Shingles in the scalp

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Summit Medical Group Web Site

What is shingles?

Shingles is a painful skin rash caused by the same virus that causes chickenpox.

Shingles is also called herpes zoster. This illness is most common in people over 50 years old.

What is the cause?

The virus that causes chickenpox and shingles is called varicella zoster. After you recover from chickenpox, the virus stays in your body but it is inactive. The virus can become active again at any time in your life and cause shingles if your body’s immune system is weakened by things like:

  • Illness
  • Aging
  • Chemotherapy or radiation
  • Certain medicines, such as steroids

Your risk for getting shingles may be higher if:

  • You have been under a lot of stress.
  • You have a poor diet.
  • You have been sunburned.

Sometimes shingles happens for no known reason.

You cannot have shingles unless you have already had chickenpox, and you cannot get shingles from someone else. However, a person with shingles can transmit chickenpox to a person who has never been exposed to the chickenpox virus. The virus is spread by contact with the blisters. The blisters are no longer contagious after they dry up and form scabs.

What are the symptoms?

The first symptoms may include:

  • Burning, sharp pain; tingling; or numbness in your skin on one side of your body, head, or face
  • Severe itching or aching
  • Feeling tired
  • Feeling sick with fever, chills, headache, and upset stomach or belly pain

One to 14 days after you start feeling pain, you will notice a rash of small blisters on reddened skin. Within a few days after the rash appears, the blisters will turn yellow, then dry up and form scabs. Over the next 2 weeks the scabs drop off, and the skin heals over the next several days to weeks.

The blisters are usually found in a path, often extending from the back or side around to the middle of the belly. The blisters are usually on just one side of the body. They may also appear on one side of your face or scalp. The painful rash may be in the area of your ear or eye. When shingles occurs on the head or scalp, it may cause weakness of one side of the face, making that side of the face look droopy.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. The diagnosis is usually obvious from the symptoms and the rash. If your provider wants to confirm the diagnosis, you may have lab tests to look for the virus in fluid from a blister.

How is it treated?

Several medicines can help treat shingles. Your healthcare provider may give you:

  • Antiviral medicine to help you heal faster
  • Pills or ointment to help relieve pain
  • Antibacterial medicine to put on the rash and help prevent bacterial infection of the blisters

For most people the pain of shingles goes away in the first month or two after the blisters heal. If you have shingles on your head or scalp, it may take longer for the pain to go away. Sometimes the virus damages a nerve. This can cause pain, numbness, or tingling for months or even years after the rash is healed and is called postherpetic neuralgia. The older you are when you have shingles, the more likely it is that you will have postherpetic neuralgia. Taking antiviral medicine as soon as shingles is diagnosed may help prevent this problem.

How can I take care of myself?

Here are some things you can do to help relieve pain:

  • Take a pain-relief medicine such as acetaminophen. Take other medicine as prescribed by your healthcare provider.
  • Put cool, moist washcloths on the rash.
  • Try not to let clothing or bed linens rub against the rash and irritate it.

Rest in bed if you have fever and other symptoms of illness.

Ask your healthcare provider:

  • How and when you will hear your test results
  • How long it will take to recover from this illness
  • What activities you should avoid and when you can return to normal activities
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

How can I help prevent shingles?

If you have never had chickenpox, you can get a shot to help prevent infection with the chickenpox virus. Most children now get shots to prevent chickenpox.

If you are 50 or older, you can get a different shot that helps prevent shingles. This shot is recommended for people 60 years of age and older. The shingles shot does not always prevent shingles. However, if you do get shingles sometime after you got the shot, you may have less pain. The shingles shot is not used to treat shingles once you have it.

You can also lessen your chances of getting shingles by trying to keep stress under control, exercising regularly, and eating a healthy diet.

If you have shingles, make sure that anyone who has not had chickenpox or the chickenpox shot does not come into close contact with you until the blisters are completely dry. You are no longer contagious after the blisters dry up and form scabs.

Shingles (herpes zoster) results from a reactivation of the virus that also causes chickenpox. With shingles, the first thing you may notice is a tingling sensation or pain on one side of your body or face. Painful skin blisters then erupt on only one side of your face or body along the distribution of nerves on the skin. Typically, this occurs along your chest, abdomen, back, or face, but it may also affect your neck, limbs, or lower back. The area can be very painful, itchy, and tender. The blisters are contagious with skin to skin contact, After one to two weeks, the blisters heal and form scabs, although the pain may continue.

The deep pain that follows after the infection has run its course is known as post herpetic neuralgia. It can continue for months or even years, especially in older people. The incidence of shingles and of post herpetic neuralgia rises with increasing age. More than 50% of cases occur in people over 60. Shingles usually occurs only once, although it has been known to recur in some people. Read more and learn about a vaccine for shingles.

Shingles

What Is Shingles?

Read and share this infographic to learn more about shingles.

Shingles is a disease that affects your nerves. It can cause burning, shooting pain, tingling, and/or itching, as well as a rash and blisters.

You may recall having chickenpox as a child. Shingles is caused by the same virus, the varicella-zoster virus (VZV). After you recover from chickenpox, the virus continues to live in some of your nerve cells. It is usually inactive, so you don’t even know it’s there.

In fact, most adults live with VZV in their bodies and never get shingles. But, for about one in three adults, the virus will become active again. Instead of causing another case of chickenpox, it produces shingles. We do not totally understand what makes the virus go from inactive to active.

Having shingles doesn’t mean you have any other underlying disease.

How Do You Get Shingles?

Everyone who has had chickenpox has VZV in their body and is at risk for getting shingles. Right now, there is no way of knowing who will get the disease. But, some things make it more likely:

  • Advanced age. The risk of getting shingles increases as you age. People may have a harder time fighting off infections as they get older. About half of all shingles cases are in adults age 60 or older. The chance of getting shingles becomes much greater by age 70.
  • Trouble fighting infections. Your immune system is the part of your body that responds to infections. Age can affect your immune system. So can an HIV infection, cancer, cancer treatments, too much sun, or organ transplant drugs. Even stress or a cold can weaken your immune system for a short time. These all can put you at risk for shingles.

Can You Catch Shingles?

Shingles is not contagious. You can’t catch it from someone. But, you can catch chickenpox from someone with shingles. So, if you’ve never had chickenpox, try to stay away from anyone who has shingles.

If you have shingles, try to stay away from anyone who has not had chickenpox or who might have a weak immune system.

What Are the Symptoms of Shingles?

Usually, shingles develops only on one side of the body or face and in a small area rather than all over. The most common place for shingles is a band that goes around one side of your waistline.

Most people have some of the following shingles symptoms:

  • Burning, tingling, or numbness of the skin
  • Feeling sick—chills, fever, upset stomach, or headache
  • Fluid-filled blisters
  • Skin that is sensitive to touch
  • Mild itching to strong pain

Depending on where shingles develops, it could also cause symptoms like hiccups or even loss of vision.

