What is shingles?
Shingles (herpes zoster) is a viral infection that causes an outbreak of a painful rash or blisters on the skin. It is caused by the varicella-zoster virus, which is the same virus that causes chickenpox. The rash most often appears as a band of rashes or blisters in one area of the body.
Where does shingles come from?
When you have chickenpox as a child, your body fights off the varicella-zoster virus and the physical signs of chickenpox fade away but the virus always remains in your body. In adulthood, sometimes the virus becomes active again. This time, the varicella-zoster virus makes its second appearance in the form of shingles.
How common is shingles?
Shingles affects one out of every three people in the United States. More than one million cases of shingles are diagnosed every year. The risk of shingles increases as you get older, with about half the cases occurring in men and women ages 50 and older. Shingles develops in about 10 percent of people who have had chickenpox at an earlier time in their life.
Who is at risk for getting shingles?
People who have had chickenpox who are more likely to develop shingles include:
- People with a weakened immune system (such as people with cancer, HIV, organ transplant recipients or those receiving cancer chemotherapy).
- People over the age of 50.
- People who have been ill.
- People who have experienced trauma.
- People who are under stress.
After having the chickenpox, your body does not rid your system of the virus. Instead, the virus stays in a portion of the spinal nerve root called the dorsal root ganglion. For the majority of people, the virus simply stays there quietly and doesn't cause problems. We aren't always sure why the virus gets reactivated, but this typically occurs at times of stress.
Can you get shingles more than once?
Unfortunately, yes you can. One of the biggest myths about shingles is that it can only happen once. This is not true. You can have more than one episode. If you get shingles again, you usually don’t get the rash in the same place.
Symptoms and Causes
What causes shingles?
Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox.
What are the symptoms of shingles?
Early symptoms of shingles may include:
- Feeling tired.
- Sensitivity to light.
- Stomach upset.
Other signs and symptoms appearing a few days after the early symptoms include:
- An itching, tingling or burning feeling in an area of skin.
- Redness in the skin in the affected area.
- Raised rash in a small area of skin.
- Fluid-filled blisters that break open then scab over.
- Mild to severe pain in the area of skin affected.
How long does shingles last?
From the time you begin to feel symptoms until the rash has totally disappeared can take three to five weeks.
- First, a few days before the rash appears, you may feel pain in an area on your skin. The pain is described as itching, burning, stabbing, or shooting.
- Next, the raised rash appears as a band or a patch, usually on one side of the body. The rash usually appears around the waistline or on one side of the face, neck, or on the trunk (chest/abdomen/back), but can occur in other areas including the arms and legs.
- Within three to four days, the rash develops into red, fluid-filled, round, painful, open blisters.
- Usually, these blisters begin to dry out and crust over within about 10 days.
- The scabs clear up about two to three weeks later.
Do you always get the typical rash if you have shingles?
Occasionally some patients don’t get the rash. If you have any of the other symptoms of shingles (even without a rash), see your healthcare provider sooner rather than later. There are effective treatments that can be given early in the disease. If it turns out you don’t have shingles, seeing your healthcare provider allows any condition that you do have to be discovered and treated early in its course.
The shingles rash appears on the abdomen and face, neck and shoulders.
Why does shingles appear mostly on one side or in one area of the body?
The virus travels in specific nerves, so you will often see shingles occur in a band on one side of the body. This band corresponds to the area where the nerve transmits signals. The shingles rash stays somewhat localized to an area; it does not spread over your whole body. The torso is a common area, as is the face.
Is shingles contagious? How is the shingles virus spread? How long is a person contagious?
Someone with shingles can’t spread shingles to another person, but they can spread chickenpox. The varicella-zoster virus is spread through direct skin-to-skin contact with the fluid that oozes from the blisters (rarely, by breathing in airborne varicella-zoster virus). If your rash is in the blister phase, stay away from those who haven’t had chickenpox or the chickenpox vaccine and keep your rash covered.
A person with shingles remains contagious until the rash is dried and crusted over. The varicella-zoster virus can only cause chickenpox in someone who has never had chickenpox or hasn’t been vaccinated against chickenpox.
Diagnosis and Tests
How is shingles diagnosed?
Shingles can be diagnosed by the way the rash is distributed on the body. The blisters of a shingles rash usually appear in a band on one side of the body. Shingles also may be diagnosed in a laboratory with the scrapings or swab of the fluid from the blisters.
Management and Treatment
How is shingles treated?
There is no cure for shingles but there are treatments for managing the symptoms. Antiviral medications (such as acyclovir [Zovirax®], famciclovir [Famvir®], and valacyclovir [Valtrex®]) may ease the discomfort and may reduce the duration of the symptoms, particularly if started within 72 hours of the first sign of shingles. Over-the-counter pain medications such as acetaminophen (Tylenol®) or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin®, Advil®) can be effective in relieving mild pain. Antibacterial agents can be given to treat bacterial infections of the shingles rash (if this occurs).
