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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.

Shingles usually affects a specific area on one side of the body and does not cross over the midline of the body (an imaginary line running from between your eyes, down past the belly button). The main symptom is a painful rash which develops into itchy blisters that contain particles of the virus. 

An episode of shingles typically lasts around two to four weeks, although around one in five people go on to develop nerve pain called postherpetic neuralgia in the affected area of skin.

Read more about the symptoms of shingles.

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.

You should also see your GP if you are pregnant or have a weakened immune system (the body's natural defence system) and you think you have been exposed to someone with chickenpox or shingles and haven't had chickenpox before.

Your GP can usually diagnose shingles based on your symptoms and the appearance of the rash.

Read more information about diagnosing shingles.

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 (the body’s natural defence system) keeps the virus in check, but later in life it can be reactivated and cause shingles.

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:

  • being older
  • being stressed
  • a condition that affects your immune system, such as HIV and AIDS

It is not possible to catch shingles from someone with the condition or from someone with chickenpox, but you can catch chickenpox from someone with shingles if you have not had it before. It is possible to have shingles more than once, but it's very rare to get it more than twice.

Read more information about the causes of shingles.

Who is affected?

Around 9 in every 10 adults in the UK have had chickenpox previously and are potentially at risk of developing shingles.

Shingles can occur at any age, but is most common in people who are over 70 years of age. Shingles is much less common in children.

It's estimated that around one in every four people will have at least one episode of shingles during their life.

Treating shingles

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.

Can shingles be prevented?

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.

Is shingles contagious?

You can’t give shingles to someone else, and you can’t catch shingles from someone with shingles.

However, shingles and chickenpox are caused by the same virus and you can catch chickenpox from someone with shingles, but only if you’ve never had chickenpox before.

Shingles develops when the virus from a chickenpox infection earlier in life, which has lain dormant (inactive) in nerve cells, suddenly reactivates.

The blisters that form contain live virus and if a person who has never had chickenpox makes contact with an open blister, they can contract the virus and develop chickenpox.

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An episode of shingles usually lasts for between 2-4 weeks. The main symptoms are pain, followed by a rash.

Any part of your body can be affected, including your face and eyes, although the chest and abdomen (tummy) are the areas most commonly affected.

Early symptoms

In some cases, shingles may cause some early (prodromal) 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)

Not everyone will experience these prodromal symptoms. In particular, a high temperature is uncommon.


Eventually, most people with shingles experience a localised 'band' of pain in the affected area.

The pain can 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.

Pain is less common in young, healthy people and is rare in children.  It usually starts a few days before the rash appears and can remain for a few days or weeks after the rash has healed.


The shingles rash usually appears on one side of your body and develops in the area of skin that is related to the affected nerve.

Initially, the shingles rash appears as red blotches on your skin. It then 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. It usually takes two to four weeks for the rash to heal completely.

Seek medical attention

Shingles is not usually serious, but 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.

You should also see your GP if you are pregnant or have a weakened immune system (the body's natural defence system) and you think you have been exposed to someone with chickenpox or shingles and haven't had chickenpox before.

Ophthalmic shingles

Symptoms of ophthalmic shingles can include:

  • a rash over your forehead, nose and around your eye
  • headache
  • conjunctivitis - inflammation (redness and swelling) of part of your eye that causes your eye to become red and watery with a sticky coating on your eyelashes
  • a red eye
  • problems with your vision
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Shingles is caused by the reactivation of the varicella-zoster virus, which is the virus that causes chickenpox.

After you have had chickenpox, the varicella-zoster virus lies dormant (inactive) inside your body. It can become reactivated at a later stage and cause shingles.

It is not known exactly how the virus is reactivated, but it may be linked to having lowered immunity (protection against infection and diseases).

Your immunity to illness and infection can become lowered if there is a problem with your immune system (the body’s natural defence system). This can happen as a result of:

  • old age - as you age, your immunity may decrease, and shingles most commonly occurs in people over 70 years old.
  • physical and emotional stress - the chemicals released by your body when you are stressed can prevent your immune system from 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 receive before the transplant will weaken 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 appear otherwise healthy can also sometimes develop shingles.

