Shingles

Condition Basics

What is shingles?

Shingles is a painful skin rash. It's caused by the varicella zoster virus. Shingles usually appears in a band, a strip, or a small area on one side of the face or body. It's also called herpes zoster.

Shingles is most common in older adults and people who have weak immune systems because of stress, injury, certain medicines, or other reasons. Most people who get shingles will get better and won't get it again. But it's possible to get shingles more than once.

What causes it?

Shingles occurs when the virus that causes chickenpox becomes active again in your body. After you've had chickenpox, the virus "sleeps" (is dormant) in your nerve roots. In some people, the virus "wakes up" when disease, stress, or aging weakens the immune system. Some medicines may trigger the virus.

What are the symptoms?

Shingles symptoms happen in stages. First you may have a headache, sensitivity to light, and flu-like symptoms. Later you may feel tingling or pain in an area on your body where a rash may occur a few days later. The rash then turns into blisters.

How is it diagnosed?

Doctors can usually diagnose shingles when they see an area of rash on the left or right side of your body. If the diagnosis isn't clear, your doctor may order tests on cells from a blister. If your doctor thinks that you have shingles, your doctor may not wait for tests before treating you.

How is shingles treated?

Shingles is treated with medicines. These medicines include antiviral medicines and medicines for pain. Treatment may shorten the illness and prevent other problems caused by shingles.

See your doctor right away if you think you may have shingles. Starting antiviral medicine right away can help your rash heal faster and be less painful. And you may need prescription pain medicine if your case of shingles is very painful. It's important to see your doctor right away if you have shingles near your eye or nose. Treatment can help prevent lasting eye damage.

Cause

Shingles occurs when the virus that causes chickenpox becomes active again in your body.

After you've had chickenpox, the virus "sleeps" (is dormant) in your nerve roots. In some people, it stays dormant forever. In others, the virus "wakes up." In this case, you may get a rash that occurs only in the area of the affected nerve.

The virus can become active again when disease, stress, or aging weakens the immune system. Some medicines may trigger the virus. It's not clear why this happens.

After the virus becomes active again, it can cause only shingles, not chickenpox. Anyone who has had even a mild case of chickenpox can get shingles. This includes children.

You can't catch shingles from someone who has shingles. But if you haven't had chickenpox or haven't gotten the chickenpox vaccine, you can get chickenpox if you come into contact with the fluid in the shingles blisters.

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What Increases Your Risk

Things that increase your risk for getting shingles include:

• Having had chickenpox. You must have had chickenpox to get shingles.
• Being older than 50.
• Having a weakened immune system due to another disease, such as diabetes or HIV infection.
• Experiencing stress or trauma.
• Having cancer or getting treatment for cancer.
• Taking medicines that affect your immune system, such as steroids or medicines that are taken after an organ transplant.

Prevention

A shingles vaccine helps prevent shingles. It is recommended for adults age 50 and older and for adults 19 and older who have a weakened immune system.

If you have shingles, avoid close contact with people until after the rash blisters heal. It's most important to avoid contact with people who are at special risk from chickenpox. This includes infants, people who are pregnant, and anyone who has never had chickenpox, is ill, or has a weak immune system. Also cover any fluid-filled blisters that are on a part of your body that isn't covered with clothes. Choose a type of bandage that absorbs fluid and protects the sores.

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Symptoms

Shingles symptoms happen in stages. At first you may have a headache or be sensitive to light. You may also have flu-like symptoms without a fever.

Later you may feel itching, tingling, or pain in a certain area. That's where a small area of rash may occur a few days later. It can appear anywhere on the body, but on only the left or the right side of the body. Piercing pain may occur along with the skin rash.

The rash turns into clusters of blisters. The blisters fill with fluid and then crust over. It takes 2 to 4 weeks for the blisters to heal, and they may leave scars. Some people get no rash at all.

Sometimes postherpetic neuralgia (PHN) develops. Symptoms can include pain or sensitivity to touch. PHN may last for months or years.

