Shingles, also known as herpes zoster, is an infection of a nerve and the area of skin around it. It is caused by the varicella-zoster virus, which also causes chickenpox.
It's estimated around one in every four people will have at least one episode of shingles during their life.
This topic covers:
Symptoms of shingles
The main symptom is pain followed by a rash which develops into itchy blisters, similar in appearance to chickenpox.
New blisters may appear for up to a week, but a few days after appearing they become yellowish in colour, flatten and dry out.
Scabs then form where the blisters were, which may leave some slight scarring and loss of skin pigment.
The pain may be a constant, dull or burning sensation, and its intensity can vary from mild to severe.
You may have sharp stabbing pains from time to time, and the affected area of skin will usually be tender.
In some cases shingles may cause some early symptoms that develop a few days before the painful rash first appears.
These early symptoms can include:
- a headache
- burning, tingling, numbness or itchiness of the skin in the affected area
- a feeling of being generally unwell
- a high temperature (fever)
An episode of shingles typically lasts around two to four weeks. It usually affects a specific area on just one side of the body.
It doesn't cross over the midline of the body, an imaginary line running from between your eyes down past the belly button.
Any part of your body can be affected, including your face and eyes, but the chest and tummy (abdomen) are the most common areas.
When to seek medical advice
Shingles is not usually serious, but you should see your GP as soon as possible if you recognise the symptoms. Early treatment may help reduce the severity of your symptoms and the risk of developing complications.
Your GP can usually diagnose shingles based on your symptoms and the appearance of the rash.
It's uncommon for someone with shingles to be referred to hospital, but your GP may consider seeking specialist advice if:
- they suspect a complication of shingles, such as meningitis or encephalitis
- shingles is affecting one of your eyes – there's a risk you could develop permanent vision problems if the condition isn't treated quickly
- a diagnosis isn't certain
- you have an unusually persistent case of shingles that's not responding to treatment
- you've been diagnosed with the condition twice
- you're pregnant
- you have a weakened immune system – particularly in severe cases or cases affecting children
What causes shingles?
Most people will have chickenpox as a child, but after the illness has gone, the virus remains dormant (inactive) in the nervous system. The immune system keeps the virus in check, but later in life it can be reactivated and cause shingles.
It's possible to have shingles more than once, but it's very rare to get it more than twice.
It is not known exactly why the shingles virus is reactivated at a later stage in life, but most cases are thought to be due to having lowered immunity (protection against infectious diseases).
This may be the result of:
- old age – as you age, your immunity may decrease; shingles most commonly occurs in people over the age of 70
- physical and emotional stress – the chemicals released by your body when you're stressed can prevent your immune system working properly
- HIV and AIDS – people with HIV are much more likely to get shingles than the rest of the population because their immune system is weak
- recently having a bone marrow transplant – the conditioning you require before the transplant weakens your immune system
- recently having an organ transplant – you may need to take medication to suppress your immune system so your body accepts the donated organ
- chemotherapy – chemotherapy medication, often used to treat cancer, can temporarily weaken your immune system
However, young people who are otherwise healthy can also sometimes develop shingles.
Is shingles contagious?
It is not possible to catch shingles from someone with the condition or from someone with chickenpox.
However, you can catch chickenpox from someone with shingles if you have not had it before.
Preventing the spread of the virus
If you have shingles, you're contagious until the last blister has dried and scabbed over.
To help prevent the virus being passed on, avoid sharing towels or flannels, swimming or playing contact sports. You should also avoid work or school if your rash is oozing fluid (weeping) and can't be covered.
Chickenpox can be particularly dangerous for certain groups of people. If you have shingles, avoid:
- women who are pregnant and haven't had chickenpox before as they could catch it from you – this may harm their unborn baby
- people who have a weak immune system – such as someone with HIV or AIDS
- babies less than one month old – unless it's your own baby, in which case your baby should have proteins that fight infection (antibodies) to protect them from the virus
There is no cure for shingles, but treatment is available to relieve the symptoms until the condition resolves.
Most cases of shingles last around two to four weeks.
Treatment for shingles can include:
- covering the rash with clothing or a non-adherent (non-stick) dressing to reduce the risk of other people becoming infected with chickenpox, as it is very difficult to pass the virus on to someone else if the rash is covered
- painkilling medication, such as paracetamol, ibuprofen or codeine
- antiviral medication to stop the virus multiplying, although not everyone will need this
Read more information about how shingles is treated.
Shingles can sometimes lead to complications, such as postherpetic neuralgia. This is where severe nerve pain lasts for more than three months after the rash has gone.
