Shingles, also known as herpes zoster, is a viral infection that causes a painful rash. It is caused by the varicella zoster virus, which is the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant in the body. It can reactivate later in life and cause shingles.
What are the symptoms of shingles?
The most common symptom of shingles is a painful rash that appears on one side of the face or body. The rash usually occurs in a single stripe of blisters that extends from the middle of the back around one side of the torso to the breastbone. Less commonly, it can occur on the neck, face or scalp.
Other symptoms of shingles can include:
- Burning, tingling, numbness or itchiness of the skin in the area where the rash will develop
- Sensitivity to touch
- Fever
- Chills
- Headache
- Fatigue
- Upset stomach
The pain associated with shingles can be severe and debilitating for some people. The rash and pain usuallyclear up within 2-4 weeks.
What causes shingles?
Shingles is caused by the reactivation of the varicella zoster virus. After a person has chickenpox, the virus remains inactive in the body’s nerves. Years later, it can reactivate and travel along nerve fibers to the skin, causing shingles.
Doctors aren’t sure why the dormant virus reawakens in some people, but it is believed that a weakened immune system plays a role. Stress is one factor that can temporarily impair immunity and trigger an outbreak.
How does stress cause shingles?
Stress weakens the immune system and reactivates the virus that causes shingles. When you are stressed, your body produces more of the stress hormone cortisol. Higher cortisol levels suppress the immune system by reducing the production of lymphocytes, which are a type of white blood cell that fight infection.
Studies have shown that people who develop shingles report experiencing significant emotional or physical stress in the year leading up to the outbreak. Major life stressors like the loss of a loved one, divorce, job loss or a serious medical illness can impair immunity enough to bring on shingles.
What does the shingles rash look like?
The shingles rash appears as red patches or blisters on the skin in a band or strip pattern. It often wraps around one side of the torso or neck and stays on one side of the body. The rash may occur anywhere on the body, but it most commonly appears on:
- Trunk (chest, abdomen, back)
- Face and scalp
- Shoulder and neck
At first, people may feel burning or tingling pain in an area of skin. After a few days, a rash appears as clusters of small, fluid-filled blisters. The blisters often merge and form into patches that crust over when they break.
As the rash progresses, it typically goes through these stages:
- Macular rash – The first signs are red, flat spots that may look like a sunburn or insect bites.
- Papules – Small, raised and solid bumps that are less than 1 centimeter wide.
- Vesicles – Small, fluid-filled blisters less than 1 centimeter wide.
- Pustules – Blisters filled with pus.
- Crusts – Yellowish scabs or crusts that form when blisters break.
- Scabs – The rash will turn brown and scab over as it heals.
How long does the shingles rash last?
The shingles rash usually lasts 2 to 4 weeks. Blisters begin to dry out and scab over within 7 to 10 days. The rash disappears once all of the blisters have crusted over..
Some people are left with mild scarring where the deepest sores have healed. After the rash goes away, people may continue to experience nerve pain in the area for several more weeks or even months.
Are there different types of shingles rashes?
There are a few variations of shingles rashes that can appear:
- Zoster sine herpete – In some cases, shingles pain occurs without a rash ever developing. This is known as zoster sine herpete. The person experiences the burning, tingling pain but the rash never breaks out.
- Internal shingles – When the virus reactivates along nerve fibers that go to internal organs instead of the skin, it can cause internal shingles. This can involve symptoms such as chest pain, abdominal pain, bladder problems, intestinal issues, or headaches.
- Ophthalmic shingles – If shingles occurs around the eye (ophthalmic shingles), it requires urgent medical care to protect vision. The rash may develop over the forehead, eyelids, nose, or cheek on one side of the face.
How is shingles related to chickenpox?
Shingles and chickenpox are caused by the same virus, the varicella zoster virus. When a person first gets infected with the virus, they develop chickenpox. The virus then becomes dormant and hides out long-term in the nerves.
Later in life, usually after age 50, the virus can reemerge along the nerve fibers and cause shingles. Having had chickenpox as a child means the virus is already inside you, so you are at risk for shingles as an adult.
Shingles itself cannot be passed from person to person. However, the varicella zoster virus that causes shingles can spread and cause chickenpox in someone who has never had chickenpox or the vaccine before. This is why people with active shingles are advised to avoid contact with infants, pregnant women and those with weakened immune systems until the rash has healed.
Who gets shingles?
Anyone who has had chickenpox in the past can get shingles. However, some people are at higher risk:
- Older adults over 50 years of age
- People with weakened immune systems
- Individuals with certain medical conditions like HIV, cancer, lupus
- Emotional stress
- Physical trauma
- Cancer treatments like chemotherapy or radiation
- Certain medications like steroids and drugs that suppress immunity
About 1 in 3 people in the United States will develop shingles during their lifetime. There are an estimated 1 million cases per year. The risk and severity increases with age. About half of all cases occur in adults 60 years or older.
When to see a doctor
It’s important to get treatment quickly when shingles symptoms appear. Starting medication within 72 hours of the rash showing up may reduce the risk of complications. Make an appointment right away if you notice any symptoms of a shingles rash. Anti-viral drugs work best when started in the early stages.