For some people, the symptoms of shingles are mild. They might just have some itching. For others, shingles can cause intense pain that can be felt from the gentlest touch or breeze.

How Long Does Shingles Last?

Most cases of shingles last 3 to 5 weeks. Shingles follows a pattern:

  • The first sign is often burning or tingling pain; sometimes, it includes numbness or itching on one side of the body.
  • Somewhere between 1 and 5 days after the tingling or burning feeling on the skin, a red rash will appear.
  • A few days later, the rash will turn into fluid-filled blisters.
  • About a week to 10 days after that, the blisters dry up and crust over.
  • A couple of weeks later, the scabs clear up.

Most people get shingles only one time. But, it is possible to have it more than once.

Long-Term Pain and Other Lasting Problems

After the shingles rash goes away, some people may be left with ongoing pain called post-herpetic neuralgia or PHN. The pain is felt in the area where the rash had been. For some people, PHN is the longest lasting and worst part of shingles. The older you are when you get shingles, the greater your chance of developing PHN.

The PHN pain can cause depression, anxiety, sleeplessness, and weight loss. Some people with PHN find it hard to go about their daily activities, like dressing, cooking, and eating. Talk with your doctor if you have any of these problems.

There are medicines that may help with PHN. Steroids may lessen the pain and shorten the time you’re sick. Analgesics, antidepressants, and anticonvulsants may also reduce the pain. Usually, PHN will get better over time.

Some people have other problems that last after shingles has cleared up. For example, the blisters caused by shingles can become infected. They may also leave a scar. It is important to keep the area clean and try not to scratch the blisters. Your doctor can prescribe an antibiotic treatment if needed.

See your doctor right away if you notice blisters on your face—this is an urgent problem. Blisters near or in the eye can cause lasting eye damage or blindness. Hearing loss, a brief paralysis of the face, or, very rarely, swelling of the brain (encephalitis) can also occur.

Have a Rash? Go to the Doctor

If you think you might have shingles, talk to your doctor as soon as possible. It’s important to see your doctor no later than 3 days after the rash starts. The doctor will confirm whether or not you have shingles and can make a treatment plan. Although there is no cure for shingles, early treatment with drugs that fight the virus can help the blisters dry up faster and limit severe pain. Shingles can often be treated at home. People with shingles rarely need to stay in a hospital.

Should You Get the Shingles Vaccine?

The shingles vaccine is safe and easy, and it may keep you from getting shingles and PHN. Healthy adults age 50 and older should get vaccinated with a shingles vaccine called Shingrix. It is given in two doses, 2 to 6 months apart. Shingrix is preferred over Zostavax, an older shingles vaccine. Zostavax may still be used to prevent shingles in healthy adults age 60 and older. For example, you could use Zostavax if a person is allergic to Shingrix, prefers Zostavax, or requests immediate vaccination and Shingrix is not available.

You should try to get the second dose of Shingrix between 2 and 6 months after you got the first dose. If your doctor or pharmacist is out of Shingrix, you can use the Vaccine Finder to help find other providers who have Shingrix. You can also contact pharmacies in your area and ask to be put on a waiting list for Shingrix. If it’s been more than 6 months since you got the first dose, you should get the second dose as soon as possible. You don’t need to get a first dose again.

You should get Shingrix even if you have already had shingles, received Zostavax, or don’t remember having had chickenpox. However, you should not get Shingrix if you have a fever or illness, have a weakened immune system, or have had an allergic reaction to Shingrix. Check with your doctor if you are not sure what to do.

You can get the shingles vaccine at your doctor’s office and at some pharmacies. All Medicare Part D plans and most private health insurance plans will cover the cost.

What Can You Do About Shingles?

If you have shingles, here are some tips that might help you feel better:

  • Get plenty of rest and eat well-balanced meals.
  • Try simple exercises like stretching or walking. Check with your doctor before starting a new exercise routine.
  • Apply a cool washcloth to your blisters to ease the pain and help dry the blisters.
  • Do things that take your mind off your pain. For example, watch TV, read, talk with friends, listen to relaxing music, or work on a hobby you like.
  • Avoid stress. It can make the pain worse.
  • Wear loose-fitting, natural-fiber clothing.
  • Take an oatmeal bath or use calamine lotion to see if it soothes your skin.
  • Share your feelings about your pain with family and friends. Ask for their understanding.

Also, you can limit spreading the virus by:

  • Keeping the rash covered
  • Not touching or scratching the rash
  • Washing your hands often

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Shingles

National Shingles Foundation
1-212-222-3390

This content is provided by the National Institute on Aging (NIA), part of the National Institutes of Health. NIA scientists and other experts review this content to ensure that it is accurate, authoritative, and up to date.

Content reviewed: October 29, 2018

Shingles: Overview

Shingles

What is shingles?
Most people who get this disease develop a painful, blistering rash.

Is it contagious?
Yes, but you cannot give anyone shingles. While you have blisters, you can spread a virus. If that virus infects someone who hasn’t had chickenpox (or the chickenpox vaccine), the person can get chickenpox.

If you had chickenpox, the virus that caused it is still inside your body. When the chickenpox cleared, the virus moved from your skin to your nerves.

Should this virus travel back to your skin, you will get shingles instead of chickenpox.

Get medical care for shingles immediately

If you have a blistering rash, you want to see a doctor as soon as possible. Should you have shingles, starting prescription medication within 2 to 3 days of developing the rash can dramatically:

  • Reduce your symptoms, such as pain

  • Lessen the amount of time you have shingles

  • Lower your risk of developing other health problems, such as a condition called postherpetic neuralgia, which is pain that can linger for months or years after the rash clears

If you’ve had the rash for longer than 2 or 3 days, it’s still important to see a doctor. Shingles can lead to other health problems aside from long-lasting pain. For example, when the shingles rash develops on your face, it can affect your eyesight. Treatment can save your eyesight.

A few people who get shingles develop pneumonia, hearing loss, or a disease that causes the brain to swell (encephalitis). It’s important to find signs of these early, so that you can receive treatment.

When you see your doctor, you may hear the medical term “herpes zoster.” This is the medical name for shingles.

Get medical care immediately

Getting medical treatment within 3 days of developing the shingles rash can greatly reduce your risk of developing long-lasting pain.

Herpes zoster differs from other types of herpes

Hearing the word “herpes” can be confusing. Herpes zoster (also called zoster) is not a sexually transmitted infection (STI). It cannot cause genital herpes. Herpes zoster also doesn’t cause cold sores. Both genital herpes and cold sores are caused by the herpes simplex virus.

The virus that causes shingles and chickenpox is called the varicella-zoster virus. It’s common.