If I have disseminated zoster/shingles (more than one area of blisters), what can I expect for my hospital stay?
It is important to note that most people with shingles do not need to be in a hospital, but if you do:
- You will be in an airborne-contact isolation room.
- The door will be kept closed.
- A sign on your door will remind people who have never had chickenpox or the vaccine not to enter.
- The sign will also remind staff to wear gowns and gloves when entering the room.
If I have localized shingles (only one area of my body) that cannot be covered, what can I expect for my hospital stay?
- You will be in a contact isolation room.
- The sign on the door will remind staff to wear gowns and gloves when entering the room.
What are the complications of shingles?
After the shingles rash has disappeared, you might continue to have nerve pain in that same area. This pain, called postherpetic neuralgia, can last for months or years and become quite severe.
About 10% to 15% of people who get shingles develop postherpetic neuralgia. Researchers don’t know why some people get postherpetic neuralgia and others don’t. It may be that nerves become more sensitive or the virus may be invading and damaging the central nervous system.
Other complications include other types of nerve issues like numbness or itching, bacterial infection of the shingle rash, and eye and ear inflammation if the rash is near these organs.
How is postherpetic neuralgia treated?
Treatments include lotions or creams (such as lidocaine or capsaicin) and/or other medications not specifically used for pain, such as antidepressants or drugs for epilepsy. Regular pain relievers are not usually effective for this type of pain.
If pain doesn’t lessen, other treatments such as nerve blocks or steroid injections near the area where the nerves exit the spine can be tried. Implantable nerve stimulator devices are an option for severe, ongoing pain that has not responded to other treatments.
Is a vaccine available to prevent shingles?
Two vaccines are available in the United States to reduce your chance of developing shingles and postherpetic neuralgia. One vaccine, Zostavax®, has been available since 2006. The second vaccine, Shingrix®, has been available since 2017. Shingrix is recommended as the preferred vaccine by the Advisory Committee on Immunization Practices, a group of medical and public health experts.
Shingrix® (recombinant zoster vaccine) is given as a two-dose shot in the upper arm. You should receive the second dose (shot) two to six months after receiving the first. Shingrix has been shown to be more than 90% effective in preventing shingles and postherpetic neuralgia. Its effectiveness remains above 85% for at least four years after receiving the vaccine.
Due to high levels of demand for the Shingrix vaccine and a supply shortage, the vaccine manufacturer is managing the timing and distribution of the vaccine throughout the United States. It plans to continue to manage the availability of the vaccine and hopes to make available the same or increased number of doses and to shorten the wait time for delivery this year (2020).
Who should be vaccinated with Shingrix?
The Shingrix vaccine is recommended for those 50 years of age and older who are in good health.
You should get the Shingrix vaccine even if:
- You have had shingles already.
- You have been previously vaccinated with Zostavax (zoster vaccine live). (If you’ve been vaccinated with Zostavax, wait at least 8 weeks before getting vaccinated with Shingrix.)
- You do not know for sure if you’ve ever had chickenpox.
Ask your healthcare provider, who knows your entire health history, if getting this vaccine is right for you.
Who should not be vaccinated with Shingrix?
You should not receive the Shingrix vaccine if you:
- Have ever had a severe allergy to this vaccine or any ingredient in this vaccine.
- Are breastfeeding or pregnant.
- Currently have shingles.
- Are somewhat ill or very ill and have a high fever.
- Have tested negative for immunity to varicella zoster virus (get the chickenpox vaccine instead).
Ask your healthcare provider if the benefits of getting the vaccine outweigh any potential risks.
What serious side effects should I watch for after getting the Shingrix vaccine?
Serious side effects from vaccines are extremely rare. However, call 911 or get to a hospital right away if you experience any of the following within minutes to hours after receiving Shingrix:
- Swelling of the face or throat.
- Difficulty breathing.
- Fast heartbeat.
- Dizziness, lightheadedness, weakness.
If I’ve had shingles recently, how long should I wait before getting the Shingrix vaccine?
You can get the Shingrix vaccine any time after the shingles rash has gone away.
Is the Zostavax vaccine still being used?
Yes. It is still recommended for preventing shingles and postherpetic neuralgia in healthy people age 50 and older. (The CDC, however, recommends Zostavax for adults age 60 and older.) Zostavax is given as a single-dose shot versus the two-dose shot for Shingrix. Zostavax is less effective than Shingrix in preventing shingles (51% vs over 90%) and postherpetic neuralgia (67% vs more than 90%).
Zostavax can be considered if you are allergic to Shingrix or if Shingrix is unavailable due to supply shortage and you want some immediate protection from a possible case of shingles and/or postherpetic neuralgia. Because it is a weakened live vaccine, it may be dangerous if you have cancer, HIV, take steroids or chemotherapy or other medications that suppress your immune system. Ask your healthcare provider if the Zostavax vaccine is an option for you.
Do I need to stay away from children, pregnant women, people with cancer or anyone with a weak immune system after I get the Zostavax vaccine?
