Topic Overview
What is shingles?
Shingles is a
painful skin rash. It is caused by the varicella zoster virus. Shingles usually appears in a band, a strip, or a small area on one side of the face or body. It is also called herpes zoster.
Shingles is most common in
older adults and people who have weak immune systems because of stress, injury,
certain medicines, or other reasons. Most people who get shingles will get
better and will not get it again.
What causes shingles?
Shingles occurs when the
virus that causes
chickenpox starts up again in your body. After you get
better from chickenpox, the virus "sleeps" (is dormant) in your nerve roots. In
some people, it stays dormant forever. In others, the virus "wakes up" when
disease, stress, or aging weakens the
immune system. Some medicines may trigger the virus to wake up and cause a shingles rash. It is not clear why this happens. But
after the virus becomes active again, it can only cause shingles, not
chickenpox.
You can't catch shingles from someone else who has
shingles. But there is a small chance that a person with a shingles rash can spread the virus to another
person who hasn't had chickenpox and who hasn't gotten the chickenpox
vaccine.
What are the symptoms?
Shingles symptoms happen in
stages. At first you may have a headache or be sensitive to light. You may also
feel like you have the flu but not have a fever.
Later, you may
feel itching, tingling, or pain in a certain area. That's where a band, strip,
or small area of rash may occur a few days later. The rash turns into clusters
of blisters. The blisters fill with fluid and then crust over. It takes 2 to 4
weeks for the blisters to heal, and they may leave scars. Some people only get
a mild rash. And some do not get a rash at all.
It's possible that
you could also feel dizzy or weak. Or you could have long-term pain or a rash
on your face, changes in your vision, changes in how well you can think, or a
rash that spreads. If you have any of these problems from shingles, call your
doctor right away.
How is shingles treated?
Shingles is treated with medicines. These medicines include antiviral medicines and medicines for pain.
Starting antiviral medicine right away can help your rash heal faster and be less painful. So if you think you may have shingles, see your doctor right away.
Good home care also can help you feel better faster. Take care
of any skin sores, and keep them clean. Take your medicines as directed. If you are bothered by pain, tell your doctor. He or she may write a prescription for pain medicine or suggest an over-the-counter pain medicine.
Who gets shingles?
Anyone who has had chickenpox
can get shingles. You have a greater chance of getting shingles if you are older than 50 or if you have a weak immune system.
There is a shingles vaccine for people who are 50 years and older. This lowers your chances of getting shingles and prevents long-term pain that can occur after shingles. And if you do get shingles, having the vaccine makes it more likely that you will have less pain and your rash will clear up more quickly.
Frequently Asked Questions
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Cause
Shingles is a
reactivation of the varicella-zoster virus, a type of herpes virus that causes
chickenpox. After you have had chickenpox, the virus
lies inactive in your
nerve roots and remains inactive until, in some
people, it flares up again. If the virus becomes active again, you may get a rash that occurs only in the area of the affected nerve. This rash is called shingles.
Anyone who has had even a mild
case of chickenpox can get shingles. This includes children.
Transmission
Exposure to shingles will not cause
you to get shingles. But if you have not had chickenpox and have not gotten the
chickenpox vaccine, you can get chickenpox if you are exposed to shingles.
Someone who has shingles can expose you to the virus if you come into contact
with the fluid in the shingles blisters.
If you are having an active outbreak of shingles, you can help prevent the spread of the virus to other people. Cover any fluid-filled blisters that are on a part of your body that isn't covered with clothes. Choose a type of dressing that absorbs fluid and protects the sores.
Symptoms
When the virus that causes
chickenpox reactivates, it causes
shingles. Early symptoms of shingles include headache,
sensitivity to light, and flu-like symptoms without a fever. You may then feel
itching, tingling, or pain where a band, strip, or small area of rash may
appear several days or weeks later. A rash can appear anywhere on the body but
will be on only one side of the body, the left or right. The rash will first
form blisters, then scab over, and finally clear up over a few weeks. This band
of pain and rash is the clearest sign of shingles.
The
rash caused by shingles is more painful than itchy.
The
nerve roots that supply sensation to your skin run in
pathways on each side of your body. When the virus becomes reactivated, it
travels up the nerve roots to the area of skin supplied by those specific nerve
roots. This is why the rash can wrap around either the left or right side of
your body, usually from the middle of your back toward your chest. It can also
appear on your face around one eye. It is possible to have more than one area
of rash on your body.
