dermatomes.
Common locations for this include:
- the chest
- the abdomen
- the back
- around the waist
It usually occurs only on one side of the body.
The location of the symptoms will depend on which dermatome distribution the virus affects.
Facial Symptoms
If the rash affects the face, symptoms usually appear on one side only — usually around one eye and the forehead.
They can include:
- pain over the affected dermatome
- a rash
- muscle weakness
- headache
Eye Symptoms
If the virus affects an ophthalmic nerve, it means that a person has herpes zoster ophthalmicus.
This can cause pain, redness, and swelling in and around the eye, as well as temporary or permanent loss of vision
Ear Symptoms
Shingles can also occur in or around the ear, leading to problems with balance and hearing, as well as muscle weakness on the affected side of the face.
These changes can be long term or even permanent. A person who develops symptoms in or around the ears and eyes should seek immediate medical attention to reduce the risk of complications.
Mouth Symptoms
If shingles affects the mouth, a person may experience:
- facial tenderness
- pain in the mouth
- toothache
- lesions in hard and soft palate tissues
The pain and discomfort of these symptoms can make it difficult to eat or drink.
Internal Shingles
Shingles can also affect the internal organs. There will not be a rash, but other problems can arise.
For example, researchers have found evidence of shingles in the digestive system, which can lead to gastrointestinal dysfunction, and in the arteries in the brainTrusted Source, which may increase the risk of stroke and dementia.
Symptom Progression
Symptoms typically progress as follows:
- Pain, tingling, numbness, and itching start to affect a specific part of the skin.
- After up to 2 weeks, a rash appears.
- Red blotches and itchy, fluid-filled blisters develop and continue to do so for 3-5 daysTrusted Source.
- The blisters may merge, forming a solid red band that looks similar to a severe burn. The gentlest touch may be painful.
- Inflammation may affect the soft tissue under and around the rash.
- After 7–10 days, the blisters gradually dry up and form scabs or crusts. As the blisters disappear, they may leave minor scarring.
Shingles usually lasts around 2–4 weeks. It is contagious until the blisters dry up and crust over.
Most people will only have an episode of shingles once, but it can recur in some people.
Causes
After you get chickenpox, your body does not get rid of the virus. Instead, the virus remains in the body but is inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes active again in these nerves after many years. Many people had such a mild case of chickenpox that they do not realize they have had the infection.
The reason the virus suddenly becomes active again is not clear. Often only one attack occurs.
Shingles can develop in any age group. You are more likely to develop the condition if:
You are older than age 60
You had chickenpox before age 1
Your immune system is weakened by medicines or disease
If an adult or child has direct contact with the shingles rash and did not have chickenpox as a child or get the chickenpox vaccine, they can develop chickenpox, not shingles.
The same virus that made you itch and scratch from chickenpox when you were a child can come back to haunt you when you get older. You’ll know it’s come back by the painful, blistery rash it leaves on your skin. Shingles is caused by the varicella-zoster virus, the same virus that’s responsible for chickenpox. Before there was a vaccine to prevent chickenpox, it was a very common childhood illness. After you have chickenpox, the virus can lie hidden in your body for years. Then when you get older, it can become active again.
This time it’s called shingles, not chickenpox. Doctors don’t really know why the shingles virus reappears in some people but not others. If you’re over age 60 or you have a weak immune system, your risk of getting the disease is higher. You can tell that it’s shingles by the red, blistery patches on your skin, especially if you had chickenpox when you were young. Usually the rash is focused on your trunk area around your back, belly, and chest. You may also have blisters on your face. It will probably hurt, tingle, or burn, sometimes even before there is a rash. When the blisters break open, they’ll dry out and form crusts.
If you do have shingles, your doctor may prescribe an antiviral drug like acyclovir, famciclovir, or valacyclovir. These drugs fight the virus that causes shingles, but you need to start taking them within 24 hours after you start feeling the pain and burning of the rash for them to be effective. You may also get medicines to reduce swelling and relieve itching and pain. To ease really bothersome itching at home, soak in a soothing bath or gently rub calamine lotion on your skin.
Most cases of shingles clear up within a couple of weeks. Sometimes, though, shingles can leave behind permanent nerve damage, called postherpetic neuralgia. The good news about shingles is that once it clears up, it’s usually gone for good. But the pain, and nerve damage it causes, can sometimes linger. If you’ve had shingles and your pain isn’t subsiding or your rash isn’t clearing up, call your doctor. To avoid getting shingles, stay away from anyone who has either shingles or chickenpox, especially if you’ve never had chickenpox before. And get vaccinated against the varicella-zoster virus if you’re over age 60.
Diagnosis
Shingles can often be diagnosed by your doctor based upon the distinctive appearance and distribution of the characteristic shingles rash. A painful, blistering rash that is localized to defined dermatomes is a sign highly suggestive of shingles. Blood work or other testing is usually not necessary. Diagnosing shingles before the appearance of the rash or in cases of zoster sine herpete (zoster without rash) can be challenging. In cases where the diagnosis is unclear, laboratory tests are available to help confirm the diagnosis. Depending on the clinical situation, testing can be done using either blood work (to detect antibodies to the varicella-zoster virus) or by specialized testing of skin lesion samples.
Treatment
There is no cure for shingles, but antiviral medicine may relieve the symptoms and help prevent complications. See your doctor for a prescription of antiviral medicines as soon as possible after symptoms develop. Treatment should be started within 3 days of the shingles rash appearing.
If you are pregnant, talk to your doctor about whether antivirals are right for you.
Over-the counter medicines, such as paracetamol and non-steroidal anti-inflammatories, can be used for pain relief. If over-the-counter medicines are not controlling your pain, your doctor may prescribe other medicines.
There are several things you can do to help manage the condition. They include the following.
- Try to keep the rash dry and clean.
- Cover the rash if possible to avoid spreading the virus to others. Use a non-stick dressing. Do not use antibiotic creams or sticking plasters on the blisters since they may slow down the healing process.
- Try not to scratch the rash. Scratching may cause infection and scarring of the blisters.
- After a bath or shower, gently pat yourself dry with a clean towel. Do not rub or use the towel to scratch yourself and do not share towels.
- Wear loose cotton clothes around the parts of the body that are affected.
- Cool compresses, baths or ice packs may help with the discomfort. Do not apply ice packs directly to the skin. Wrap the ice pack in a light towel and place it gently over the dressing. Wash the towel in hot water after use.
- If the blisters are open, applying creams or gels is not recommended because they might increase the risk of a secondary bacterial infection.
- Avoid contact with people who may be more at risk, such as pregnant women who are not immune to chickenpox, people who have a weak immune system and babies less than one month old.
- Do not share towels, play contact sports, or go swimming. Wash your hands often.
Prevention
Two vaccines are available in the United States to reduce your chance of developing shingles and postherpetic neuralgia. One vaccine, Zostavax®, has been available since 2006. The second vaccine, Shingrix®, has been available since 2017. Shingrix is recommended as the preferred vaccine by the Advisory Committee on Immunization Practices, a group of medical and public health experts.
Shingrix® (recombinant zoster vaccine) is given as a two-dose shot in the upper arm. You should receive the second dose (shot) two to six months after receiving the first. Shingrix has been shown to be more than 90% effective in preventing shingles and postherpetic neuralgia. Its effectiveness remains above 85% for at least four years after receiving the vaccine.
Due to high levels of demand for the Shingrix vaccine and a supply shortage, the vaccine manufacturer is managing the timing and distribution of the vaccine throughout the United States. It plans to continue to manage the availability of the vaccine and hopes to make available the same or increased number of doses and to shorten the wait time for delivery this year (2020).
