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Shingles is a
painful skin rash. It is caused by the varicella zoster virus. Shingles usually appears in a band, a strip, or a small area on one side of the face or body. It is also called herpes zoster.
Shingles is most common in
older adults and people who have weak immune systems because of stress, injury,
certain medicines, or other reasons. Most people who get shingles will get
better and will not get it again. But it is possible to get shingles more than once.
Shingles occurs when the
virus that causes
chickenpox starts up again in your body. After you get
better from chickenpox, the virus "sleeps" (is dormant) in your nerve roots. In
some people, it stays dormant forever. In others, the virus "wakes up" when
disease, stress, or aging weakens the
immune system. Some medicines may trigger the virus to wake up and cause a shingles rash. It is not clear why this happens. But
after the virus becomes active again, it can only cause shingles, not
You can't catch shingles from someone else who has
shingles. But there is a small chance that a person with a shingles rash can spread the virus to another
person who hasn't had chickenpox and who hasn't gotten the chickenpox
Shingles symptoms happen in
stages. At first you may have a headache or be sensitive to light. You may also
feel like you have the flu but not have a fever.
Later, you may
feel itching, tingling, or pain in a certain area. That's where a band, strip,
or small area of rash may occur a few days later. The rash turns into clusters
of blisters. The blisters fill with fluid and then crust over. It takes 2 to 4
weeks for the blisters to heal, and they may leave scars. Some people only get
a mild rash. And some do not get a rash at all.
It's possible that
you could also feel dizzy or weak. Or you could have long-term pain or a rash
on your face, changes in your vision, changes in how well you can think, or a
rash that spreads. If you have any of these problems from shingles, call your
doctor right away.
Shingles is treated with medicines. These medicines include antiviral medicines and medicines for pain.
Starting antiviral medicine right away can help your rash heal faster and be less painful. So if you think you may have shingles, see your doctor right away.
Good home care also can help you feel better faster. Take care
of any skin sores, and keep them clean. Take your medicines as directed. If you are bothered by pain, tell your doctor. He or she may write a prescription for pain medicine or suggest an over-the-counter pain medicine.
Anyone who has had chickenpox
can get shingles. You have a greater chance of getting shingles if you are older than 50 or if you have a weak immune system.
There is a shingles vaccine for adults. It lowers your chances of getting shingles and prevents long-term pain that can occur after shingles. And if you do get shingles, having the vaccine makes it more likely that you will have less pain and your rash will clear up more quickly.
Learning about shingles:
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Shingles is a
reactivation of the varicella-zoster virus, a type of herpes virus that causes
chickenpox. After you have had chickenpox, the virus
lies inactive in your
nerve roots and remains inactive until, in some
people, it flares up again. If the virus becomes active again, you may get a rash that occurs only in the area of the affected nerve. This rash is called shingles.
Anyone who has had even a mild
case of chickenpox can get shingles. This includes children.
Exposure to shingles will not cause
you to get shingles. But if you have not had chickenpox and have not gotten the
chickenpox vaccine, you can get chickenpox if you are exposed to shingles.
Someone who has shingles can expose you to the virus if you come into contact
with the fluid in the shingles blisters.
If you are having an active outbreak of shingles, you can help prevent the spread of the virus to other people. Cover any fluid-filled blisters that are on a part of your body that isn't covered with clothes. Choose a type of dressing that absorbs fluid and protects the sores.
When the virus that causes
chickenpox reactivates, it causes
shingles. Early symptoms of shingles include headache,
sensitivity to light, and flu-like symptoms without a fever. You may then feel
itching, tingling, or pain where a band, strip, or small area of rash may
appear several days or weeks later. A rash can appear anywhere on the body but
will be on only one side of the body, the left or right. The rash will first
form blisters, then scab over, and finally clear up over a few weeks. This band
of pain and rash is the clearest sign of shingles.
rash caused by shingles is more painful than itchy.
nerve roots that supply sensation to your skin run in
pathways on each side of your body. When the virus becomes reactivated, it
travels up the nerve roots to the area of skin supplied by those specific nerve
roots. This is why the rash can wrap around either the left or right side of
your body, usually from the middle of your back toward your chest. It can also
appear on your face around one eye. It is possible to have more than one area
of rash on your body.