Complications such as this are usually in elderly people who have had the condition and those with a weakened immune system.
Read more about the complications of shingles.
The shingles vaccine
It's not always possible to prevent shingles, but a vaccine called Zostavax can reduce your chances of developing the condition.
If you still develop shingles after having this vaccine, the condition may be milder and last for a shorter time than usual.
This vaccine is now routinely offered to older people on the NHS. It is given as a single injection to anyone who has reached the age of 70 since the program started in 2013. There is also a catch up program for those who have reached the age of 78 or 79 since the program started in 2013. However, in both cases, you must also be under 80 on the day of vaccination.
If you wish to have the shingles vaccine and you are not eligible for the NHS vaccination programme, you will usually need to visit a private clinic. Private vaccination is likely to cost £100-200.
Read more about the shingles vaccination.
Some cases of shingles can affect one of the eyes and are known as ophthalmic shingles.
This occurs when the virus is reactivated in part of the trigeminal nerve, a nerve that controls sensation and movement in your face.
Symptoms can include:
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- a rash over your forehead, nose and around your eye
- conjunctivitis – inflammation of your eye that causes it to become red and watery, with a sticky coating on your eyelashes
- a red eye
- problems with your vision
There is no cure for shingles but treatment can help ease your symptoms until the condition improves. In many cases, shingles gets better within around two to four weeks.
However it's still important to see your GP as soon as possible if you recognise the symptoms of shingles. Early treatment may help reduce the severity of the condition and the risk of potential complications.
Staying off work or school
If you or your child has shingles, you only need to stay away from work or keep your child off school while:
- the rash is weeping (oozing fluid) and cannot be covered
- you or your child are feeling unwell
If the rash is only on your body and can be covered by clothing, there is little risk of passing the infection on to others.
If you develop the shingles rash there are a number of things you can do to help relieve your symptoms, such as:
- keep the rash as clean and dry as possible - this will reduce the risk of your rash becoming infected with bacteria.
- wear loose-fitting clothing - this may help you to feel more comfortable.
- do not use topical (rub-on) antibiotics or plasters (adhesive dressings) as this can slow down the healing process.
- use a non-adherent dressing (a dressing that will not stick to the rash) if you need to cover the blisters this prevents passing the virus to anyone else.
Calamine lotion has a soothing, cooling effect on the skin and can be used to relieve the itching.
If you have any weeping blisters, you can use a cool compress (a cloth or a flannel cooled with tap water) several times a day to help soothe the skin and keep blisters clean.
It's important to only use the compress for around 20 minutes at a time and stop using them once the blisters stop oozing. Don't share any cloths, towels or flannels if you have the shingles rash.
As well as painkilling medication, some people with shingles may also be prescribed a course of antiviral tablets lasting 7 days. Commonly prescribed antiviral medicines include aciclovir, valaciclovir and famciclovir.
This type of medicine cannot kill the shingles virus, but it can help to stop it multiplying. Antiviral medicine may:
Antiviral medicines are most effective when they are taken within 72 hours (three days) of your rash appearing. However, they may be started up to a week after your rash appears if you are at risk of severe shingles or developing complications.
Side effects of antiviral medication are very uncommon, but can include:
Who is prescribed antiviral medication?
If you are over 50 years of age, and you have the symptoms of shingles,
you will usually be prescribed an antiviral medication.
You may also be prescribed antiviral medication if you have:
- shingles that affects one of your eyes
- a weakened immune system
- moderate to severe pain
- a moderate to severe rash
Pregnancy and antiviral medication
If you are pregnant and have shingles, it is likely that your GP will discuss your case with a specialist to decide whether the benefits of antiviral medication significantly outweigh any possible risks. Shingles will not harm your unborn baby.
If you are under 50 years of age, you are at less risk of developing complications from shingles. You may not need antiviral medication, unless the pain can't be controlled by over-the-counter painkillers.
Antiviral medication is good at controlling pain in the first week or two of the rash.
Children and antiviral medication
Antiviral medication is not usually necessary for otherwise healthy children because children:
- usually only experience mild symptoms of shingles
- only have a small risk of developing complications
However, if your child has a weakened immune system, they may need to be admitted to hospital to receive antiviral medication directly into a vein (intravenously).
To ease the pain caused by shingles, your GP may prescribe a painkilling medicine. Some of the main medications used to relieve pain associated with shingles are described below.
The most commonly used painkiller is paracetamol, which is available over-the-counter (OTC) without a prescription. Always read the manufacturer’s instructions to make sure that the medicine is suitable for you and that you are taking the correct dose.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, are an alternative type of painkilling medicine, which are also available over-the-counter without prescription.
