What is shingles?
Shingles is a painful disease caused by reactivation of the same virus that causes chickenpox, the varicella zoster virus. Shingles, also called herpes zoster, attacks nerve cells and causes severe nerve pain and a skin rash that appears over the affected nerve.
Shingles develops in people who have had chickenpox in the past. The chickenpox virus (varicella zoster virus) can remain in the body in an inactive form for years. In some people, the dormant virus is reactivated later in life by something that stresses the immune system, such as an illness.
Shingles is not spread through contact with a person who has shingles. However, a person who has never had chickenpox can contract chickenpox from a person with shingles through direct contact with the shingles rash.
Shingles is most common in older adults and the elderly who have had chickenpox at some point during their lives. Shingles is preventable 50% of the time through a shingles vaccination, and it has become less common since the introduction of the shingles vaccine. The pain of shingles generally resolves within three to five weeks. Most people who develop shingles will have only one episode, but in rare cases a person will have a second or third episode.
Complications of untreated shingles can be serious and include vision damage, meningitis, and postherpetic neuralgia (ongoing pain at the site). Seek prompt medical care if you, or someone you are with, have symptoms of shingles, including itching, tingling, or severe burning pain that precedes the appearance of a rash in the affected area. Prompt diagnosis and treatment of shingles reduces the risk of serious complications.
What are the symptoms of shingles?
Symptoms of shingles affect the nerves and the skin. Shingles can occur in almost any part of the body, but most often affects one side of the torso.
Common symptoms of shingles
The most common symptoms of shingles are:
- Itching, tingling, or severe burning or shooting pain that precedes a rash, often on one side of the torso
- Painful rash in a band or patch-like shape over the affected area that develops into fluid-filled blisters that eventually dry out, crust over, and heal
Stages of shingles symptoms
There are no formal, clinical stages of shingles, but signs and symptoms generally fall into three stages. The first stage of shingles is marked by a burning sensation, numbness, or itchiness in the area where the shingles rash appears. A common site of the rash is around the waistline, chest or back, usually on one side of the body. The rash appears as a band, or strap. Other sites include one side of the face or neck, or in one arm or leg. This stage of shingles can be very painful; you may also begin to experience flu-like symptoms at this stage.
The second stage of shingles is an eruption of the rash itself, typically 3 to 4 days after you first experience the tingling and burning sensation. The rash lasts 7 to 10 days. Some people experience a minor rash or skin irritation; for other people, the rash can cover a larger area.
In the third stage, shingles blisters dry out and scab over before disappearing. Beginning to end, shingles lasts 2 to 5 weeks.
See your healthcare provider right away if you have signs and symptoms of shingles. Early treatment with an antiviral medication may help you recover more quickly and lessen the chance of complications.
Serious symptoms that might indicate complications of shingles
In some cases, shingles can affect the nerves of the face, eyes or ears and cause serious symptoms and complications, such as facial paralysis or impaired vision and hearing. Seek prompt medical care if you, or someone you are with, have symptoms of shingles, particularly the following symptoms or conditions:
- Decreased or double vision
- Painful, widespread rash, a sign of disseminated shingles
- Poor immune system caused by a chronic disease or immune-suppressing medications
- Rash near your eyes or involving the tip of the nose
What does shingles look like?
Shingles produces a red, blistering rash. The rash occurs in a band or strip, and may develop along one side of the chest, abdomen or back, one side of the face or neck, or along either arm or leg.
|Shingles across the upper back|
|Shingles rash with blisters on the arm|
|Shingles rash on the hand|
||Shingles across the abdomen (torso)|
What causes shingles?
Shingles is a disease caused by the same virus that causes chickenpox, the varicella zoster virus (VZV). When a person has chickenpox, the immune system eventually clears the infection, but some virus particles stay behind in specialized nerve cells. The virus remains there in an inactive (dormant) form for years until it reactivates later in life and causes shingles. When the virus “wakes up,” it travels along sensory nerve fibers from the central nervous system down to the nerve endings in the skin. The virus quickly multiplies causing the characteristic blistering rash.
The risk of shingles increases with age. This is likely due to age-related general weakening of the immune system and loss of VZV-specific immunity. Besides naturally waning immunity, anything that taxes the immune system, such as illness or stress, can trigger VZV reactivation.
What are the risk factors for shingles?