Shingles develops in stages:
Shingles may be confused with
other conditions that cause similar symptoms. The rash from shingles may be mistaken for an infection from herpes simplex virus (HSV), poison oak or ivy, impetigo, or scabies. The pain from PHN may feel like appendicitis, a heart attack, ulcers, or migraine headaches.
caused by the same virus that causes
chickenpox. After an attack of chickenpox, the virus
remains in the tissues in your nerves. As you get older, or if you have an
illness or stress that weakens your
immune system, the virus may reappear in the form of
You may first have a headache, flu-like symptoms
(usually without a fever), and sensitivity to light, followed by itching,
tingling, or pain in the area where a
rash may develop. The pain usually occurs several days
or weeks before a rash appears on the left or right side of your body. The rash
will be in a band, a strip, or a small area. In 3 to 5 days, the rash turns
into fluid-filled blisters that ooze and crust over. The rash heals in about 2
to 4 weeks, although you may have long-lasting scars.
A few people won't get a rash, or the rash will be mild.
people who get shingles will not get the disease again.
Delaying or not getting medical treatment may increase your risk for complications. Complications of shingles include:
Things that increase risk for shingles include:
If a pregnant woman gets chickenpox, her baby has a high
risk for shingles during his or her first 2 years of life. And if a baby gets chickenpox in the first year of life, he or she has a higher risk for shingles during childhood.1
Postherpetic neuralgia (PHN) is a common
complication of shingles that lasts for at least 30 days and may continue for
months or years. You can reduce your risk for getting shingles and developing PHN by getting the shingles vaccine.
If you think you have shingles, see a doctor as soon as possible. Early treatment with
antiviral medicines may help reduce pain and prevent
complications of shingles, such as
disseminated zoster or
If you still feel intense pain
for more than 1 month after the skin heals, see your doctor to find
out whether you have postherpetic neuralgia (PHN). Getting your pain under control right away may prevent nerve damage that may cause pain that lasts for months or years.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Doctors can usually identify
shingles when they see an area of
rash around the left or right side of your body. If a
diagnosis of shingles is not clear, your doctor may order lab tests, most
herpes tests, on cells taken from a blister.
If there is reason to think that shingles is present, your doctor may
not wait to do tests before treating you with antiviral medicines. Early
treatment may help shorten the length of the illness and prevent complications
There is no cure for
shingles, but treatment may shorten the length of
illness and prevent complications. Treatment options include:
As soon as you are diagnosed
shingles, your doctor probably will start treatment
with antiviral medicines. If you begin medicines within the first 3 days of
seeing the shingles rash, you have a lower chance of having later
problems, such as
The most common
treatments for shingles include:
For severe cases of shingles, some doctors may have their patients use corticosteroids along with antiviral medicines. But corticosteroids are not used very often for shingles. This is because studies show that taking a corticosteroid along with an antiviral medicine doesn't help any more than just taking an antiviral medicine by itself.2
If you have pain that persists
longer than a month after your
shingles rash heals, your doctor may diagnose
postherpetic neuralgia (PHN), the most common complication
of shingles. PHN can cause pain for months or years. It
affects 10 to 15 out of 100 people who have had shingles.3
Treatment to reduce the pain of postherpetic neuralgia includes:
Topical creams containing
capsaicin may provide some relief from pain. There is also a high-dose skin patch available by prescription (Qutenza) for postherpetic neuralgia. Capsaicin
may irritate or burn the skin of some people, and it should be used with
shingles causes long-term
complications. Treatment depends on the specific
Anyone who has had chickenpox may get
shingles later in life. But there's a vaccine that may
help prevent shingles or make it less painful if you do get it. The
shingles vaccineshingles vaccine(What is a PDF document?) is known as Zostavax. It is recommended for adults ages 60 and older, whether or not they've had shingles before. You can ask your doctor or pharmacist about getting the vaccine at age 50 to 59 instead. But insurance may not cover it.
