What is shingles?
Shingles, also known as herpes zoster, is an infection of a nerve and the skin around it. It's caused by the varicella-zoster virus, which also causes chickenpox.
It's estimated around one in every four people will have at least one episode of shingles during their life.
Symptoms of shingles
New blisters may appear for up to a week, but a few days after appearing they become yellowish in colour, flatten and dry out.
Scabs then form where the blisters were, which may leave some slight scarring and loss of skin pigment.
The pain may be a constant, dull or burning sensation, and its intensity can vary from mild to severe.
You may have sharp stabbing pains from time to time, and the affected area of skin will usually be tender.
In some cases, shingles may cause some early symptoms that develop a few days before the painful rash first appears.
These early symptoms can include:
- a headache
- burning, tingling, numbness or itchiness of the skin in the affected area
- a feeling of being generally unwell
- a high temperature (fever)
An episode of shingles typically lasts around 2 to 4 weeks. It usually affects a specific area on just one side of the body.
It doesn't cross over the midline of the body, an imaginary line running from between your eyes down past the belly button.
Any part of your body can be affected, including your face and eyes, but the chest and tummy (abdomen) are the most common areas.
When to get medical advice
Shingles isn't usually serious but see your doctor as soon as possible if you recognise the symptoms. They'll usually be able to diagnose shingles based on your symptoms and the appearance of the rash.
Early treatment may help reduce the severity of your symptoms and the risk of developing complications.
Referral to hospital
It's uncommon for someone with shingles to be referred to hospital, but your doctor may consider seeking specialist advice if:
- they suspect a complication of shingles, such as meningitis or encephalitis
- shingles is affecting one of your eyes – there's a risk you could develop permanent vision problems if the condition isn't treated quickly
- a diagnosis isn't certain
- you've an unusually persistent case of shingles that's not responding to treatment
- you've been diagnosed with the condition twice
- you're pregnant
- you have a weakened immune system – particularly in severe cases or cases affecting children
Causes of shingles
Most people have chickenpox in childhood, but after the illness has gone the varicella-zoster virus remains inactive (dormant) in the nervous system.
The immune system keeps the virus in check, but it can be reactivated later in life and cause shingles.
It's possible to have shingles more than once, but it's very rare to get it more than twice.
It's not known exactly why the shingles virus is reactivated at a later stage in life, but most cases are thought to be caused by having lowered protection against infections and diseases (immunity).
This may be the result of:
- old age – as you age, your immunity may decrease; shingles most commonly occurs in people over the age of 70
- physical and emotional stress – the chemicals released by your body when you're stressed can prevent your immune system from working properly
- HIV and AIDS – people with HIV are much more likely to get shingles than the rest of the population because their immune system is weak
- having recently had a bone marrow transplant – the conditioning you require before the transplant weakens your immune system
- having recently had an organ transplant – you may need to take medication to suppress your immune system so your body accepts the donated organ
- chemotherapy – chemotherapy medication, often used to treat cancer, can temporarily weaken your immune system
However, young people who are otherwise healthy can also sometimes develop shingles.
Is shingles contagious?
It's not possible to catch shingles from someone with the condition or from someone with chickenpox.
However, you can catch chickenpox from someone with shingles if you haven't had chickenpox before, but this is uncommon.
The blisters of shingles contain a live virus. If a person who has never had chickenpox makes direct contact with an open blister or something with the fluid on it, they can contract the virus and develop chickenpox.
Preventing the spread of the virus
If you have shingles, you're contagious until the last blister has dried and scabbed over.
To help prevent the virus being passed on, avoid sharing towels or flannels, swimming or playing contact sports. You should also avoid work or school if your rash is oozing fluid (weeping) and can't be covered.
Chickenpox can be particularly dangerous for certain groups of people. If you have shingles, avoid:
- women who are pregnant and haven't had chickenpox before as they could catch it from you – this may harm their unborn baby
- people who have a weak immune system – such as someone with HIV or AIDS
- babies less than 1-month-old – unless it's your own baby, in which case your baby should have proteins that fight infection (antibodies) to protect them from the virus
Although there's no cure for shingles, treatment is available to relieve the symptoms until the condition resolves. Most cases of shingles last around 2 to 4 weeks.
Treatment for shingles can include:
- covering the rash with clothing or a non-stick (non-adherent) dressing to reduce the risk of other people becoming infected with chickenpox – it's very difficult to pass the virus on to someone else if the rash is covered
- painkilling medication – such as paracetamol, ibuprofen or codeine
- antiviral medication to stop the virus from multiplying – although not everyone will need this
Read more about treating shingles.