Millions get shingles each year

Doctors diagnose more than 1 million cases of shingles in the United States every year.1 Many of these people are surprised to find out that they have shingles because they don’t remember having had chickenpox. Chickenpox can be very mild. You may have had it when you were too young to remember.

If you were born before 1980, you have a greater than 99% chance of having had chickenpox, according to the Centers for Disease Control and Prevention (CDC).

Anyone who has had chickenpox can get shingles.

Shingles vaccine can prevent shingles and related health problems

A vaccine can reduce your risk of developing shingles and possible health problems that can follow.

Because shingles usually develops in people who are 50 or older, the CDC recommends that every healthy adult who is 50 years of age or older get the recombinant zoster vaccine (Shingrix®).

In the clinical trials required to approve this vaccine, researchers found that it to be extremely effective. The Shingrix® vaccine reduced the risk of developing shingles by:

  • 96.6% in people 50-59 years old

  • 97.4% in people 60-69 years old

  • 91.3% in people 70 or older 2

Shingles is contagious

Getting the shingles vaccine can also greatly reduce your risk of infecting others. While you have shingles blisters, you can spread the virus to others.

You cannot give anyone shingles; however, someone who hasn’t had chickenpox can get chickenpox. Anyone who has gotten the chickenpox vaccine has much less risk of developing chickenpox.

Because you are contagious while you have shingles blisters, it’s extremely important to keep the rash covered and stay away from:

  • Pregnant women

  • Babies younger than 12 months

  • Anyone who is sick, especially with cancer or AIDS

  • Everyone who has not had chickenpox

If you have shingles, you may have more than a rash on your skin. You’ll find the symptoms of shingles along with pictures of the rash at, Shingles: Signs and symptoms.

1Centers for Disease Control and Prevention. “Shingles (herpes zoster): Overview.” Page lasted updated 1/19/2018. Last accessed 4/1/2019.

2Dooling KL, Guo A, et al. “Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines.” Morb Mortal Wkly Rep 2018;67:103-8.

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Getty Images

Centers for Disease Control and Prevention (CDC). About shingles. Page last reviewed 10/17/2017. Last accessed 4/1/2019.

Dooling KL, Guo A, et al. “Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines.” Morb Mortal Wkly Rep 2018;67:103-8.

Straus SE, Oxman MN. “Varicella and herpes zoster.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1885-98.

Why It’s Important for Young Adults to Look Out for These Shingles Symptoms

Have you ever had chickenpox? If the answer is yes, then the virus that causes shingles (the varicella-zoster virus) is present in your body. Right now, it’s most likely lying inactive. But at some point in the future, it could resurface, traveling from your nerves to your skin and causing an eruption of painful blisters forming a shingles rash.

Don’t worry, it’s not uncommon—nearly one in three people in the U.S. will get shingles during their lifetime. Scientists aren’t sure why some of us go on to develop shingles and others don’t, but people with weakened immune systems, like those with HIV or lupus, are more likely to get a shingles rash. Stress or trauma can also play a role.

RELATED: I Got Shingles as a Healthy 34-Year-Old, and It Was the Worst Pain I’ve Ever Felt

Shingles has long been thought of as an infection that mostly affects older adults, specifically those between the ages of 60 and 80. But a 2016 study in the journal Clinical Infectious Diseases shows that’s changing. The prevalence of shingles among Americans younger than 50 more than quadrupled from the late 1940s to the early 2000s, according to the study.

Recently, a news anchor from Florida shared his experience with shingles to raise awareness among younger people that they might also be at risk. According to News4Jax, Scott Johnson, who’s in his early 40s, developed an excruciatingly painful case just last month.

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Johnson said he first noticed a hard, painful welt on the back of his neck. But soon it turned into an unbearable rash and the symptoms then spread to his face. Along with a painful rash, common symptoms of shingles include burning, numbness, and itching. There’s no cure for it, but prompt treatment with antiviral drugs can speed healing.

It turns out Johnson isn’t the only one sharing photos of shingles. Others who experienced the infection have posted their photos online, hoping to warn people about what it looks like and how it can manifest. Below, we’ve gathered 7 photos from Instagram users who want you to know what to look out for.

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When Shingles Affects the Scalp

Shingles can form a blistering, itchy, painful rash anywhere on the body, but can be particularly excruciating and challenging if it spreads to the scalp. Shingles blisters can leave you with a sensitive scalp and make grooming very difficult. What’s worse, the infection can result in bald patches if you aren’t careful about how you treat the rash.

Shingles are caused by the reactivation of the virus that causes chickenpox, the varicella zoster virus. After you recover from chickenpox, the virus can travel down into the nerve tissues of the body and lay there dormant for decades. Shingles occurs when the virus reawakens and travels back up the nerve pathways and out to the skin. Anyone who has had chickenpox is at risk for contracting shingles later in life.

Shingles and a Sensitive Scalp

The itching and pain of shingles can leave your scalp incredibly sensitive to even the slightest pressure. That can make running a brush or comb through your hair a terrible ordeal, with the bristles scraping the rash and potentially causing the blisters to burst. At other times, the urge to scratch your itchy scalp may seem irresistible.

However, you must avoid both scratching and combing too hard. The viral infection that causes shingles can result in hair loss through a condition known as cicatricial alopecia or scarring alopecia. Scarring caused by the shingles rash destroys stem cells in hair follicles that create new hair growth. The destruction of these cells prevents hair regeneration, resulting in permanent hair loss. Scratching or scraping at the rash can increase your chances of scarring alopecia.

Note that shingles only affects one side of the body. That means a scalp rash will also be limited to one side of your head.

Scalp Treatment for Shingles

There are some specific scalp treatments and hair care techniques you can use to relieve the pain and itching of a sensitive scalp and help head off permanent damage:

  • Apply cool water and cold compresses to the part of your scalp affected by the shingles rash.
  • Pat calamine or menthol lotion on your head as a soothing scalp treatment.
  • Avoid using harsh soaps or scented shampoos when washing your hair. Try to find a gentle, unscented hair cleanser.
  • When washing your hair, use lukewarm or warm water — never hot.
  • Avoid scrubbing when washing your hair. Use gentle motions with your fingertips, never the nails.
  • Pat your hair dry with a towel after washing, rather than rubbing it dry.
  • Comb your hair carefully, trying to scrape your rash as little as possible.
  • Do not use any hair care products on a sensitive scalp rash. Avoid hair spray, pomade, mousse, and other products.
  • Discuss with your doctor or dermatologist any prescription emollients or creams that might help soothe your shingles rash or decrease itching to prevent scratching.

More general treatments to address your shingles scalp infection and symptoms include:

  • Antiviral medications that attack the shingles virus
  • Tricyclic antidepressants, which have been shown to interrupt pain signals
  • Topical lidocaine patches, which can relieve itching and pain when applied directly to the rash
  • Nerve blocks, which are topical anesthetics injected directly into the rash
  • Over-the-counter pain relievers such as aspirin or NSAIDs

There are a number of ways to deal with shingles that affects your scalp. By using shingles scalp treatments carefully, you may avoid permanent scarring and hair loss.