In the United States, 1 in 3 people will develop shingles in their lifetime. There are about 1 million cases a year. A number of factors increase your risk of reactivating the dormant varicella zoster virus and developing shingles including:
- Being an older adult with a history of having had chickenpox who has not had the shingles vaccination. Half of people ages 85 or older will have developed shingles.
- Having a condition that weakens the immune system, such as HIV/AIDS, cancer, chemotherapy, or an organ transplant
- Having a weakened or impaired immune system, which also increases the risk for having recurring episodes of shingles
- Recent illness
Reducing your risk of shingles
You can lower your risk of shingles and its complications by getting vaccinated for shingles. The shingles vaccine, Shingrix, is approved for people ages 50 and older. The risk of shingles is 10 times greater in people ages 80 and older than people ages 10 and younger. Much of the increase in shingles risk occurs around age 50, which is why the vaccine was tested in and approved for people ages 50 and older.
Shingrix is 97% effective in preventing shingles in people ages 50 to 69 years and 91% effective in the 70 and older age group. The vaccine also reduces the risk of severe shingles and complications of shingles.
You can reduce your risk of chickenpox and subsequent development of shingles by avoiding exposure to a person with chickenpox and by getting vaccinated for these diseases as recommended by your healthcare provider.
Is shingles contagious?
A person with shingles cannot give someone else shingles, but they can spread the varicella zoster virus (VZV) and cause chickenpox in a susceptible individual. Shingles only occurs in someone who’s had chickenpox. A person with shingles can give chickenpox to someone who is not immune to VZV, either naturally (by having had chickenpox) or by vaccination (by the chickenpox vaccine).
With shingles, reactivated VZV is spread by skin-to-skin contact, such as touching a shingles blister and then touching a susceptible individual. If you have shingles, do not spend time with someone who has not had chickenpox or the chickenpox vaccine, such as an infant.
Shingles in a pregnant woman does not seem to cause birth defects or problems for the baby. However, if a pregnant woman develops chickenpox 21 to 5 days before birth, her newborn may have chickenpox at birth or days after. There is a low risk the baby will develop shingles in the first five years of life because the baby’s immune system may fail to keep VZV latent after the initial (chickenpox) infection.
How do doctors diagnose shingles?
A healthcare professional may diagnose shingles based on the distinct rash, type of pain, and other symptoms. Even if a rash is not present, the distribution of pain and other skin sensations may be enough to make a diagnosis. In some cases, a provider may scrape some skin or sample the fluid from the blister for laboratory testing. Varicella zoster virus will be present if it is shingles.
If you experience signs and symptoms of shingles, don’t wait for a rash to appear to call your healthcare provider, because not everyone develops a rash. The sooner you begin shingles treatment, the less likely you are to experience more severe disease or complications.
How is shingles treated?
There is no cure for shingles, but antiviral medications can reduce the severity and duration of the disease. Antiviral medications can also reduce the risk of developing postherpetic neuralgia, which is a serious complication of shingles.
Antivirals are most effective within 72 hours of the first sign of shingles.
Antiviral medications include:
Other medications that may be used to treat shingles include:
- Antidepressant medications, which may help reduce pain
- Corticosteroids, which may reduce the risk of developing postherpetic neuralgia, although this treatment is controversial
- Pain medications, which may include over-the-counter general pain relievers and prescription gabapentin for nerve-related pain. Your doctor can prescribe more powerful painkillers if necessary.
In some cases of shingles, including disseminated shingles or shingles complications, hospitalization is necessary to provide comprehensive medical care.
Home remedies for shingles
Self-care for shingles at home includes:
- Calamine lotion or other creams to soothe the skin and relieve pain
- Cleaning the rash area gently to prevent bacterial infection
- Cool compresses on blisters to lessen pain and help the blisters heal
- Drinking water and other healthy liquids
- Reducing stress as much as possible, such as walking every day and eating nutritious food
- Resting (If you can’t sleep due to pain, ask your doctor for prescription pain medicine.)
What are the potential complications of shingles?
Untreated shingles can lead to serious complications. People with compromised immune systems are at a higher risk for developing serious complications of shingles including:
- Bacterial skin infections such as impetigo
- Ear pain
- Facial paralysis
- Meningitis or encephalitis
- Permanent eye damage and impaired vision
- Postherpetic neuralgia, which is shingles pain that lingers for months or even years (10 to 18% of people with shingles develop PHN; the risk of PHN is greater in older adults and people who have severe pain with shingles)
- Scarring and loss of hair over the affected area