Complications of shingles
Shingles can sometimes lead to complications, such as postherpetic neuralgia. This is where severe nerve pain lasts for several months or more after the rash has gone.
Complications like this are usually in elderly people who have had the condition and those with a weakened immune system.
Read more about the complications of shingles.
The shingles vaccine
It's not always possible to prevent shingles, but a vaccine called Zostavax can reduce your chances of developing the condition.
If you still develop shingles after having this vaccine, it may be milder and last for a shorter time than usual.
Some cases of shingles can affect one of the eyes and are known as ophthalmic shingles.
This occurs when the virus is reactivated in part of the trigeminal nerve, a nerve that controls sensation and movement in your face.
Symptoms can include:
- a rash over your forehead, nose and around your eye
- conjunctivitis – inflammation of your eye that causes it to become red and watery, with a sticky coating on your eyelashes
- a red eye
- problems with your vision
Treatment for shingles
Treatment for shingles can help ease your symptoms until the condition improves. In many cases, shingles gets better within around 2 to 4 weeks.
However, it's still important to see your doctor as soon as possible if you recognise the symptoms of shingles.
Early treatment may help reduce the severity of the condition and the risk of potential complications.
Self-care for shingles
If you develop the shingles rash, there are a number of things you can do to help relieve your symptoms, such as:
- keeping the rash as clean and dry as possible – this reduces the risk of the rash becoming infected with bacteria
- wearing loose-fitting clothing – this may help you feel more comfortable
- not using rub-on (topical) antibiotics or adhesive dressings such as plasters – this can slow down the healing process
- using a dressing that won't stick to the rash (non-adherent) if you need to cover the blisters – this avoids passing the virus to anyone else
Calamine lotion has a soothing, cooling effect on the skin and can be used to relieve the itching.
If you have any weeping blisters, you can use a cool compress – a cloth or flannel cooled with tap water – several times a day to help soothe the skin and keep blisters clean.
It's important to only use the compress for around 20 minutes at a time and stop using them once the blisters stop oozing.
Don't share any clothes, towels or flannels if you have shingles.
Staying off work or school
You only need to stay away from work or keep your child off school while:
- the rash is oozing fluid (weeping) and can't be covered
- you or your child are feeling unwell
If the rash is only on your body and can be covered by clothing, there's little risk of passing the infection on to others.
As well as painkilling medication, some people with shingles may also be prescribed a course of antiviral tablets lasting 7 days.
Commonly prescribed antiviral medicines include aciclovir, valaciclovir and famciclovir.
These medications can't kill the shingles virus, but can help stop it multiplying. This may:
- reduce the severity of your shingles
- reduce how long your shingles lasts
- prevent complications of shingles, such as postherpetic neuralgia (although the evidence for this is uncertain)
Antiviral medicines are most effective when taken within 72 hours of your rash appearing, although they may be started up to a week after your rash appears if you're at risk of severe shingles or complications.
Side effects of antiviral medication are very uncommon, but can include:
- feeling sick
- tummy (abdominal) pain
Who may be prescribed antiviral medication?
If you're over 50 years of age and have symptoms of shingles , you'll usually be prescribed an antiviral medication.
You may also be prescribed antiviral medication if you have:
- shingles that affects one of your eyes
- a weakened immune system
- moderate to severe pain
- a moderate to severe rash
Pregnancy and antiviral medication
If you're pregnant and have shingles, it's likely your doctor will discuss your case with a specialist to decide whether the benefits of antiviral medication significantly outweigh any possible risks. Shingles won't harm your unborn baby.
If you're under 50 years of age, you're at less risk of developing complications from shingles.
You may not need antiviral medication, unless the pain can't be controlled by over-the-counter painkillers.
Antiviral medication is good at controlling pain in the first week or 2 of the rash.
Children and antiviral medication
Antiviral medication isn't usually necessary for otherwise healthy children because they tend to only experience mild symptoms of shingles and have a small risk of developing complications.
However, if your child has a weakened immune system, they may need to be admitted to hospital to receive antiviral medication directly into a vein (intravenously).
To ease the pain caused by shingles, your doctor may recommend painkilling medication.
Some of the main medications used to relieve pain associated with shingles are described below.
The most commonly used painkiller is paracetamol, which is available without a prescription.
Always read the manufacturer's instructions to make sure the medicine is suitable and you're taking the correct dose.