Shingles develops in stages:
Prodromal stage (before the rash appears)
- Pain, burning, tickling, tingling, and/or
numbness occurs in the area around the affected nerves several days or weeks
before a rash appears. The discomfort usually occurs on the chest or back, but
it may occur on the belly, head, face, neck, or one arm or
leg.
- Flu-like symptoms (usually without a fever), such as chills,
stomachache, or diarrhea, may develop just before or along with the start of
the rash.
- Swelling and tenderness of the
lymph nodes may occur.
Active stage (rash and blisters appear)
- A band, strip, or small area of rash appears.
It can appear anywhere on the body but will be on only one side of the body,
the left or right. Blisters will form. Fluid inside the blisters is clear at
first but may become cloudy after 3 to 4 days. A few people won't get a rash,
or the rash will be mild.
- A rash may occur on the forehead, cheek, nose, and around one
eye (herpes zoster ophthalmicus), which may threaten your
sight unless you get prompt treatment.
- Pain, described as "piercing needles in the skin," may occur
along with the skin rash.
- Blisters may break open, ooze, and crust
over in about 5 days. The rash heals in about 2 to 4 weeks, although some scars
may remain.
Postherpetic neuralgia (chronic pain stage)
-
Postherpetic neuralgia
(PHN) is the most
common complication of shingles. It lasts for at least 30 days and may continue
for months or years. Symptoms are:
- Aching, burning, stabbing pain in the area of the earlier
shingles rash.
- Persistent pain that may linger for
years.
- Extreme sensitivity to touch.
- The pain associated with PHN most commonly affects the forehead or chest. This pain may make it
difficult for the person to eat, sleep, and do daily activities. It may
also lead to
depression.
Shingles may be confused with
other conditions that cause similar symptoms. The rash from shingles may be mistaken for an infection from herpes simplex virus (HSV), poison oak or ivy, impetigo, or scabies. The pain from PHN may feel like appendicitis, a heart attack, ulcers, or migraine headaches.
What Happens
Shingles is
caused by the same virus that causes
chickenpox. After an attack of chickenpox, the virus
remains in the tissues in your nerves. As you get older, or if you have an
illness or stress that weakens your
immune system, the virus may reappear in the form of
shingles.
You may first have a headache, flu-like symptoms
(usually without a fever), and sensitivity to light, followed by itching,
tingling, or pain in the area where a
rash may develop. The pain usually occurs several days
or weeks before a rash appears on the left or right side of your body. The rash
will be in a band, a strip, or a small area. In 3 to 5 days, the rash turns
into fluid-filled blisters that ooze and crust over. The rash heals in about 2
to 4 weeks, although you may have long-lasting scars.
A few people won't get a rash, or the rash will be mild.
Most
people who get shingles will not get the disease again.
Complications of shingles
Delaying or not getting medical treatment may increase your risk for complications. Complications of shingles include:
-
Postherpetic neuralgia (PHN)
, which is pain
that does not go away within 1 month. It may last for months or even years
after shingles heals. It is more common in people
age 50 and older and in people who have a weakened immune system due to another
disease, such as
diabetes or
HIV infection.
- Disseminated zoster, which is a
blistery rash that spreads over a large portion of the body and can affect the
heart, lungs, liver, pancreas, joints, and intestinal tract. Infection may
spread to nerves that control movement, which may cause temporary
weakness.
- Cranial nerve complications. If shingles affects the
nerves originating in the brain (cranial nerves), complications may include:
- Inflammation,
pain, and loss of feeling in one or both eyes. The infection may threaten your
vision. A rash may appear on the side and tip of the nose (Hutchinson's
sign).
- Intense ear pain, a rash around the ear, mouth, face, neck,
and scalp, and loss of movement in facial nerves (Ramsay Hunt syndrome). Other
symptoms may include hearing loss, dizziness, and ringing in the ears. Loss of
taste and dry mouth and eyes may also occur.
- Inflammation, and
possibly blockage, of blood vessels, which may lead to
stroke.
- Scarring and skin
discoloration.
- Bacterial infection of the
blisters.
- Muscle weakness in the area of the infected skin before,
during, or after the episode of shingles.
What Increases Your Risk
Things that increase risk for shingles include:
- Having had
chickenpox. You must have had chickenpox to get
shingles.
- Being older than 50.
- Having a weakened immune system due to another disease, such as
diabetes or
HIV infection.
- Experiencing stress or
trauma.
- Having cancer or receiving treatment for cancer.
- Taking medicines that affect your immune system, such as steroids or medicines that are taken after having an organ transplant.
If a pregnant woman gets chickenpox, her baby has a high
risk for shingles during his or her first 2 years of life. And if a baby gets chickenpox in the first year of life, he or she has a higher risk for shingles during childhood.1
Postherpetic neuralgia (PHN)
is a common
complication of shingles that lasts for at least 30 days and may continue for
months or years. You can reduce your risk for getting shingles and developing PHN by getting the shingles vaccine.
When To Call a Doctor
If you think you have shingles, see a doctor as soon as possible. Early treatment with
antiviral medicines may help reduce pain and prevent
complications of shingles, such as
disseminated zoster or
postherpetic neuralgia.
If you still feel intense pain
for more than 1 month after the skin heals, see your doctor to find
out whether you have postherpetic neuralgia (PHN). Getting your pain under control right away may prevent nerve damage that may cause pain that lasts for months or years.
Who to see
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Doctors can usually identify
shingles when they see an area of
rash around the left or right side of your body. If a
diagnosis of shingles is not clear, your doctor may order lab tests, most
commonly
herpes tests, on cells taken from a blister.
If there is reason to think that shingles is present, your doctor may
not wait to do tests before treating you with antiviral medicines. Early
treatment may help shorten the length of the illness and prevent complications
such as
postherpetic neuralgia.
Treatment Overview
There is no cure for
shingles, but treatment may shorten the length of
illness and prevent complications. Treatment options include:
- Antiviral medicines to reduce the pain and
duration of shingles.
- Pain medicines, antidepressants, and topical creams to relieve
long-term pain.
Initial treatment
As soon as you are diagnosed
with
shingles, your doctor probably will start treatment
with antiviral medicines. If you begin medicines within the first 3 days of
seeing the shingles rash, you have a lower chance of having later
problems, such as
postherpetic neuralgia.
The most common
treatments for shingles include:
-
Antiviral medicines, such as acyclovir,
famciclovir, or valacyclovir, to reduce the pain and the duration of
shingles.
- Over-the-counter pain medicines, such
as acetaminophen, aspirin, or ibuprofen, to help reduce pain during an attack
of shingles.
- Topical
antibiotics, applied directly to the skin, to stop
infection of the blisters.
For severe cases of shingles, some doctors may have their patients use corticosteroids along with antiviral medicines. But corticosteroids are not used very often for shingles. This is because studies show that taking a corticosteroid along with an antiviral medicine doesn't help any more than just taking an antiviral medicine by itself.2
Ongoing treatment
If you have pain that persists
longer than a month after your
shingles rash heals, your doctor may diagnose
postherpetic neuralgia (PHN), the most common complication
of shingles. PHN can cause pain for months or years. It
affects 10 to 15 out of 100 people who have had shingles.3
Treatment to reduce the pain of postherpetic neuralgia includes:
- Antidepressant medicines, such as a
tricyclic antidepressant (for example,
amitriptyline).
- Topical anesthetics that include benzocaine, which are available in over-the-counter forms that you can apply directly to the skin for pain relief. Lidocaine patches, such as Lidoderm, are available only by prescription.
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Anticonvulsant
medicines, such as gabapentin or pregabalin.
-
Opioids, such as
codeine.
Topical creams containing
capsaicin may provide some relief from pain. There is also a high-dose skin patch available by prescription (Qutenza) for postherpetic neuralgia. Capsaicin
may irritate or burn the skin of some people, and it should be used with
caution.
Treatment if the condition gets worse
In some
cases,
shingles causes long-term
complications. Treatment depends on the specific
complication.
-
Postherpetic neuralgia (PHN)
is persistent
pain that lasts months or even years after the shingles rash heals. Certain
medicines, such as anticonvulsants, antidepressants, and opioids, can relieve
pain. Most cases of PHN resolve within a year.
- Disseminated zoster is a
blistery rash over a large portion of the body. It may affect the heart,
lungs, liver, pancreas, joints, and intestinal tract. Treatment may include
both antiviral medicines to prevent the virus from multiplying and antibiotics
to stop infection.
- Herpes zoster ophthalmicus is a rash on
the forehead, cheek, nose, and around one eye, which could threaten your sight.
You should seek prompt treatment from an
ophthalmologist for this condition. Treatment may include rest, cool compresses, and antiviral
medicines.
