What to Know About Shingles

Shingles (herpes zoster) is a painful rash that usually appears on one side of the body or face. It is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox. The shingles rash burns, itches and looks like a strip of blisters. Vaccines can prevent shingles, and medications can help treat the condition.

According to the CDC, about one in three people in the United States will get shingles in their lifetime. Roughly one million people get it each year.

“There is no known cure for shingles,” said Rahul Parikh, DO, Catholic Health Family Medicine Physician. “Knowing the symptoms of shingles is helpful, so call your doctor immediately to seek treatment.”

What are the symptoms of shingles?

Pain is typically the first symptom of shingles. A red rash may appear several days after the pain begins, but not everyone will experience a rash. Without the rash, some people may mistake the pain for heart, lung or kidney problems.

Shingles symptoms usually affect a small area on a single side of the face or body and last two to six weeks. Common symptoms include:

Fluid-filled blisters that break open and crust over
Intense pain, itching and burning
Sensitivity to touch

You may also experience:

Fatigue
Fever and chills
Headache
Sensitivity to light
Upset stomach

What is the treatment for shingles?

“Medication can help reduce the length and severity of shingles if started early,” said Dr. Parikh. “Talk to your primary care physician as soon as you notice symptoms.”

Antivirals that treat shingles include:

Acyclovir (Zovirax)
Famciclovir (Famvir)
Valacyclovir (Valtrex)

Calamine lotion or an oatmeal bath can soothe itchiness from the shingles rash. Over-the-counter medication such as acetaminophen or ibuprofen can help relieve pain. If you have severe pain, your physician may prescribe medication that reduces inflammation, such as a corticosteroid.

For most people, the rash will start to scab within 7 to 10 days. It usually takes two to four weeks for the rash to go away completely.

Until the rash clears, you should do the following daily:

Wash the rash with a fragrance-free cleanser and make sure it is completely dry
Apply a thin layer of petroleum jelly to the rash
Cover the rash with a nonstick dressing to protect it from bacteria and prevent others from coming in contact with it
Wash your hands after touching the rash

Avoid scratching the rash to prevent infection or scarring. If the rash causes discomfort, you can apply a cool towel to the area to soothe the itch. Wear loose-fitting clothing to avoid irritation.

What causes shingles?

Dr. Parikh explained that after chickenpox, the varicella-zoster virus remains inactive in the body. Sometimes, the virus reactivates, and you develop shingles.

The virus does not reactivate in everyone who had chickenpox. Physicians do not fully understand why some people develop shingles while others do not.

Who is at high risk for shingles?

Anyone who has had chickenpox is at risk of developing shingles. However, your risk increases as you age and your immune system becomes less effective. It is rare to get shingles before age 40. Shingles typically occurs in adults 50 and older. Children can have shingles, but it is uncommon.

You also have a high risk of developing shingles if you:

Are undergoing chemotherapy or radiation for cancer treatment
Have medical conditions that keep your immune system from working correctly, such as certain cancers or HIV
Take drugs or medication that keep your immune system working, such as steroids or drugs to prevent rejection of transplanted organs

Is shingles contagious?

“You cannot get shingles from someone who has shingles,” said Dr. Parikh. “You can get chickenpox from someone who has shingles if you have never had chickenpox or gotten the chickenpox vaccine.”

He noted that people who have chickenpox are more likely to spread the VZV than those with shingles.

If you have shingles, you can pass the virus to others until your rash scabs over. Avoid physical contact with others and keep the rash covered.

Exposure to shingles is especially dangerous for:

Pregnant women who have not had chickenpox or the vaccine
Newborns or low birth-weight babies
Anyone with a compromised immune system, including:
- Organ transplant recipients
- People undergoing treatment for cancer
- People with HIV

What are the complications of shingles?

Shingles affects the nervous system and can cause serious complications such as:

Encephalitis (brain inflammation)
Facial paralysis
Hearing and balance problems

The most common complication of shingles is long-term nerve pain. One in five people experience postherpetic neuralgia, a condition causing damaged nerves to send incorrect pain messages from your skin to your brain. Nerve damage can cause issues for months or even years after the shingles rash heals. Medication can decrease the pain associated with postherpetic neuralgia.

Vision loss can also occur if you contract shingles in or around your eye. You can develop a bacterial skin infection if you do not take an antiviral medication to treat shingles blisters.

When should I see my physician?

“Call your physician or a dermatologist immediately if you think you have shingles,” said Dr. Parikh.

Starting treatment within three days of developing a rash can prevent possible complications. Receiving treatment after three days can still be beneficial, so you should see a physician if you have had a rash for more than three days. Before taking any medication, make sure you have a shingles diagnosis.

The following situations can lead to a serious case of shingles if left untreated:

The rash is near your eye. If you do not treat the rash, it can cause permanent eye damage.
The rash is widespread and painful.
You are older than 50 (the risk of complications increases with age).
You or someone you live with has a weak immune system.

Can I get shingles more than once?

Although uncommon, it is possible to get shingles more than once. VZV remains in the body after someone recovers from chickenpox. It can lay dormant before reactivating as shingles years or decades later.

Recurrent shingles—shingles that come back more than once—is more common among people with weakened immune systems.

Risk factors for recurrent shingles include:

Cancer
HIV
Medication that suppresses the immune system
Reexposure to VZV
Stress
Underlying health conditions

Should I get the shingles vaccine?

The CDC recommends two doses of recombinant zoster vaccine (RZV, Shingrix) to prevent shingles and related complications in adults 50 and older. You will receive the doses two to six months apart.

Shingrix is for adults 19 and older with weakened immune systems due to disease or therapy.

You can get the shingles vaccine at the same time as other vaccines. Your physician or pharmacist can give it to you as a shot in the upper arm.

Talk with your physician to determine if the vaccine is right for you. You should not get Shingrix if you: