Shingles

Shingles, also known as herpes zoster, occurs when an inactive virus in nerve cells becomes active again and causes a blistering skin rash. Nothing can cure a shingles attack; however, antiviral medications may help you recover faster and reduce your risk of developing complications.

While shingles can affect people of any age, it’s most likely to strike people after age 60. You can’t prevent shingles, but getting the recombinant zoster vaccine (Shingrix) can greatly reduce your risk.

What causes shingles?

The virus that causes shingles, the varicella zoster virus, is the same virus that causes chickenpox. Once you’ve had chickenpox, the varicella zoster virus remains in your body’s nerve tissues, but in a dormant, or inactive, state.

Doctors aren’t sure how or why the varicella zoster virus reactivates, but they believe the immune system’s response to it weakens over the years. Anyone who has had chickenpox is at risk of developing shingles. However, it most often affects people older than age 60 and those with weakened immune systems.

When the virus reactivates, it travels through nerves, often causing a burning or tingling sensation in the affected areas. A rash soon appears, and two or three days later, when the virus reaches the skin surface, blisters appear, grouped along the affected nerve. The skin becomes very sensitive and painful.

Is shingles contagious?

You can’t catch shingles from someone.

However, you can get infected with the varicella zoster virus and develop chickenpox if you aren’t vaccinated against the virus and haven’t had chickenpox before.

Shingles symptoms

Shingles usually begins with a burning sensation, a mild itching or tingling, or a shooting pain in a specific skin area. The affected area is generally located only on one side of the chest, abdomen, face, or on a portion of an arm or leg. The skin can be so sensitive that you can’t tolerate clothing touching or rubbing the area. Shingles also can cause fatigue, a low-grade fever, and mild muscle aches.

Shingles rash

The affected skin soon becomes red and mildly swollen and a rash appears. After several days, blisters cluster in patches or form a continuous line that roughly follows the path of the affected nerve. The blisters can be painful and itchy, and some may be as large as the palm of your hand. Blisters typically scab over in a week to 10 days and clear up within two to four weeks. Some people retain dark skin spots around the original rash area. Pain decreases within two or three months, although it can sometimes last a year or longer.

Complications of shingles

Shingles can cause severe complications in some people. The most common are postherpetic neuralgia (PHN) and herpes zoster ophthalmicus (HZO), which is also called ophthalmic shingles.

Postherpetic neuralgia

PHN occurs in about 10% of adults who get shingles. Symptoms include long-term pain around the skin where blisters occured, even after the rash has healed. PHN may last for months or years. Prescription drugs such as amitriptyline (Elavil, Endep), doxepin (Adapin, Sinequan), and gabapentin (Neurontin) can help manage lingering pain. Severe pain is most common in older patients, who may also experience extreme heat and cold sensitivity in the affected skin area.

Ophthalmic shingles

Ophthalmic shingles occurs when blisters are in or close to the eye. This condition may lead to an eye infection that can scar your cornea (the clear outer layer of the eye) and result in permanent vision loss. Treatment may include antiviral medications, oral or topical steroids, eye lubricants, and, less commonly, laser or surgical procedures.

Other complications of shingles include:

Otic zoster. Also called Ramsay Hunt syndrome or geniculate zoster, otic zoster occurs when shingles affect the ears. It can cause hearing loss.

Bell's palsy. Shingles can cause Bell's palsy, in which a facial nerve becomes paralyzed.

Shingles treatments

Shingles can be difficult to diagnose before visible signs appear. Once a rash and blisters develop, your doctor will diagnose shingles based on your symptoms and your skin’s appearance. If you have a rash across the bridge of your nose or anywhere near your eyes, your doctor will include an ophthalmologist (eye doctor) in your care.

Shingles usually takes seven to 10 days to run its course, although blisters may take several weeks to disappear completely.

Contact your doctor right away if you suspect you have shingles. If shingles is diagnosed within 72 hours after a rash appears, your doctor can prescribe an antiviral medication such as acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex). These drugs help reduce the severity of shingles and the risk of developing complications.

Home remedies can manage pain and itching. To help relieve itching, apply cool compresses, calamine lotion, or both to the affected areas; take soothing baths (like oatmeal or starch baths); and use an oral or topical antihistamine such as diphenhydramine (Benadryl).

Over-the-counter pain relievers such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can help manage the pain. If the pain worsens, your doctor may recommend a topical numbing agent called lidocaine (Xylocaine). Another option is an intercostal nerve block, in which a numbing medication is injected near the nerves under the ribs.

Preventing shingles: Shingles vaccine

The recombinant zoster vaccine (Shingrix) is over 90% effective at preventing shingles and postherpetic neuralgia in adults 50 years and older with healthy immune systems. Shingrix works by strengthening the immune system's defenses against the reactivation of the virus.

The CDC recommends adults ages 50 and older get two doses of the vaccine, separated by two to six months. The vaccine is also recommended in adults age 19 or older if they have compromised immune systems.

It’s possible to get shingles more than once. As a result, people should get Shingrix even if they've had shingles before. You should also get the shingles vaccine if you don't recall having chickenpox as a child, or received an older, less effective shingles vaccine called Zostavax.

If you currently have shingles, wait to get the vaccine until the outbreak has resolved and you have stopped taking antiviral medications.

Shingles vaccine side effects

Most people who get the Shingrix vaccine experience only mild side effects lasting two to three days. These include soreness, redness, swelling, or pain in the arm at the injection site. Some people also experience fatigue, headache, muscle ache, stomach pain, nausea, fever, or chills for a day or two. Symptoms might be more intense after the second dose.