- If the shingles virus affects the nerves originating in
the brain (cranial nerves), serious complications involving the face, eyes,
nose, and brain can occur. Treatment depends on the nature and location of
the complication.
Prevention
Anyone who has had chickenpox may get
shingles later in life. But there's a vaccine that may
help prevent shingles or make it less painful if you do get it. The
shingles vaccine(What is a PDF document?) is known as Zostavax. Adults ages 50 and older can get one dose, whether or not they've had shingles before.
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Shingles: Should I Get a Shot to Prevent Shingles?
If you have never had
chickenpox, you may avoid getting the virus that
causes both chickenpox and later shingles by receiving the
varicella vaccine.
If you
have never had chickenpox and have never gotten the chickenpox vaccine, avoid
contact with people who have shingles or chickenpox. Fluid from shingles
blisters is contagious and can cause chickenpox (but not
shingles) in people who have never had chickenpox and who have never gotten the
chickenpox vaccine.
If you have shingles, avoid close contact
with people until after the
rash blisters heal. It is especially important to
avoid contact with people who are at special risk from chickenpox,
such as:
- Pregnant women, infants, children, or anyone
who has never had chickenpox.
- Anyone who is currently
ill.
- Anyone with a weak
immune system who is unable to fight infection (such
as someone with
HIV infection or
diabetes).
If you cover the shingles sores with a type of dressing
that absorbs fluid and protects the sores, you can help prevent the spread of
the virus to other people.
Home Treatment
You may reduce the duration and pain
of
shingles by:
- Taking good care of skin sores.
- Avoid picking at and scratching blisters. If left alone, blisters will crust over and fall off naturally.
- Use cool, moist compresses if they help ease discomfort. Lotions, such as calamine, may be applied after wet compresses.
- Apply cornstarch or baking soda to help dry the sores so that they heal more quickly.
- Soak crusted sores with tap water or Burow's solution to help clean away crusts, decrease oozing, and dry and soothe the skin.
- Ask your doctor about using topical creams to help relieve the inflammation caused by shingles.
- If your skin becomes infected, ask your doctor about prescription antibiotic creams or ointments.
- Using medicines as prescribed to treat shingles or
postherpetic neuralgia, which is pain that lasts for
at least 30 days after the shingles rash heals.
- Using
nonprescription pain medicines, such as acetaminophen, aspirin, or ibuprofen,
to help reduce pain during an attack of shingles or pain caused by postherpetic
neuralgia. If you are already taking a prescription pain medicine, talk with your doctor before using any over-the-counter pain medicine. Some prescription pain medicines have acetaminophen (Tylenol), and getting too much acetaminophen can be harmful.
If home treatment doesn't help with pain, talk with your doctor. Getting your pain under control right away may prevent nerve damage that may cause pain that lasts for months or years.
Medications
Medicines can help limit the pain and
discomfort caused by
shingles, shorten the time you have symptoms, and
prevent the spread of the disease. Medicines also may reduce your chances of
developing shingles
complications, such as
postherpetic neuralgia (PHN) or disseminated zoster.
Medicine choices
Medicines to treat shingles when the
rash is present (active stage) may include:
- Over-the-counter pain medicines, such as
acetaminophen, aspirin, or ibuprofen, to help reduce pain.
-
Antiviral medicines, to reduce the pain and duration of
shingles.
- Topical
antibiotics, which are applied directly to the skin,
to stop infection of the blisters.
Medicines to treat postherpetic neuralgia pain may include:
What to think about
For some people, nonprescription
pain relievers (analgesics) are enough to help control pain caused by shingles
or postherpetic neuralgia. But for others, stronger medicines may be needed. And if prescription medicines don't help control your pain, you may need to see a pain specialist about other ways to treat PHN.
Other Treatment
Postherpetic neuralgia (PHN)
, the most common complication of
shingles, is difficult to treat. Your doctor may
recommend other treatments, along with medicines, to
control the pain of PHN.
Other treatment choices
There are other treatments that may be used for shingles and postherpetic neuralgia. These treatments may help, but there is no clear evidence from studies that show how well these treatments work. These other treatments include:
Psychological therapies that help you tolerate long-term
pain, such as cognitive-behavioral therapy, may be helpful. These methods can include counseling as well as learning
techniques that teach you to shift your focus of attention away from the pain, such as relaxation and breathing exercises.