Shingles: An acute infection caused by the herpes zoster virus, the same virus as causes chickenpox. Shingles is most common after the age of 50 and the risk rises with advancing age. Shingles occurs because of exposure to chickenpox or reactivation of the herpes zoster virus. The virus remains latent (dormant) in nerve roots for many years following chickenpox.

Shingles is an extraordinarily painful condition that involves inflammation of sensory nerves. It causes numbness, itching or pain followed by the appearance of clusters of little blisters in a strip pattern on one side of the body. The pain can persist for weeks, months or years after the rash heals and is then known as post-herpetic neuralgia.

People with shingles are contagious to persons who have not had chickenpox and can catch chickenpox from close contact with a person who has shingles. The Herpes zoster vaccine is effective in preventing or reducing the symptoms of shingles, and it is recommended for people 60 years and older. Treatment includes antiviral medication and pain medication.

The term shingles has nothing to do with a shingle on a roof or the small signboard outside the office of a doctor but is derived from the Latin cingulum meaning girdle, the idea being that shingles often girdles part of the body.

See also shingles pain and postherpetic neuralgia.

Shingles: Hope Through Research

What is shingles?
What are the symptoms and signs of shingles?
What is the varicella-zoster virus and how does it cause shingles?
How are chickenpox and shingles different?
Who is at risk for shingles?
How is shingles treated?
Can shingles be prevented?
What is postherpetic neuralgia?
What are other complications of shingles?
Can infection with VZV during pregnancy harm the baby?
What research is being done?
How can I learn about or participate in clinical research?
Where can I find more information about research on shingles?
Where can I get more information?
Glossary

What is shingles?

Shingles is the reactivation of a viral infection in the nerves to the skin that causes pain, burning, or a tingling sensation, along with an itch and blisters in the skin supplied by the affected nerve. It is caused by the varicella zoster virus, or VZV—the same virus that causes chickenpox. When the itchy red spots of childhood chickenpox disappear, the virus remains in a dormant state in our nerve cells, ready to strike again in later life. This second eruption of the chickenpox virus is called shingles or herpes-zoster.

You cannot develop shingles unless you have had an earlier exposure to chickenpox. Shingles occurs when an unknown trigger causes the virus to become activated. Most adults who have the dormant virus in their body never get shingles.

Words in italics appear in the Glossary at the end of this document.

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What are the symptoms and signs of shingles?

The first symptom of shingles is often burning or tingling pain, or itch, generally in a band-like distribution on one side of the body, i.e., around the waist, chest, stomach, or back. Shingles pain can be mild or intense. Some people have mostly itching; some feel severe pain from the gentlest touch, such as the weight of bed linens or clothing. A few people may have general symptoms of a viral infection, like fatigue, fever, and headache.

After several days or up to two weeks after the first symptoms are felt, a rash of fluid-filled blisters (vesicles) appears. These are similar to chickenpox but occur in a cluster rather than scattered over the body. The number of vesicles is variable. Some rashes merge and produce an area that looks like a burn. Other people may have just a few small scattered lesions. The clusters most often appear in a band called a dermatome, which contains nerves that branch out from the virus-affected nerve root exiting the spine. The second most common location is on one side of the face around the eye and on the forehead. However, shingles can involve any part of the body, including internal organs.

Recent studies have shown that subtle cases of shingles with only a few blisters, or none, are more common than previously thought. These cases may remain unrecognized.

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What is the varicella-zoster virus and how does it cause shingles?

The word “varicella” is derived from “variola,” the Latin word for smallpox. “Zoster” is the Greek word for girdle; shingles often produces a girdle or belt of blisters or lesions around one side of the waist. This striking pattern also underlies the condition’s common name: shingles comes from “cingulum,” the Latin word for belt or girdle.

VZV belongs to a group of viruses called herpesviruses. This group includes the herpes simplex virus (HSV) that causes cold sores, fever blisters, and genital herpes. Like VZV, HSV can hide in the nervous system after an initial infection and then travel down nerve cell fibers to cause a renewed infection. Repeated episodes of cold sores on the lips are the most common example.

Most adults in the United States have had chickenpox, even if it was so mild as to pass unnoticed, and they are at risk for developing shingles later in life. In the original exposure to VZV (chickenpox), some of the virus particles settle into nerve cells (neurons) of sensory ganglia (a group of nerve cells that connect the sensory periphery and central nervous system), where they remain for many years in an inactive, hidden (latent) form. The neurons in the sensory ganglia have nerve fibers that supply the skin and relay information to the brain about what the body is sensing—heat, cold, touch, pain.

When the VZV reactivates, it spreads down the long nerve fibers (axons) that extend from the sensory cell bodies to the skin. As the virus multiplies, the telltale rash erupts. With shingles, the nervous system is more deeply involved than it was during the bout with chickenpox, and the symptoms are often more complex and severe.

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How are chickenpox and shingles different?

When a person, usually a child, who has not received the chickenpox vaccine is exposed to VZV, he or she usually develops chickenpox, a highly contagious disease that can be spread by breathing as well as by contact with the rash. The infection begins in the upper respiratory tract where the virus incubates for 15 days or more. VZV then spreads to the bloodstream and migrates to the skin, giving rise to the familiar chickenpox rash.

In contrast, you can’t catch shingles from someone else. You must already have been exposed to chickenpox and harbor the virus in your nervous system to develop shingles. When reactivated, the virus travels down nerves to the skin, causing the painful shingles rash. In shingles, the virus does not normally spread to the bloodstream or lungs, so the virus is not shed in air.

But a person with a shingles rash—which contains active virus particles—can pass the virus to someone who has never had chickenpox or who has not been vaccinated. In this case, the person will develop chickenpox, not shingles. A person must come into direct contact with the open sores of the shingles rash. Merely being in the same room with someone who has shingles will not cause chickenpox. Children who develop chicken pox generally fully recover; however, adults who develop chicken pox can become seriously ill.

Likewise, a person with chickenpox cannot give shingles to someone else—but they can pass the virus to someone who has never had chickenpox.

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Who is at risk for shingles?

Anyone who had previously had chickenpox is at risk for shingles. About 25 percent of all adults, mostly otherwise healthy, will get shingles during their lifetime, usually after age 50. The incidence increases with age so that shingles is 10 times more likely to occur in adults over 60 than in children under 10. People with compromised immune systems, a natural consequence of aging or from use of immunosuppressive medications such as prednisone, are at increased risk of developing shingles. Immune-suppressive drugs are used to treat serious illnesses such as cancer or from chemotherapy or radiation treatment, or from infection with HIV. Some individuals can also have re-eruptions and some, particularly those with significantly impaired immunity from drugs and diseases, may have shingles that spread over the body.