Non-steroidal anti-inflammatory drugs (NSAIDs)
However, NSAIDs may not be suitable if you:
- have stomach, liver or kidney problems, such as a stomach ulcer, or had them in the past
- have asthma
- are pregnant or breastfeeding
Ask your doctor or pharmacist if you're unsure about whether you should take NSAIDs.
For more severe pain, your doctor may prescribe an opioid, such as codeine. This is a stronger type of painkiller sometimes prescribed alongside paracetamol.
Occasionally, your doctor may consider seeking specialist advice before prescribing an even stronger opioid, such as morphine.
If you have severe pain as a result of shingles, you may be prescribed an antidepressant medicine.
These medications are commonly used to treat depression, but are also proven to be useful in relieving nerve pain.
The antidepressants most often used to treat shingles pain are known as tricyclic antidepressants (TCAs).
Examples of TCAs most commonly prescribed for people with shingles are amitriptyline, imipramine and nortriptyline.
Side effects of TCAs can include:
If you have shingles, you'll usually be prescribed a much lower dose of TCAs than if you were being treated for depression.
This will usually be a tablet to take at night. Your dose may be increased until your pain settles down.
It may take several weeks before you start to feel the antidepressants working, although this is not always the case.
Anticonvulsants are most commonly used to control fits (seizures) caused by epilepsy, but they're also useful in relieving nerve pain.
Gabapentin and pregabalin are the most commonly prescribed anticonvulsants for shingles pain.
Side effects of these medications can include:
- increased appetite
- weight gain
- feeling sick
As with antidepressants, you may need to take anticonvulsants for several weeks before you notice it working.
If your pain doesn't improve, your dose may be gradually increased until your symptoms are effectively managed.
Complications of shingles
Complications of shingles are more likely if you have a weakened immune system (the body's natural defence system) or are elderly.
Some of the main complications associated with shingles are described below.
Postherpetic neuralgia is the most common complication of shingles. It's not clear exactly how many people are affected, but some estimates suggest as many as 1 in 5 people over 50 could develop postherpetic neuralgia as the result of shingles.
Postherpetic neuralgia can cause severe nerve pain (neuralgia) and intense itching that persists after the rash and any other symptoms of shingles have gone.
Types of pain experienced by people with postherpetic neuralgia include:
- constant or intermittent burning, aching, throbbing, stabbing, or shooting pain
- allodynia – where you feel pain from something that should not be painful, such as changes in temperature or the wind
- hyperalgesia – where you are very sensitive to pain
Postherpetic neuralgia sometimes resolves after around 3 to 6 months, although it can last for years and some cases can be permanent. It can be treated with a number of different painkilling medicines.
Read about treating postherpetic neuralgia.
If one of your eyes is affected by shingles (ophthalmic shingles), there's a risk you could develop further problems in the affected eye, such as:
- sores (ulceration) and permanent scarring of the surface of your eye (cornea)
- inflammation of the eye and optic nerve, the nerve that transmits signals from the eye to the brain
- glaucoma – where pressure builds up inside the eye
If not treated promptly, there's a risk that ophthalmic shingles could cause a degree of permanent vision loss.
Ramsay Hunt syndrome
Ramsay Hunt syndrome is a complication that can occur if shingles affects certain nerves in your head.
In the US Ramsay Hunt syndrome is estimated to affect 5 in 100,000 people every year and may affect a similar number of people in the UK.
Ramsay Hunt syndrome can cause:
- hearing loss
- the sensation that you or the environment around you is moving or spinning (vertigo)
- hearing sounds coming from inside your body, rather than an outside source (tinnitus)
- a rash around the ear
- loss of taste
- weakness (paralysis) of your face
Ramsay Hunt syndrome is usually treated with antiviral medication and corticosteroids.
The earlier treatment is started, the better the outcome. Around three-quarters of people given antiviral medication within 72 hours of the start of their symptoms usually make a complete recovery.
If treatment is delayed, only about half of those treated will recover completely.
Those who don't make a full recovery may be left with permanent problems, such as a degree of permanent facial paralysis or hearing loss.
A number of other possible problems can also sometimes develop as a result of shingles, including:
- the rash becoming infected with bacteria – see your doctor if you develop a high temperature, as this could be a sign of a bacterial infection
- white patches (a loss of pigment) or scarring in the area of the rash
- inflammation of the lungs (pneumonia), liver (hepatitis), brain (encephalitis), spinal cord (transverse myelitis), or protective membranes that surround the brain and spinal cord (meningitis) – these complications are rare, however
Shingles is rarely life-threatening, but complications like those mentioned above mean around 1 in every 1,000 cases in adults over the age of 70 is fatal.