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.
Referral to hospital
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 (you can catch chickenpox from someone with shingles if you have not had it before).
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
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.
Complications
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.
It's not always possible to prevent shingles, but a vaccine called Zostavax can reduce your chances of developing the condition. Zostavax is licensed for people aged 50 and above.
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 as part of the national vaccination programme they are most at risk of getting shingles, and also the group most likely to be very ill if they get it. 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 are 77, 78 or 79 on 1st September 2017 and is available up until your 80th birthday.
If you wish to have the shingles vaccine and you are not eligible for the NHS vaccination programme, discuss it with your GP who will make an individual clinical assessment to decide if the vaccine is indicated. You may need to visit a private clinic to have it as a private vaccination which is likely to cost £100-200.
Read more about the shingles vaccination.
Ophthalmic shingles
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:
- 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