Shingles, or herpes zoster, is a common infection of the nerves. It is caused by a virus.

Shingles triggers a painful rash or small blisters on an area of skin. It can appear anywhere on the body, but it typically appears on only one side of the face or body. Burning or shooting pain and tingling or itching are early signs of the infection. Even after the rash is gone, the pain can continue for months, even years.

What causes shingles?

Shingles is caused when the chickenpox virus is reactivated. After a person has had chickenpox, the virus lies dormant in certain nerves for many years. Shingles is more common in people with weakened immune systems, and in people over the age of 50.

What are the symptoms of shingles?

However, each person may experience symptoms differently. Symptoms may include:

• Skin sensitivity, tingling, itching, and/or pain in the area of the skin before the rash appears
• Rash, which typically appears after 1 to 5 days once symptoms begin and initially looks like small, red spots that turn into blisters
• Blisters typically scab over in 7 to 10 days and clear up within 2 to 4 weeks 

Other early symptoms of shingles may include:

• Stomach upset
• Feeling ill
• Fever and/or chills
• Headache

The symptoms of shingles may look like other medical conditions or problems. Always talk with your healthcare provider for a diagnosis.

How is shingles diagnosed?

Your healthcare provider will do a complete physical exam and ask about your medical history, specifically about whether you have ever had chickenpox.

Your healthcare provider will likely know right away that it is shingles based on the unique rash. The rash usually appears one area on one side of the body or face. It appears as red spots, small fluid- or pus-filled vesicles, or scabs.

The healthcare provider may also take skin scrapings for testing.

How is shingles treated?

Specific treatment for shingles will be determined by your healthcare provider based on:

• Your age, overall health, and medical history
• How long the shingles have been present (some medicines are not as effective if given more than 2 to 3 days after the rash has appeared)
• Extent of the condition
• Your tolerance for specific medicines, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference

There is no cure for shingles. It simply has to run its course. Treatment focuses on pain relief. Painkillers may help relieve some of the pain. Antiviral drugs may help lessen some of the symptoms and reduce nerve damage. Other treatments may include:

• Creams or lotions to help relieve itching
• Cool compresses applied to affected skin areas
• Antiviral medicines (such as acyclovir, valacyclovir, and famciclovir)
• Steroids
• Antidepressants
• Anticonvulsants

What are the complications of shingles?

Symptoms of shingles usually don’t last longer than 3 to 5 weeks. However, complications can happen. The main complications that can result from shingles include:

• Postherpetic neuralgia (PHN). The most common complication of shingles is called postherpetic neuralgia (PHN). This continuous, chronic pain lasts even after the skin lesions have healed. The pain may be severe in the area where the blisters were present. The affected skin may be very sensitive to heat and cold.
• If you had severe pain during the active rash or have impaired senses, you are at increased risk for PHN. The elderly are also at greater risk. Early treatment of shingles may prevent PHN. Pain relievers and steroid treatment may be used to treat the pain and inflammation. Other treatments include antiviral drugs, antidepressants, anticonvulsants, and topical agents.
• Bacterial infection. A bacterial infection of the skin where the rash happens is another complication. Rarely, infections can lead to more problems, such as tissue death and scarring. When an infection happens near or on the eyes, a corneal infection can happen. This can lead to temporary or permanent blindness.

Can shingles be prevented?

There is a vaccine available to prevent shingles. The vaccine is called Zostavax. It’s advised for healthy adults 60 years of age and older, though there is some literature that supports starting the vaccine in patients 50 years of age and older. Talk with your healthcare provider about the most appropriate time for you to get vaccinated. The vaccine has been found to reduce the number of episodes of shingles and the incidence of PHN in older adults.

When should I call my healthcare provider?

To reduce the severity and shorten the length of the illness, treatment must be started as soon as possible. If you think you have shingles, call your healthcare provider as soon as possible.

Key points about shingles

• Shingles is a common viral infection of the nerves. It causes a painful rash or small blisters on an area of skin.
• Shingles is caused when the chickenpox virus is reactivated.
• It is more common in people with weakened immune systems, and in people over the age of 50.
• Shingles starts with skin sensitivity, tingling, itching, and/or pain followed by rash that looks like small, red spots that turn into blisters.
• The rash is typically affects just one area on one side of the body or face.
• Treatment that is started as soon as possible helps reduce the severity of the disease.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.