Youngsters whose mothers had chickenpox late in pregnancy—5 to 21 days before giving birth—or who had chickenpox in infancy have an increased risk of pediatric shingles. Sometimes these children are born with chickenpox or develop a typical case within a few days (see section entitled “Can shingles during pregnancy or at birth harm the baby?” for more information).

Most people who get shingles have it only once, but it is possible for the outbreak to appear again.

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How is shingles treated?

Currently there is no cure for shingles, but attacks can be made less severe and shorter by using prescription antiviral drugs such as acyclovir, valacyclovir, or famcyclovir as soon as possible after symptoms begin. Early treatment can reduce or prevent severe pain and help blisters dry faster. Antiviral drugs can reduce by about half the risk of being left with postherpetic neuralgia, which is chronic pain that can last for months or years after the shingles rash clears. Doctors recommend starting antiviral drugs at the first sign of the shingles rash, or if the telltale symptoms indicate that a rash is about to erupt. Other treatments to consider are anti-inflammatory corticosteroids such as prednisone. These are routinely used when the eye or other facial nerves are affected.

Most people with shingles can be treated at home.

People with shingles should also try to relax and reduce stress (stress can make pain worse and lead to depression); eat regular, well-balanced meals; and perform gentle exercises, such as walking or stretching to keep active and stop thinking about the pain (but check first with your physician). Placing a cool, damp washcloth on the blisters—but not when wearing a topical cream or patch—can help blisters dry faster and relieve pain. Keeping the area clean can help avoid a secondary bacterial infection.

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Can shingles be prevented?

Shingles vaccine

In May 2006, the Food and Drug Administration (FDA) approved a VZV vaccine (Zostavax) for use in people 60 and older who have had chickenpox. In March 2011, the FDA extended the approval to include adults ages 50-59. A new shingles vaccine called Shingrix was licensed by the FDA in 2017 for adults age 50 and older. Talk with your healthcare professional if you have questions about shingles vaccination.

The Shingles Prevention Study—a collaboration between the Department of Veterans Affairs, the National Institute of Allergy and Infectious Diseases, and Merck & Co., Inc.—involved more than 38,000 veterans aged 60 and older. The purpose was to find out how safe the vaccine is, and if it can prevent shingles. Half the study participants received the shingles vaccine, and half received a similar looking, inactive vaccine (placebo vaccine). Neither volunteers nor researchers knew if a particular subject had gotten active or placebo vaccine until after the end of the study (called a double-blind study). During more than 3 years of follow-up, the vaccine reduced shingles cases by 51 percent; 642 cases of shingles developed in the placebo group compared with only 315 in the vaccinated group. And in people who received the active vaccine and still got shingles, the severity and discomfort were reduced by 61 percent. The vaccine also reduced the number of cases of long-lasting nerve pain (postherpetic neuralgia) by two-thirds compared with the placebo.

The shingles vaccine is a preventive therapy and not a treatment for those who already have shingles or postherpetic neuralgia.

Chickenpox vaccine

The chickenpox vaccine became available in the United States in 1995. Immunization with the varicella vaccine (or chickenpox vaccine)—now recommended in the United States for all children between 18 months and adolescence—can protect people from getting chickenpox. People who have been vaccinated against chickenpox are probably less likely to get shingles because the weak, “attenuated” strain of virus used in the chickenpox vaccine is less likely to survive in the body over decades.

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What is postherpetic neuralgia?

Sometimes, particularly in older people, shingles pain persists long after the rash has healed. This is postherpetic neuralgia, defined as pain lasting three months after onset of the rash. Pain can be mild or severe—the most severe cases can lead to insomnia, weight loss, depression, and disability. There may be other sensations, such as tingling, coldness, or loss of feeling. About 20 percent of people age 70 or greater who develop shingles may have long-lasting pain. Postherpetic neuralgia is not directly life-threatening and may get better over time.

About a dozen medications in four categories have been shown in clinical trials to provide some pain relief for postherpetic neuralgia. These include:

Tricyclic antidepressants (TCAs): TCAs are often the first type of drug given to people suffering from postherpetic neuralgia. The TCA amitryptiline was commonly prescribed in the past, but although effective, it has a high rate of side effects. Desipramine and nortriptyline have fewer side effects and are therefore better choices for older adults, the most likely group to have postherpetic neuralgia.

Common side effects of TCAs include dry eyes and mouth, constipation, and impaired memory. People with heart arrhythmias (irregular heartbeats), previous heart attacks, or narrow angle glaucoma should usually use a different class of drugs.

Anticonvulsants: Some drugs developed to reduce seizures can also treat postherpetic neuralgia because seizures and pain both involve abnormally increased firing of nerve cells. The antiseizure medication gabapentin is most often prescribed. Carbamazepine is effective for postherpetic neuralgia but has somewhat common side effects including drowsiness or confusion, dizziness, and sometimes ankle swelling. Some small studies have shown positive effects using divalproex sodium to treat postherpetic neuralgia.

Opioids: Opioids are strong pain medications used for all types of pain. They include oxycodone, morphine, tramadol, and methadone. Opioids can have side effects—including drowsiness, mental dulling, and constipation—and can be addictive, so their use must be monitored carefully in those with a history of addiction.

Topical local anesthetics: Local anesthetics are effective when applied directly to the skin of the painful area affected by postherpetic neuralgia. Lidocaine, the most commonly prescribed, is available in cream, gel, or spray form. It is also available in a patch that has been approved by the FDA for use specifically in postherpetic neuralgia. With topical local anesthetics, the drug stays in the skin and therefore does not cause problems such as drowsiness or constipation.Capsaicin cream may be somewhat effective and is available over the counter, but most people find that it causes severe burning pain during application. An alternative approach using a high concentration capsciacin patch has been reported to be effective.

Postherpetic itch

The itch that sometimes occurs during or after shingles can be quite severe and painful. Clinical experience suggests thatpostherpetic itch is harder to treat than postherpetic neuralgia. Topical local anesthetics (which numb the skin) provide substantial relief to some individuals. Since postherpetic itch typically develops in skin that has severe sensory loss, it is particularly important to avoid scratching. Scratching numb skin too long or too hard can cause injury.

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What are other complications of shingles?

Complications of zoster are more frequent in people with lesions in or around the eyes, forehead, and nose (ophthalmic shingles), or around the ear and on the face (herpes zoster oticus or Ramsay-Hunt syndrome). People with shingles in or near the eye should see an ophthalmologist immediately, as they can suffer painful eye infections and, in some cases, temporary or permanent vision loss. Symptoms can include redness and swelling involving just the white of the eye (sclera), the clear front of the eye (cornea), or internal parts of the eye. If the cornea is involved, treatment to avert permanent scarring is important to preventing lasting vision loss. The disease can cause damage to or death of the nerve cells that react to light (called acute retinal necrosis).

