Shingles, or herpes zoster, is a rash caused from the varicella-zoster virus, which is also the cause of chickenpox. This virus remains inactive after someone has had chickenpox. The virus may reactivate in the nerves in adulthood, causing the painful rash. The understanding why some people develop shingles and others don’t isn’t understood; typically there is just one attack and patients are often older than age 60, had chickenpox as a baby and have an otherwise immune system issues.
Herpes zoster is interesting in that if a child is exposed to someone with shingles, he or she will likely develop chickenpox if unvaccinated. If an adult comes into contact with someone with shingles – the illness is not infectious.
Preliminary symptoms of shingles include tingling and burning before a rash appears. From there, the rash typically increases to small blisters, which burst and create small ulcers. Within 2–3 weeks, the ulcers heal. The rash is often seen on the spine, stomach and chest, although it may also be found on the face and mouth. Other symptoms reported included abdominal pain, chills, facial distortion due to muscle cramping, fever, headaches, joint pain, swollen glands and vision issues.
Signs and tests
Your doctor can make the diagnosis by looking at your skin and asking questions about your medical history.
Tests are rarely needed, but may include taking a skin sample to see if the skin is infected with the virus that causes shingles.
Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus but cannot confirm that the rash is due to shingles.
Your doctor may prescribe a medicine that fights the virus, called an antiviral. The drug helps reduce pain and complications and shorten the course of the disease. Acyclovir, famciclovir, and valacyclovir may be used.
The medications should be started within 24 hours of feeling pain or burning, and preferably before the blisters appear. The drugs are usually given in pill form, in doses many times greater than those recommended for herpes simplex or genital herpes. Some people may need to receive the medicine through a vein (by IV).
Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and the risk of continued pain. These drugs do not work in all patients.
Other medicines may include:
- Antihistamines to reduce itching (taken by mouth or applied to the skin)
- Pain medicines
- Zostrix, a cream containing capsaicin (an extract of pepper) that may reduce the risk of postherpetic neuralgia
Cool wet compresses can be used to reduce pain. Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or calamine lotion, may help to relieve itching and discomfort.
Resting in bed until the fever goes down is recommended.
The skin should be kept clean, and contaminated items should not be reused. Nondisposable items should be washed in boiling water or otherwise disinfected before reuse. The person may need to be isolated while lesions are oozing to prevent infecting other people who have never had chickenpox — especially pregnant women.
Herpes zoster usually clears in 2 to 3 weeks and rarely recurs. If the virus affects the nerves that control movement (the motor nerves), you may have temporary or permanent weakness or paralysis.
Sometimes, the pain in the area where the shingles occurred may last from months to years. See: Postherpetic neuralgia
Sometimes, the pain in the area where the shingles occurred may last for months or years. This pain is called postherpetic neuralgia. It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe pain. It is more likely to occur in people over 60 years.
Other complications may include:
- Another attack of shingles
- Blindness (if shingles occurs in the eye)
- Infection, including encephalitis or sepsis (blood infection) in persons with weakened immune systems
- Bacterial skin infections
- Ramsay Hunt syndrome if shingles affected the nerves in the face
Calling your health care provider
Call your health care provider if you have symptoms of shingles, particularly if you have a weakened immune system or if your symptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you do not receive emergency medical care.
Avoid touching the rash and blisters of persons with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine.
A herpes zoster vaccine is available. It is different than the chickenpox vaccine. Older adults who receive the herpes zoster vaccine are less likely to have complications from shingles. Adults older than 60 should receive the herpes zoster vaccine as part of routine medical care.
- Sampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc. 2009 Mar;84(3):274-80. [PubMed]
- Whitley RJ. Varicella-Zoster virus. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 137.
- Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2010. Ann Intern Med. 2010;152:36-39.