See a doctor immediately if the rash is near your eye or you are experiencing any vision changes or eye pain. Shingles can lead to permanent eye damage and blindness if it involves the optic nerve.
You should also call your doctor if:
- Your pain is very severe and not relieved by over-the-counter pain medication
- The rash is spreading or getting worse
- You have a fever above 100.4°F
- You are immunocompromised
- You think you may have internal shingles
Shingles treatment
While there is no cure for shingles, prompt treatment can help shorten the duration of the illness and prevent complications. Treatment options may include:
- Antiviral medications like acyclovir, valacyclovir or famciclovir – These medications can reduce viral replication and halt progression of the rash. They are most effective when started within 72 hours of rash onset.
- Pain medication – Over-the-counter options like ibuprofen, acetaminophen or aspirin can help manage mild pain. Prescription medications or numbing agents may be needed for more severe pain.
- Wet compress – Applying a cool, wet compress to the rash may help provide relief from itching and pain.
- Antidepressants – Low doses of certain types of antidepressants are sometimes used to treat lingering nerve pain after shingles.
Keeping the rash clean, not scratching the blisters and wearing loose clothing over the affected area will also promote healing and comfort.
Shingles complications
Around 1 in 5 people who get shingles will experience complications. Potential problems include:
- Postherpetic neuralgia – Pain that continues after the rash has cleared up. This is the most common complication.
- Vision loss – If shingles impacts the eye region, it can lead to permanent eye damage or vision loss.
- Neurological problems – Weakness, muscle paralysis, loss of hearing or balance problems may occur.
- Skin infections – Bacterial skin infections are possible if the blisters are scratched.
- Debilitating pain – For some, shingles pain continues to be severe and disabling.
Prompt treatment is vital, as the risk of complications rises the longer shingles goes untreated. Let your doctor know right away if your symptoms are getting worse or not improving with treatment.
Is shingles contagious?
Shingles itself is not contagious – it cannot spread from person to person through direct contact. However, the varicella zoster virus that causes shingles can spread. Someone who has not had chickenpox before and has not received the varicella vaccine can catch chickenpox from a person with active shingles.
This typically requires direct contact with the fluid from shingles blisters and less commonly through inhaling virus particles dispersed in the air. It does not spread through casual contact at school, work or other shared spaces.
To avoid spreading the virus, people with untreated shingles should cover their rash, avoid touching or scratching blisters and wash hands frequently. They should also avoid contact with anyone at high risk until the rash and blisters have completely healed.
Shingles vs cold sores
Both shingles and cold sores involve a painful rash, but they are distinct conditions caused by different viruses:
- Shingles is caused by the varicella zoster virus and occurs in a band or belt pattern on one side of the body.
- Cold sores (fever blisters) are caused by the herpes simplex virus and typically occur in or around the mouth.
| Shingles | Cold Sores | |
|---|---|---|
| Location | One side of face, torso or neck | Around the mouth or nose |
| Pattern | Band or stripe | Clustered blisters |
| Pain | Severe, burning | Mild to moderate tingling |
| Duration | 2-4 weeks | 7-10 days |
While shingles can be very painful, cold sores tend to cause only minor discomfort. Shingles does not recur, whereas cold sores may outbreak multiple times.
Shingles vaccine
The shingles vaccine helps your body build immunity to varicella zoster, which reduces your risk of developing shingles. The Centers for Disease Control and Prevention (CDC) recommends two doses of the shingles vaccine for healthy adults 50 years and older, even if they’ve had shingles before or received the previous shingles vaccine.
The vaccine is about 90% effective at preventing shingles and even if you still get shingles after vaccination, symptoms are likely to be milder with a shorter duration.
The shingles vaccine is available in two options:
- Zostavax – This is the older shingles vaccine approved for use in adults 50 and over. It is a live vaccine given in one dose as a shot.
- Shingrix – The preferred vaccine approved for adults 50 and older. It requires two doses given 2-6 months apart. Shingrix offers greater protection that lasts longer.
Common side effects are generally mild and may include pain, redness or swelling at the injection site, headache, stomach upset or muscle aches. Talk to your doctor about what vaccine is recommended for you based on your health history and risks.
How to reduce your risk of shingles
While anyone who has had chickenpox can develop shingles, the following precautions may help lower your risk:
- Get the shingles vaccine according to CDC recommendations
- Manage stress levels with relaxation techniques, therapy or meditation
- Eat a healthy, balanced diet and exercise regularly
- Get enough sleep and rest
- Manage any chronic health conditions carefully
- Avoid close contact with anyone who has active shingles
Notify your doctor right away if you think you are developing shingles symptoms. Early treatment provides the best chance of an uncomplicated recovery.
Conclusion
Shingles is a painful viral infection that causes a blistering rash, usually on one side of the body or face. It is caused by the varicella zoster virus reactivating many years after someone had chickenpox. The shingles rash typically progresses through fluid-filled blisters, pustules and scabbing over a period of 2-4 weeks.
Prompt medical treatment can reduce the duration and severity of shingles. Antiviral medication offers the most benefit when given within 72 hours of rash onset. Anyone experiencing the signs of shingles should contact their doctor right away to prevent potential complications.