Shingles infections within or near the ear can cause hearing or balance problems as well as weakness of the muscles on the affected side of the face. These problems can be long-lasting or permanent.

In rare cases, shingles can spread into the brain or spinal cord and cause serious complications such as stroke or meningitis (an infection of the membranes outside the brain and spinal cord).

The varicella zoster virus also may involve blood vessels or provoke an immune reaction irritating the surface of blood vessels (vasculopathy). People with shingles have slightly increased risk of stroke, greatest in the first few weeks after vesicle eruption, but lasting for several months. The risk of stroke is highest in people with eye zoster, perhaps as much as five percent.

People with shingles need to seek immediate medical evaluation if they notice neurological symptoms outside the region of the primary shingles attack. People who are immunosuppressed, whether from diseases such as HIV or medications, have an increased risk of serious complications from shingles. They may develop shingles that spreads to involve more parts of the body, or shingles rashes that persist for long periods or return frequently. Many such individuals are helped by taking antiviral medications on a continuous basis. People taking immunosuppressive drugs, or with diseases such as HIV or leukemia, should see a doctor immediately for treatment to avoid possible serious complications.

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Can infection with VZV during pregnancy harm the baby?

Some infections can be transmitted across the mother’s bloodstream to the fetus or can be acquired by the baby during the birth process. Chickenpox during pregnancy poses some risk to the unborn child, depending upon the stage of pregnancy. During the first 30 weeks, maternal chickenpox may, in some cases, lead to congenital malformations (although such cases are rare). Most experts agree that shingles in a pregnant woman is even less likely to cause harm to the unborn child.

If a pregnant woman gets chickenpox between 21 to 5 days before giving birth, her newborn can have chickenpox at birth or develop it within a few days. But the time lapse between the start of the mother’s illness and the birth of the baby generally allows the mother’s immune system to react and produce antibodies to fight the virus. These antibodies can be transmitted to the unborn child and thus help fight the infection. Still, a small percent of the babies exposed to chickenpox in the 21 to 5 days before birth develop shingles in the first 5 years of life because the newborn’s immune system is not yet fully functional and capable of keeping the virus latent.

If a mother contracts chickenpox at the time of birth, the newborn will have little ability to fight off the attack because its immune system is immature. If these babies develop chickenpox as a result, it can be fatal. They are given zoster immune globulin, a preparation made from the antibody-rich blood of adults who have recently recovered from chickenpox or shingles, to lessen the severity of their chickenpox.

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What research is being done?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS is a component of the National Institutes of Health, the leading supporter of biomedical research in the world.

The NINDS funds and conducts research on a wide range of neurological disorders, such as shingles, to understand their causes and to develop and improve ways to diagnosis, treat, and prevent them.

Medical research on shingles has two main goals. The first is to develop drugs to fight the disease and to prevent or treat its complications. The second is to understand the disease well enough to prevent it, especially in people at high risk. To achieve these goals, scientists need to learn much more about VZV and its effects, including how it becomes latent in nerve cells (neurons), what induces it to become active again, and how such reactivation can lead to postherpetic neuralgia and other complications..

For example, the NINDS supports research on the interplay between the viral proteins and virus defense mechanisms in neurons to understand why the varicella-zoster virus establishes latency uniquely in neurons and not in other cell types. Other studies focus on how VZV travels along sensory nerve fibers, or axons, and its role in latency and viral reactivation. Scientists also hope to identify molecular mechanisms that regulate the expression of latent viral genes, which may lead to targeted therapy to prevent reactivation.

Research on postherpetic neuralgia includes studies in animal models of the condition, to better understand cellular changes that lead to persistent pain. These changes may represent future targets in the form of improved vaccines, new medicines, or even gene therapy.

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How can I learn about or participate in clinical research?

  • Clinical trials are research studies on humans that are designed to answer specific questions about vaccines or new therapies, to test new ways of using known treatments, or to find out more about a disorder. Clinical studies and trials involving the zoster virus and postherpetic neuralgia may lead to better understanding of shingles and identify potential treatments. Both healthy individuals and people with disorders are needed to advance the understanding of diseases and how to treat them. For more information about clinical trials and how you may participate in a study, see
  • ClinicalTrials.gov (www.clinicaltrials.gov) provides information about ongoing and completed federally and privately supported clinical studies for a wide range of diseases and conditions, including shingles.
  • NIH Clinical Research Trials and You (www.nih.gov/health/clinicaltrials/) provides information about clinical trials, why they matter, and how to participate, including links to search for a trial or enroll in a research matching registry.

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Where can I find more information about research on shingles?

In addition to the NINDS, several other NIH organizations support research relevant to understanding, treating, or preventing shingles and its complications, including the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute on Aging (NIA).

  • NIH RePORTER (http://projectreporter.nih.gov) is a searchable database of current and previously funded research supported by NIH and some other federal agencies. RePORTER also includes links to research results such as patents and publications citing support from these projects.
  • PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) allows users to search millions of journal article abstracts in biomedical research fields. The full text of many articles describing research funded by NIH and other sources is also freely available through PubMedCentral (www.ncbi.nlm.nih.gov/pmc/)

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Where can I get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
800-352-9424

Information also is available from the following organizations:

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Glossary

acyclovir—one of three available antiviral drugs that can reduce the severity and duration of a shingles attack if given soon after onset.

capsaicin—an active ingredient in hot chili peppers used in topical ointments to relieve pain. It appears to work by reducing a chemical substance found at nerve endings and involved in transmitting pain signals to the brain. While somewhat effective for postherpetic neuralgia, it can cause severe burning in some people.

carbamazepine—a drug that works both as an anticonvulsant and a pain reliever.

chickenpox—an acute contagious disease that usually occurs in children and is caused by the varicella-zoster virus.

desipramine—an antidepressant often prescribed to help reduce the pain from postherpetic neuralgia. Doctors often prescribe it because it has fewer side effects than some other antidepressants.

famcyclovir—one of three available antiviral drugs that can reduce the severity and duration of a shingles attack if given soon after onset.

gabapentin—an antiseizure medicine that is also used as a pain reliever.

herpes zoster—the medical term for shingles; an infection caused by the varicella-zoster virus, one of the herpesviruses family of viruses.

herpes simplex—the medical term for a related but different virus that causes repeated mild blisters of the skin or mucous membrane. Herpes simplex rashes can return many times, whereas shingles usually appears no more than once or twice in a person’s lifetime.

herpesviruses—a large family of viruses that cause a number of related conditions including, but not limited to, oral and genital herpes simplex, varicella (chickenpox), and herpes-zoster (shingles).

immunosuppressed—having a weakened immune system. Common causes are certain illnesses (HIV, some cancers) or use of certain drugs such as prednisone.