Is shingles contagious?

It is not possible to catch shingles from someone else with the condition, or from someone with chickenpox. However, it is possible for someone who has never had chickenpox to catch chickenpox from someone with shingles, as the shingles blisters contains the live virus.

In the UK, chickenpox is so common during childhood that 9 out of 10 adults have already had it and will not be at risk from someone with shingles.

Catching chickenpox

The blisters (vesicles) that develop as a result of shingles contain virus particles. If you have not had chickenpox before, you can catch it from direct contact with:

  • the fluid from the blisters of someone who has shingles
  • something that has the fluid on it, such as bed sheets or a towel

If you have shingles, you are contagious until the last blister has scabbed over. This will usually occur after about 10 to 14 days.

Spreading the virus

If you have the shingles rash, do not:

  • share towels or flannels
  • go swimming
  • play contact sports

This will help prevent the virus being passed on to someone who has not had chickenpox.

People to avoid

You should also avoid work or school if your rash is weeping (oozing fluid) and cannot be covered.

Chickenpox can be particularly dangerous for certain groups of people. If you have shingles, avoid:

  • women who are pregnant and have not had chickenpox before, as they could catch chickenpox from you, which 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 is your own baby, in which case your baby should have antibodies (proteins that fight infection) to protect them from the virus

Once your blisters have dried and scabbed over, you are no longer contagious and will not need to avoid anyone.

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Your GP can normally diagnose shingles from your symptoms and the appearance of your rash. Testing will not normally be necessary.


It is uncommon for someone with shingles to be referred to a specialist for further assessment and treatment, but your GP may consider seeking specialist advice or refering you if:

  • they think you may have a complication of shingles, such as meningitis or encephalitis
  • shingles is affecting one of your eyes – there is a risk you could develop permanent vision problems if the condition is not treated quickly
  • you have a weakened immune system – particularly in severe cases or cases affecting children
  • you are pregnant
  • a diagnosis is not certain

You may also be referred to a specialist if you have an unusually persistent case of suspected shingles that is not responding to treatment, or if you have been diagnosed with the condition more than twice.

Who might I see?

Who you are referred to will depend on your circumstances. It could be:

  • a paediatrician, who specialises in the care of babies and children (if your child is affected)
  • an ophthalmologist (a doctor who specialises in treating eye conditions), if shingles is affecting one of your eyes
  • your own consultant (a specialist in a particular area of medicine) if you have one for an existing medical condition, for example HIV or AIDS
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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.

Self care

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.

Antiviral medication

As well as painkilling medication, some people with shingles may also be prescribed a course of antiviral tablets lasting 7 to 10 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, it is likely that you will be prescribed an antiviral medicine. You may also be prescribed antiviral medication if you have:

  • shingles that affects one of your eyes (ophthalmic shingles)
  • 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. If this is the case, you may not need antiviral medication.

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).

Painkilling medication

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 in adults, your GP may prescribe a weak 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, such as the pain caused by shingles. 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:

  • amitriptyline
  • imipramine
  • nortriptyline

Side effects of tricyclic antidepressants may include:

  • constipation
  • difficulty urinating
  • blurred vision
  • dry mouth
  • weight gain
  • drowsiness

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:

  • dizziness
  • drowsiness
  • increased appetite
  • weight gain
  • feeling sick
  • vomiting

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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A number of complications can sometimes occur as a result of shingles.  They are more likely to occur if you have a weakened immune system (the body’s natural defence system) or if you are elderly.

Some of the main complications associated with shingles are described below.

Postherpetic neuralgia

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.

Eye problems

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:

  • earache
  • hearing loss
  • dizziness
  • 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, known as Bell's palsy

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.

Other complications

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
  • scarring
  • 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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The Shingles vaccination which was introduced on the 1 September 2013 is now offered routinely as part of the NHS vaccination programme for those aged 70, 78 and 79. Eligibility for this vaccine is based on a person’s age on that date (see below).

