Shingles (Herpes Zoster)
Shingles is an infection caused by the varicella-zoster virus, which is the same virus that causes chickenpox. Even after the chickenpox infection is over, the virus may live in your nervous system for years before reactivating as shingles. Shingles may also be referred to as herpes zoster.
This type of viral infection is characterized by a red skin rash that can cause pain and burning. Shingles usually appears as a stripe of blisters on one side of the body, typically on the torso, neck, or face.
Most cases of shingles clear up within two to three weeks. Shingles rarely occurs more than once in the same person, but approximately 1 in 3 people in the United States will have shingles at some point in their life, according to the Centers for Disease Control and Prevention.
The first symptoms of shingles are usually pain and burning. The pain is usually on one side of the body and occurs in small patches. A red rash typically follows.
Rash characteristics include:
- red patches
- fluid-filled blisters that break easily
- a rash that wraps around from the spine to the torso
- a rash on the face and ears
Some people experience symptoms beyond pain and rash with shingles. These symptoms may include:
Rare and serious complications of shingles include:
- pain or rash that involves the eye, which should be treated in order to avoid permanent eye damage
- loss of hearing or intense pain in one ear, dizziness, or loss of taste on your tongue, which can be symptoms of Ramsay Hunt syndrome
- bacterial infections, which you may have if your skin becomes red, swollen, and warm to the touch
Shingles can occur in anyone who has had chickenpox. However, certain factors put people at risk for developing shingles.
Risk factors include:
Shingles is particularly prevalent in older adults and is most common in those who are between 60 and 80 years old, according to NIH Senior Health. Of the 1 in 3 people who will get shingles in their lifetime, about half of those will be in people 60 or older. Seniors are most likely to get shingles, as their immune systems are more likely to be compromised.
Senior citizens with shingles are more likely to experience complications than the general population, including more extensive rashes and bacterial infections from open blisters. They are also more susceptible to both pneumonia and brain inflammation, so being seen by a doctor early on for anti-viral treatment is important.
To prevent shingles, adults who are 60 years old and older should receive the shingles vaccine. To relieve pain, you can apply a cool washcloth to the blisters. Keep the rash covered as much as possible to avoiding spreading the varicella virus to others. Ask your doctor if you’re a candidate for anti-viral medications, which can reduce the length and intensity of the virus. You doctor can also prescribe pain medications if necessary.
While getting shingles during pregnancy is unusual, it is possible. If you come into contact with someone who has the chickenpox or an active shingles infection, you can develop chickenpox if have not been vaccinated or if you have never had it before.
Depending on what trimester you’re in, having chickenpox during pregnancy can result in birth defects. Getting a chickenpox vaccine before pregnancy can be an important step in protecting your child. Shingles is less likely to cause complications, but it can still be unpleasant. See your doctor right away if you develop any rash during pregnancy.
Most cases of shingles can be diagnosed with a physical examination of rashes and blisters. Your doctor will also ask questions about your medical history.
In rare instances, your doctor may need to test a sample of your skin or the fluid from your blisters. This involves using a sterile swab to collect a sample of tissue or fluid. Samples are then sent to a medical laboratory to confirm the presence of the virus.
There’s no cure for shingles, but medication may be prescribed to ease symptoms and shorten the length of the infection.
Medications prescribed are varied:
|anti-viral medications, including acyclovir, valacyclovir, and famciclovir||to reduce pain and speed recovery||2 to 5 times daily, as prescribed by your doctor||oral|
|anti-inflammation drugs, including ibuprofen||to ease pain and swelling||every 6 to 8 hours||oral|
|narcotic medications or analgesics||to reduce pain||likely to be prescribed once or twice daily||oral|
|anticonvulsants or tricyclic antidepressants||to treat prolonged pain||once or twice daily||oral|
|antihistamines, such as diphenhydramine (Benadryl)||to treat itching||every 8 hours||oral|
|numbing creams, gels, or patches, such as lidocaine||to reduce pain||can be applied as needed||topical|
|capsacin (Zostrix)||to help reduce the risk of a nerve pain called post-herpetic neuralgia, which occurs after recovery from shingles||can be applied as needed||topical|
Home treatment can also help ease your symptoms. Home treatments may include:
- applying cold, wet compresses to the rash to reduce pain and itching
- applying calamine lotion to reduce itching
- taking colloidal oatmeal baths to ease pain and itching
Shingles typically clears up within a few weeks and rarely recurs. If your symptoms haven’t lessened within 10 days, you should call your doctor for follow-up and re-evaluation.
While shingles can be painful and bothersome on its own, it’s important to monitor symptoms for potential complications. These complications include:
- eye damage, which can occur if you have a rash or blister too close to your eye (the cornea is particularly susceptible)
- bacterial skin infections, which can easily occur from open blisters and can be severe
- Ramsay Hunt syndrome, which can occur if shingles affects the nerves in your head and can result in partial facial paralysis or hearing loss if left untreated (if treated early, most patients make a full recovery)
- brain or spinal cord inflammation, such as encephalitis or meningitis, which is serious and life-threatening
Vaccines can help keep you from developing severe shingles symptoms or complications from shingles. All children should receive two doses of the chickenpox vaccine, also known as a varicella immunization. Adults who’ve never had chickenpox should also get this vaccine. The immunization doesn’t necessarily mean that you won’t get chickenpox, but it does prevent it in 9 out of 10 people who get the vaccine.
Adults who are 60 years old or older should get a shingles vaccine, also known as the varicella-zoster immunization. This vaccine helps to prevent severe symptoms and complications associated with shingles.
Shingles is contagious. If you become infected, certain steps must be taken to prevent the spread of the infection, including:
- keeping your rash covered
- avoiding contact with people who haven’t had chickenpox or who have weakened immune systems
- frequent handwashing
Written by: Janelle Martel and Ana Gotter
Medically reviewed on Aug 31, 2016 by Judith Marcin, MD