According to the CDC, it is safe to be around babies and young children, pregnant women or anyone with a weakened immune system after you get the Zostavax vaccine. Even though the Zostavax vaccine contains a weakened live varicella zoster virus, the CDC says there is no documented case of a person getting chickenpox from someone who has received the Zostavax vaccine. (And a person can’t get shingles unless they have already had chickenpox.)
If I have previously received the Zostavax vaccine, how long should I wait before getting the Shingrix vaccine?
If you have previously received the Zostavax vaccine, the CDC recommends waiting at least eight weeks before getting the Shingrix vaccine.
If I get the shingles vaccine, does this mean I’m 100% protected from getting shingles?
No, just like most vaccines, getting vaccinated doesn’t provide 100% protection from disease. However, getting the shingles vaccine reduces your risk of developing shingles. Even if you do develop shingles, you’ll be more likely to have a mild case. Also, you’ll be much less likely to develop postherpetic neuralgia, the painful condition that can follow a shingles outbreak.
If I have a medical condition that suppresses my immune system, should I get the shingles vaccine?
Having a weakened immune system can increase the likelihood of getting shingles, so that’s even more of a reason to get the shingles vaccine. However, you must get the Shingrix vaccine, which is not made from a live virus (The older – and still available – vaccine Zostavax is made from a weakened live virus and should not be given to people with weakened immune systems.)
Outlook / Prognosis
What should I expect will happen to me if I get shingles?
Shingles can be a very painful condition. If you think you have the symptoms of shingles, see your healthcare provider right away. Starting antiviral medications early can ease your discomfort and reduce the duration of your symptoms.
A better approach to shingles is to take action and do what you can to lessen your risk of getting it. If you never had shingles or had a bout of them in the past, talk to your healthcare provider about getting the shingles vaccine. If you’ve never had chickenpox, talk with your healthcare provider about getting the chickenpox vaccine.
Is shingles dangerous or even fatal?
If shingles involves the eye, it can lead to blindness. In rare cases, shingles can lead to hearing problems, pneumonia, inflammation of the brain (encephalitis) and even death.
When is it safe to return to work if I have shingles?
You can return to work when you feel well enough to return AND you are no longer contagious. This means that your blistered rash has dried up and scabbed over. This usually takes up to 10 days from the time the rash first appears.
Why doesn’t having chickenpox earlier in life provide immunity against having shingles later?
After having chickenpox, your body does not rid your system of the virus. Instead, the virus stays in a portion of the spinal nerve root called the dorsal root ganglion. In most people, the virus simply stays there quietly and doesn’t cause problems. Scientists aren’t always sure why the virus gets active again, but they know stress can be a cause.
If I’ve been vaccinated for chickenpox, can I still develop shingles later in life?
Unfortunately, yes, despite being vaccinated for chickenpox, you can still get shingles. No vaccine is 100% protective and the effects of vaccines lessen with time. However, people who get the chickenpox vaccine are significantly less likely to develop shingles later in life compared with people who never received the chickenpox vaccine. One recent 12-year study found that the number of shingles cases was 72% lower in children who had received the chickenpox vaccine compared with those who did not.
Can I get shingles if I haven’t had chickenpox?
No. You can’t get shingles if you’ve never had chickenpox, but you can get chickenpox from someone who has shingles. If you’ve never had chickenpox and you come into direct contact with the oozing, blister-like rash of someone with shingles, the varicella-zoster virus can infect you and you would develop chickenpox.
Once you’ve had chickenpox, you could develop shingles at some point in your life. This is because the varicella-zoster virus never fully goes away after you’ve had chickenpox. It lies quietly “inactive” in your nerve tissue. Later in life, the virus may become active again and appears as shingles.
If I’ve had chickenpox once in my life can I get it again?
It’s rare to get chickenpox twice in your life. Once you’ve had chickenpox, you’re usually immune to it for the rest of your life. However, it’s not totally impossible. If you have a severely weakened immune system (because you’ve had an organ transplant, HIV, or cancer, for example), you can get chickenpox a second time. If you’ve had chickenpox, you are more likely to get shingles at some point in your life than a repeat bout of chickenpox.
Are there natural ways to boost the immune system to help lessen the chances of developing shingles?
Stress is a risk factor for developing shingles. So limiting your stress can be helpful. Try meditation, yoga or other relaxation methods. Eat healthy, maintain a healthy weight, exercise regularly, get seven to nine hours of sleep each night, don’t smoke – these are all good living tips, not just for reducing your chance of getting shingles, but also many other diseases and health conditions too.
What is the difference between herpes zoster and varicella zoster?
Herpes zoster is simply another medical name for shingles. Varicella zoster is the virus that causes both shingles and chickenpox.
Measles and shingles both produce a rash. Are these diseases related?
Although both diseases produce a rash, measles and shingles are completely different and unrelated diseases. Shingles is caused by the varicella-zoster virus and measles is caused by the rubeola virus.