However, NSAIDs may not be suitable if you:
- have stomach, liver or kidney problems, such as a peptic ulcer or have had them in the past
- have asthma
- are pregnant or breastfeeding
Ask your GP or pharmacist if you are unsure about whether you should take NSAIDs.
For more severe pain, your GP may prescribe an opioid, such as codeine. This is a stronger type of painkiller which is likely to be prescribed alongside paracetamol.
Occasionally, your GP may consider seeking specialist advice before prescribing an even stronger opioid, such as morphine.
If you have severe pain as a result of shingles, you may be prescribed an antidepressant medicine.
Antidepressants are commonly used to treat depression, but they have also proven to be useful in relieving nerve pain.
The antidepressants most often used to treat shingles pain are known as tricyclic antidepressants (TCAs). Examples of TCAs most commonly prescribed for people with shingles are:
Side effects of tricyclic antidepressants may include:
If you have shingles, you will usually be prescribed a much lower dose of tricyclic antidepressants than if you were being treated for depression. This will usually be as a tablet to take at night. Your dose may be increased until your pain settles down. It may take several weeks before you start to feel the antidepressants working, although this is not always the case.
Anticonvulsants are most commonly used to control seizures (fits) caused by epilepsy, but they are also useful in relieving nerve pain.
Gabapentin and pregabalin are the most commonly prescribed anticonvulsant for shingles pain.
Side effects of these medications may include:
- increased appetite
- weight gain
- feeling sick
As with antidepressants, you may have to take an anticonvulsant for several weeks before you notice it working. If your pain does not improve, your dose may be gradually increased until your symptoms are effectively managed.
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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Complications of shingles are more likely to occur if you have a weakened immune system (the body’s natural defence system) or elderly.
Some of the main complications associated with shingles are described below.
Postherpetic neuralgia is the most common complication of shingles. It's not clear exactly how many people are affected, but some estimates suggest that as many as one in five people over 50 could develop postherpetic neuralgia as the result of shingles.
Postherpetic neuralgia can cause severe nerve pain (neuralgia) and intense itching that persists after the rash and any other symptoms of shingles have gone.
Types of pain experienced by people with postherpetic neuralgia include:
- constant or intermittent burning, aching, throbbing, stabbing or shooting pain
- allodynia, where you feel pain from something that should not be painful, such as changes in temperature or the wind
- hyperalgesia, where you are very sensitive to pain
Postherpetic neuralgia sometimes resolves after around three to six months, although it can last for years and some cases can be permanent. It may be treated with a number of different painkilling medicines.
See postherpetic neuraligia for more information.
If one of your eyes is affected by shingles (ophthalmic shingles), there is a risk you could develop further problems in the affected eye, such as:
- ulceration (sores) and permanent scarring of the surface of your eye (cornea)
- inflammation of the eye and optic nerve (the nerve that transmits signals from the eye to the brain)
- glaucoma – where pressure builds up inside the eye
If not treated promptly, there is a risk that ophthalmic shingles could cause a degree of permanent vision loss.
Ramsay Hunt syndrome
Ramsay Hunt syndrome is a complication that can occur if shingles affects certain nerves in your head. In America, Ramsay Hunt syndrome is estimated to affect 5 in 100,000 people every year and it may affect a similar number of people in the UK.
Ramsay Hunt syndrome can cause:
- hearing loss
- vertigo (the sensation that you or the environment around you is moving or spinning)
- tinnitus (hearing sounds coming from inside your body rather than from an outside source)
- a rash around the ear
- loss of taste
- paralysis (weakness) of your face
Ramsay Hunt syndrome is usually treated with following medications:
The earlier treatment is started, the better the outcome. Around three-quarters of people who are given antiviral medication within 72 hours (three days) of the start of their symptoms usually make a complete recovery. If treatment is delayed, only about half of those treated will recover completely.
Those who don't make a full recovery may be left with permanent problems, such as a degree of permanent facial paralysis or hearing loss.
A number of other possible problems can also sometimes develop as a result of shingles, including:
- the rash becoming infected with bacteria – see your GP if you develop a high temperature, as this could be a sign of a bacterial infection
- white patches (a loss of pigment) in the area of the rash
- inflammation of the lungs (pneumonia), liver (hepatitis), brain (encephalitis), spinal cord (transverse myelitis), or protective membranes that surround the brain and spinal cord (meningitis) – these complications are rare, however
Shingles is rarely life threatening, but complications such as those mentioned above mean that around 1 in every 1,000 cases in adults over the age of 70 is fatal.
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Last Updated: 31/08/2016 07:43:45