How effective is the vaccination?

Vaccination will reduce your chances of developing shingles by more than a third. And, if you do go on to have shingles it will probably be a milder and shorter illness.

Who will get the vaccine?

Each year the vaccination program runs from the 1st of April until the 31st of March. To be eligible for a vaccination in any one year, you must have had your 70th birthday by the 1st of September in that year. Once elligible, you can have the vaccine anytime before your 80th birthday.

Any person who has met the eligibility criteria since the programme started on 1 September 2013 and who has not yet received the vaccination may receive it up to the day before their 80th birthday.

Currently, there is also a catch up campaign for those reaching the age of 78.

In summary, for any April-March period you can have the vaccination  if:

  • those who are 70, 78 or 79 on 1st September 2015 (but not yet 80) and
  • those who were 70 on 1st September 2013, and those who were 70 on 1st September 2014 but remain unvaccinated are still eligible

Once the catch up programme is complete, vaccination will be offered to individuals as they reach 70 years of age.

What about people outside the 70 to 79 age group?

Shingles is less common in younger people, and those aged under 70 will not routinely get the vaccine.

The vaccine is less effective as people get older and people aged 80 and over will not be routinely vaccinated.

Do I need to do anything to get the vaccination?

Your GP will invite you for the vaccination. You can have it at any time of year, including at the same time as your flu jab in the autumn. If you think you may have missed your invitation, contact your GP surgery.

Where is the vaccination given and will I need one every year?

Most people will have the vaccine at their GP surgery.

The vaccine will be given in your upper arm. You only need one vaccination, you do not need it every year.

Is shingles serious?

Yes, it can be. Not only can shingles be very painful and uncomfortable, some people are left with long-lasting pain called postherpetic neuralgia (PHN) for years after the initial rash has healed. Very occasionally, shingles can be fatal.

How common is shingles?

It's estimated that around one in five people who have had chickenpox (usually in childhood) go on to develop shingles. That means that tens of thousands of people in England and Wales will get shingles each year.

Will there be any side effects from the shingles vaccination?

It's quite common to experience redness and discomfort at the vaccination site as well as headaches, but these side effects shouldn't last more than a few days. See your GP if you have persistent side effects, or if you develop a rash after having the shingles vaccination.

What about people who aren't yet 70? Will they get the shingles vaccine?

People under the age of 70 will get the shingles vaccine during the year following their 70th birthday. It's not available on the NHS to younger people, because shingles is more common in the over-70s.

Why can't I have the shingles vaccination if I'm over 80?

The vaccine doesn't work as well as people get older.

Will the shingles vaccine stop me getting shingles?

It won't guarantee that you won't get shingles, but it will reduce your chances. And, if you do get shingles, the vaccine will likely make the symptoms milder and the illness shorter. You'll also be less likely to get shingles complications such as postherpetic neuralgia.

Do I need the shingles vaccine if I've never had chickenpox?

Yes. The chances are that you have had chickenpox at some point without knowing it. Some people have chickenpox without displaying any of the typical chickenpox symptoms like rash.

Should I have the shingles vaccine if I've already had shingles?

Yes. The shingles vaccine works very well in people who have had shingles before and it will boost your immunity against further shingles attacks.

Are there people who shouldn’t have the vaccination?

People who have a weakened immune system, for example due to current cancer treatment, should not have the vaccine. Also anyone who has had a severe reaction to anything used in the vaccine shouldn’t have it. Your GP or practice nurse will check this.

Read more about the shingles vaccine.

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Selected links

NHS Direct Wales links



Peripheral neuropathy

External Links

Patient UK: Shingles

Public Health Wales: Shingles


"Shingles vaccination for those aged 70 to 79" (pdf) A Welsh Government Leaflet

Shingles Q&A for Health Professionals (pdf) Welsh Government Leaflet


Protect yourself against the pain of Shingles (Public Health Wales)


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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 05/04/2016 09:31:32

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