latent—hidden, dormant, inactive. The virus that causes chickenpox remains hidden in the nervous system after the initial attack of chickenpox is over. When it becomes reactivated, usually many years later, the virus can cause shingles.

lidocaine—a pain-killing drug sometimes used for treating postherpetic neuralgia. It is available in an adhesive fabric patch that can be placed on the skin directly over the site of the pain.

neuron—the functional cell of the brain and nervous system.

nortriptyline—an antidepressant often prescribed to help reduce the pain from postherpetic neuralgia. Doctors often prescribe it because it has fewer side effects than some other antidepressants.

postherpetic itch—severe, painful, and difficult to treat itching that sometimes accompanies postherpetic neuralgia. Topical local anesthetics provide relief to some individuals.

postherpetic neuralgia—a condition characterized by pain that persists for at least three months after healing of a shingles rash; caused by damage to the nervous system.

prednisone—an anti-inflammatory corticosteroid drug routinely given to individuals who have shingles when an eye or other facial nerve is involved.

valacyclovir—one of three available antiviral drugs that can reduce the severity and duration of a shingles attack if given soon after onset.

varicella-zoster virus—a virus that causes two distinct diseases, chickenpox and shingles. It is a member of the herpesvirus family. “Varicella” is Latin for little pox; “zoster” is the Greek word for girdle. Medically, zoster is sometimes used as a synonym for shingles.

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“Shingles: Hope Through Research”, NINDS, Publication date March 2015.

NIH Publication No. 15-307

Back to Shingles Information Page

See a list of all NINDS Disorders

Publicaciones en Español

Culebrilla: Esperanza en la Investigación

Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.

All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.

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Signs of Shingles: Herpes Zoster

The other, less common, forms of herpes zoster oticus are:

  • Ramsay Hunt Syndrome; a peripheral facial palsy, characterized by acute pain in one ear and the face. Vesicles may be present in the external ear canal, as well as additional auditory symptoms in some cases.
  • HZO affecting cranial nerve VIII; or nervus vestibulocochlearis, which produces vestibular (balance system) symptoms such as dizziness and vertigo in addition to the shingles rash.

If a person suspects they may be affected by herpes zoster oticus, they should consult a healthcare professional immediately, as shingles which affects the facial nerves, indicates a likelihood of developing internal shingles.

Causes of shingles

All people who have been affected by chickenpox and, rarely, people who have been vaccinated against chickenpox and thereby carry VZV ‒ the virus which causes herpes zoster/shingles ‒ in their body, are at risk of developing shingles.

Good to know: If a person who has been vaccinated against chickenpox develops shingles, the infection tends to be significantly less severe than the condition can be when it affects people who do not carry any form of VZV in their body. It is therefore, in general, worthwhile for a person, who has not experienced chickenpox, to be vaccinated against it, even though this is an attenuated vaccine (containing a weakened version of the virus that does not cause the illness), and therefore does not offer total protection against related conditions such as shingles.

Shingles will affect around one in three people in the U.S. during their lifetime. After a person has recovered from chickenpox, VZV remains dormant in their body. It is stored in the nervous system and can reactivate as shingles when a person’s immune system is compromised by aging, illness or stress.

Is shingles (herpes zoster) contagious?

Shingles is only contagious at the point when the rash is blistering. At this time, VZV can be passed from a person with shingles to others via direct bodily contact, passing on traces of infected blister fluids and the sharing of towels, bedding and utensils.

It is only possible to catch the varicella zoster virus, rather than shingles itself: If a person who has never had chickenpox before is infected with VZV by somebody with shingles, they will develop chickenpox ‒ the first infection which VZV causes when it enters the body ‒ as opposed to shingles.

Risk factors

Shingles is most common in adults over 60 years of age. The Centres for Disease Control and Prevention recommend that all people over 60 be vaccinated against shingles. The vaccine reduces the overall risk of contracting the condition by around 50 percent, and lessens the duration and severity of shingles if it occurs.

Shingles can also affect people whose immune systems have been weakened by injury or illnesses, such as human immunodeficiency virus (HIV), cancer or the use of certain medicines or treatments which place a lot of stress on the immune system – such as organ transplants and chemotherapy. People of any age, who have previously had chickenpox and are experiencing a prolonged period of severe stress, are also at risk of shingles.

Pregnant people

If a person develops shingles while pregnant, it is usually mild and poses no further risk to the individual or their unborn baby. However, pregnant people who have never had chickenpox, should avoid contact with those affected by chickenpox and those affected by shingles as a precautionary measure.

People with shingles or chickenpox both have the capacity to infect others with VZV, and developing chickenpox whilst pregnant can result in potentially severe health complications for both the pregnant person and the developing fetus.

Diagnosis

Because the shingles rash is instantly identifiable due to its dermatomal pattern, the rash and accompanying pain, usually on one side of the body, are generally the only symptoms which need to be present for a shingles diagnosis to be made. The doctor will usually perform a physical examination and may take a swab from a blister, sending a sample of cells from the aggravated area of skin for a laboratory test in order to confirm the diagnosis.

It is recommended that anyone who thinks that they may be developing shingles seek medical attention as soon as possible to get supportive treatment and decrease the chance of infecting others. Although it is not possible to cure shingles, various pharmaceutical products can be prescribed on diagnosis which can help ease the pain and lessen the duration of the condition. These work most effectively when taken as soon as possible after the onset of shingles. If you suspect that you could be experiencing the first signs of shingles, or are unsure, consult the Ada app for a free symptom assessment.

Treatment

There is no cure for shingles, but by diagnosing the condition early, it is possible to:

  • Prevent the spread and severity of shingles
  • Reduce associated health complications
  • Ease the pain
  • Lessen the duration of the outbreak

Following a diagnosis of shingles, a physician will generally advise on a recovery plan designed to alleviate the discomfort associated with the shingles rash.

Recovery plan

Activities which are usually recommended for a swift recovery from shingles may include:

  • Resting and relaxing
  • Wearing loose-fitting clothes
  • Keeping the rash clean and dry in order to dry out the blisters
  • Keeping the rash uncovered so that the blisters can progress into the scabbing stage as quickly as possible
  • Using cool compresses to alleviate the burning sensation on the skin
  • Avoiding sharing bedding, clothing or towels, as this can facilitate the spread of infection to others

Medications to aid recovery

Medications which may be prescribed for alleviating the physical discomfort of shingles and combating the flare-up of the varicella zoster virus may include:

  • Painkilling medications such as non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol or opioids in cases of severe pain. In some cases, antidepressants or anticonvulsants may be prescribed for their pain-relieving properties, which can work effectively in combination with other painkillers.
  • Antiviral medications

Signs of shingles FAQs

Q: Are there further health risks associated with shingles?
A: If left untreated, shingles is more likely to result in post herpetic neuralgia (PHN), a condition in which a burning pain continues to be felt in the areas affected by shingles for more than three months after the rash and blisters themselves have disappeared. Approximately one fifth of people who are affected by shingles will go on to develop PHN. The likelihood of shingles spreading to internal regions of the body likewise increases in the absence of a promptly initiated treatment and recovery plan.