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Stress Management: Breathing Exercises for Relaxation
For severe pain from PHN, you may need to see a
pain management specialist. These doctors are trained to help with pain that doesn't respond to medicines or usual treatments.
Other Places To Get Help
Organizations
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National Institute of Neurological Disorders and
Stroke
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| NIH Neurological Institute |
| P.O. Box 5801 |
| Bethesda, MD 20824 |
| Phone: |
1-800-352-9424 |
| Phone: |
(301) 496-5751 |
| TDD: |
(301) 468-5981 |
| Web Address: |
www.ninds.nih.gov |
| |
|
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
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American Academy of Dermatology
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| P.O. Box 4014 |
| Schaumburg, IL 60168 |
| Phone: |
1-866-503-SKIN (1-866-503-7546) toll-free
(847) 240-1280 |
| Fax: |
(847) 240-1859 |
| Email: |
MRC@aad.org |
| Web Address: |
www.aad.org |
| |
|
The American Academy of Dermatology (AAD) provides information
about the care of skin. You can locate a dermatologist in your
area by using their "Find a Dermatologist" tool. Or you can read the latest news in dermatology. "SPOT Skin Cancer" is the AAD's program to reduce deaths from melanoma. There is also a link called "Skin Conditions" that has information about many common skin problems.
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American Academy of Family
Physicians: FamilyDoctor.org
|
| P.O. Box 11210 |
| Shawnee Mission, KS 66207-1210 |
| Phone: |
1-800-274-2237 |
| Fax: |
(913) 906-6075 |
| Web Address: |
www.familydoctor.org |
| |
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The website FamilyDoctor.org is sponsored by the American Academy of Family Physicians. It offers information on adult and child health conditions and healthy living. There are topics on medicines, doctor visits, physical and mental health issues, parenting, and more.
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Centers for Disease Control and Prevention (CDC):
Vaccines and Immunizations
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| 1600 Clifton Road |
| Atlanta, GA 30333 |
| Phone: |
1-800-CDC-INFO (1-800-232-4636) |
| TDD: |
1-888-232-6348 |
| Web Address: |
www.cdc.gov/vaccines |
| |
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This CDC website has information about vaccines and the diseases that can
be prevented by immunization. It includes the recommended
immunization schedules for children, teens, and adults. You can also find
information about vaccine side effects and safety, school and state
requirements, and immunization records. Interactive schedules are also
available.
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National Institute of Allergy and Infectious Diseases
(NIAID), National Institutes of Health
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| NIAID Office of Communications and Government Relations |
| 6610 Rockledge Drive, MSC 6612 |
| Bethesda, MD 20892-6612 |
| Phone: |
1-866-284-4107 toll-free |
| Phone: |
(301) 496-5717 |
| Fax: |
(301) 402-3573 |
| TDD: |
1-800-877-8339 |
| Web Address: |
www.niaid.nih.gov |
| |
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The National Institute of Allergy and Infectious
Diseases conducts research and provides consumer information on infectious and
immune-system-related diseases.
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References
Citations
-
Gershon AA (2009). Varicella zoster virus. In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 2, pp. 2077–2088. Philadelphia: Saunders Elsevier.
-
Chen N, et al. (2010). Corticosteroids for preventing postherpetic neuralgia (Review). Cochrane Database of Systematic Reviews (12).
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Dubinsky RM, et al. (2004, reaffirmed 2008). Practice parameter: Treatment of postherpetic neuralgia. An evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 63(6): 959–965.
Other Works Consulted
- Centers for Disease Control and Prevention (2008). Prevention of herpes zoster: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 57(05): 1–30. Also available online: ... [Erratum in MMWR...]
- Habif TP (2010). Herpes zoster. In Clinical Dermatology, A Color Guide to Diagnosis and Therapy, 5th ed., pp. 479–490. Philadelphia: Mosby.
- Herpes zoster vaccine (Zostavax) revisited (2010). Medical Letter on Drugs and Therapeutics, 52(1339): 41.
- Wolff K, Johnson RA (2009). Varicella-zoster virus infections. In Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 6th ed., pp. 837–845. New York: McGraw-Hill Medical.
Credits
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By
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Healthwise Staff |
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Primary Medical Reviewer
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E. Gregory Thompson, MD - Internal Medicine |
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Specialist Medical Reviewer
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Christine Hahn, MD - Epidemiology |
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Last Revised
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December 18, 2012 |