What Happens

Some people will have other problems from shingles. These can include:

• Postherpetic neuralgia (PHN). This is pain that does not go away for months or even years after shingles heals.
• Disseminated zoster. This is a blistery rash that spreads over the body and can affect the heart, lungs, liver, pancreas, joints, and intestinal tract.
• Cranial nerve problems. If shingles affects the nerves that start in the brain (cranial nerves), problems may include:
  • Inflammation, pain, and loss of feeling or vision in one or both eyes.
  • Intense ear pain and a rash around the ear, mouth, face, neck, and scalp.
  • Inflammation, and possibly blockage, of blood vessels, which may lead to stroke.
• Bacterial infection of the blisters.
• Muscle weakness in the area of the infected skin before, during, or after the episode of shingles.

Delaying or not getting medical treatment may increase your risk for problems.

When to Call a Doctor

Call your doctor now if you:

• Have a rash or blisters on your face, especially near an eye or on the tip of your nose. This can be a warning of eye problems. Treatment can help prevent permanent eye damage.
• Think you have shingles. Early treatment with antiviral medicines may help reduce pain and prevent complications of shingles, such as disseminated zoster or postherpetic neuralgia (PHN).

If you still feel intense pain for more than 1 month after the skin heals, see your doctor to find out if you have PHN. Getting your pain under control right away may prevent nerve damage that may cause pain that lasts for months or years.

Treatment Overview

Shingles is treated with medicines. There's no cure for shingles. But treatment can help your rash heal faster and be less painful. It may shorten the length of illness and prevent other problems. See your doctor right away if you think you may have shingles. This is very important if you have it near your eye or nose.

Common treatments

The most common treatments for shingles include:

• Antiviral medicines, such as acyclovir, famciclovir, or valacyclovir. They can reduce the pain and the duration of shingles.
• Over-the-counter pain medicines, such as acetaminophen or ibuprofen. They can help reduce pain during an attack of shingles. Be safe with medicines. Read and follow all instructions on the label.

Your doctor probably will start treatment with antiviral medicines. If you start taking medicines within the first 3 days of seeing the shingles rash, you have a lower chance of having later problems, such as postherpetic neuralgia (PHN). Early treatment can also reduce how long your symptoms last and how severe they are. It also can prevent lasting eye damage.

If you have pain that lasts longer than 3 months after your shingles rash heals, your doctor may diagnose postherpetic neuralgia (PHN). Treatment to reduce pain from PHN includes:

• Anti-seizure medicines, such as gabapentin or pregabalin.
• Antidepressant medicines, such as amitriptyline.
• Numbing medicines that are put on the skin, such as capsaicin and lidocaine.
• Other medicines that help treat pain.

Treatments for other problems caused by shingles

In some cases, shingles causes long-term problems. Treatment depends on what the problem is.

• Disseminated zoster. This is a blistery rash over a large portion of the body. It may affect the heart, lungs, liver, pancreas, joints, and intestinal tract. Treatment is done in the hospital. It may include antiviral medicines to prevent the virus from multiplying and antibiotics to stop infection.
• Herpes zoster ophthalmicus. This is a rash on the forehead, cheek, nose, and around one eye. It could threaten your sight. Get treatment from an ophthalmologist right away. Treatment may include antiviral medicines and steroid eye drops.
• If the shingles virus affects the nerves that begin in the brain (cranial nerves), serious problems involving the face, eyes, nose, and brain can occur. Treatment depends on what the problem is and where it is.

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Self-Care

• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. Antiviral medicine helps you get better faster.
• Try not to scratch or pick at the blisters.
• Keep the blisters moist until they heal over. One way to do this is to cover them with a thin layer of petroleum jelly, such as Vaseline, and a nonstick bandage.
• Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.
• Avoid close contact with people until the blisters have healed. It is very important for you to avoid contact with anyone who has never had chickenpox or the chickenpox vaccine. Young babies and anyone who is pregnant or has a hard time fighting infection (such as someone with HIV, diabetes, or cancer) are especially at risk.