Q: Are the signs of shingles different in adults to those in children?
A: The signs of shingles in children are largely the same as the signs of shingles in adults. However, shingles in children is generally less severe and lasts for a shorter duration than in adults, and most children recover well with no associated health complications. Shingles rarely affects children under three years of age and can only affect children who have already had chickenpox. Shingles are not common in children. However, having a weakened immune system as a result of an autoimmune disease, other chronic or serious disease or because of being overly stressed, however, can increase the likelihood of a child developing shingles.

Does stress cause shingles?
A: Stress itself does not cause shingles. However, it can, in some cases, make an attack of shingles more likely. This is because stress may weaken the immune system, potentially leaving a person more vulnerable to all types of infection, including the varicella zoster virus.

Good to know: People who have a weakened immune system, and who have never been infected by VZV before, will develop chickenpox the first time they catch the virus, rather than its subsequent form, shingles.

Q: Can herpes zoster cause encephalitis?
A: This rare condition occurs when the brain becomes inflamed, which is usually caused by the spread of an infection in the body to the brain. Viral infections, including the herpes simplex virus causing oral and genital herpes and VZV, which causes shingles, are more associated with developing encephalitis than bacterial infections. The possibility of developing encephalitis due to the spread of VZV or another virus is greater in people with a weakened immune system; for example, if a person’s immune system is compromised due to another underlying health condition, such as human immunodeficiency virus (HIV).

Early signs of encephalitis include flu-like symptoms such as headaches, fever, aching muscles and nausea,. More serious symptoms include drowsiness, seizures and difficulty speaking. Immediate medical attention should be sought if encephalitis is suspected, as it can be life-threatening and should be treated as soon as possible. Diagnostic tests for encephalitis will involve an MRI or CT scan of the head to visualize the extent of the inflammation and a lumbar puncture to determine its cause. This will allow doctors to decide on the best course of treatment. If encephalitis is caused by the herpes simplex of VZV virus, treatment will involve a course of antiviral medication.

Q: What are the signs of shingles healing?
A: Normally, the blisters that feature in the shingles rash will burst around five days after they first develop. At this point, the stages of shingles healing are as follows: they will weep, turn into crusty scabs and begin to heal thereafter. From the time they burst, the scabbing and healing process takes approximately two weeks. Signs that shingles is healing as normal during this time include the size of the scabs diminishing, and, correspondingly, the severity of the pain associated with the rash reducing.

Q: Should I get the shingles vaccine?
A: The Centres for Disease Control and Prevention recommend the shingles vaccine for all people over 60 years of age, whether they have had chickenpox or not. The vaccine reduces the overall risk of contracting the condition by around 50 percent, and lessens the duration and severity of shingles if it occurs.

The shingles vaccine is not recommended for certain population groups, including people who are:

  • Pregnant. A person who has had the shingles vaccine should wait a minimum of four weeks before trying to become pregnant
  • Affected by a condition which weakens the immune system, such as HIV
  • Affected by any type of cancer affecting bone marrow or the lymphatic system
  • Using immunosuppressive medications such as steroids
  • Undergoing radiation therapy or chemotherapy
  • Receiving an organ or bone marrow transplant in less than 4 weeks time, just having received it or while being on immunosuppressive medication after receiving one
  1. “Varicella Zoster Virus Infection: Clinical Features, Molecular Pathogenesis of Disease, and Latency.” Neurological Clinics. August 2008. Accessed: 24 October 2017. ↩

  2. “Facts about chickenpox.” Pediatric Child Health. September 2005. Accessed: 24 October 2017. ↩

  3. “How Long Does It Take to Recover from Shingles?.” New Health Guide. 24 October 2017. Accessed: 24 October 2017. ↩

  4. “Dermatomes Anatomy.” Medscape. 13 October 2017. Accessed: 24 October 2017. ↩

  5. “Varicella-Zoster Virus Reactivation without Rash.” Journal of Infectious Diseases. 01 August 1992. Accessed: 24 October 2017. ↩

  6. “Diagnosis & testing.” National Center for Immunization and Respiratory Diseases, Division of Viral Diseases. 19 August 2016. Accessed: 24 October 2017. ↩

  7. “Can you have internal shingles without a rash?” Medical News Today. 15 March 2018. Accessed: 16 July 2018. ↩

  8. “Managing ophthalmic herpes zoster in primary care.” British Medical Journal. 16 July 2005. Accessed: 24 October 2017. ↩

  9. “Q: Should I get the shingles vaccine?.” Journal of the American Academy of Physician Assistants. September 2012. Accessed: 24 October 2017. ↩

  10. “Transmission.” National Center for Immunization and Respiratory Diseases, Division of Viral Diseases. 19 August 2016. Accessed: 24 October 2017. ↩

  11. “What are the risks of shingles during pregnancy?.” NHS Choices. 12 December 2015. Accessed: 24 October 2017. ↩

  12. “Shingles – Treatment.” 08 July 2016. NHS Choices. Accessed: 24 October 2017. ↩

  13. “Post-herpetic neuralgia.” Continuing Education in Anaesthesia Critical Care & Pain. 01 August 2017. Accessed: 24 October 2017. ↩ ↩

  14. “Herpes Zoster (Shingles) and Postherpetic Neuralgia.” Mayo Clinic Proceedings. March 2009. Accessed: 24 October 2017. ↩

  15. “Shingles (herpes zoster) in children.” University of Rochester Medical Center. 2018. Accessed: 18 July 2018. ↩

  16. Stress induced immune dysfunction: implications for health.” Perspectives. March 2005. Accessed: 13 September 2018. ↩ ↩

  17. “Shingles.” The British Skin Foundation. Accessed: 16 July 2018. ↩

  18. “Meningitis and encephalitis fact sheet.” National Institute of Neurological Disorders and Stroke. 06 July 2017. Accessed: 16 July 2018. ↩ ↩

  19. “Encephalitis.” Patient. 08 July 2015. Accessed: 16 July 2018. ↩

  20. “Encephalitis.” NHS Choices. 06 December 2016. Accessed: 08 July 2018. ↩

  21. “Shingles.” National Institute on Ageing. 31 December 2016. Accessed: 13 September 2018. ↩

  22. “What everyone should know about Zostavax.” Centres for Disease Control and Prevention. 25 January 2018. Accessed: 16 July 2018. ↩ ↩

  23. “A Comprehensive Review of Immunization Practices in Solid Organ Transplant and Hematopoietic Stem Cell Transplant Recipients.” Clinical Therapeutics. 2017. Accessed: 13 September 2018. ↩

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