If you have never had
chickenpox, you may avoid getting the virus that
causes both chickenpox and later shingles by receiving the
have never had chickenpox and have never gotten the chickenpox vaccine, avoid
contact with people who have shingles or chickenpox. Fluid from shingles
blisters is contagious and can cause chickenpox (but not
shingles) in people who have never had chickenpox and who have never gotten the
If you have shingles, avoid close contact
with people until after the
rash blisters heal. It is especially important to
avoid contact with people who are at special risk from chickenpox,
If you cover the shingles sores with a type of dressing
that absorbs fluid and protects the sores, you can help prevent the spread of
the virus to other people.
You may reduce the duration and pain
If home treatment doesn't help with pain, talk with your doctor. Getting your pain under control right away may prevent nerve damage that may cause pain that lasts for months or years.
Medicines can help limit the pain and
discomfort caused by
shingles, shorten the time you have symptoms, and
prevent the spread of the disease. Medicines also may reduce your chances of
complications, such as
postherpetic neuralgia (PHN) or disseminated zoster.
Medicines to treat shingles when the
rash is present (active stage) may include:
Medicines to treat postherpetic neuralgia pain may include:
For some people, nonprescription
pain relievers (analgesics) are enough to help control pain caused by shingles
or postherpetic neuralgia. But for others, stronger medicines may be needed. And if prescription medicines don't help control your pain, you may need to see a pain specialist about other ways to treat PHN.
Postherpetic neuralgia (PHN), the most common complication of
shingles, is difficult to treat. Your doctor may
recommend other treatments, along with medicines, to
control the pain of PHN.
There are other treatments that may be used for shingles and postherpetic neuralgia. These treatments may help, but there is no clear evidence from studies that show how well these treatments work. These other treatments include:
Psychological therapies that help you tolerate long-term
pain, such as cognitive-behavioral therapy, may be helpful. These methods can include counseling as well as learning
techniques that teach you to shift your focus of attention away from the pain, such as relaxation and breathing exercises.
For severe pain from PHN, you may need to see a
pain management specialist. These doctors are trained to help with pain that doesn't respond to medicines or usual treatments.
The website FamilyDoctor.org is sponsored by the American Academy of Family Physicians. It offers information on adult and child health conditions and healthy living. There are topics on medicines, doctor visits, physical and mental health issues, parenting, and more.
Gershon AA (2009). Varicella zoster virus. In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 2, pp. 2077–2088. Philadelphia: Saunders Elsevier.
Chen N, et al. (2010). Corticosteroids for preventing postherpetic neuralgia (Review). Cochrane Database of Systematic Reviews (12).
Dubinsky RM, et al. (2004, reaffirmed 2008). Practice parameter:
Treatment of postherpetic neuralgia. An evidence-based report of the Quality
Standards Subcommittee of the American Academy of Neurology. Neurology, 63(6): 959–965.
Other Works Consulted
Centers for Disease Control and Prevention (2008).
Prevention of herpes zoster: Recommendations of the Advisory Committee on
Immunization Practices (ACIP).
MMWR, 57(05): 1–30. Also available online:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5705a1.htm. [Erratum in MMWR, 57(28): 779. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5728a5.htm.]
Habif TP (2010). Herpes zoster. In Clinical Dermatology, A Color Guide to Diagnosis and Therapy, 5th ed., pp. 479–490. Philadelphia: Mosby.
Herpes zoster vaccine (Zostavax) revisited (2010). Medical Letter on Drugs and Therapeutics, 52(1339): 41.
Wolff K, Johnson RA (2009). Varicella-zoster virus infections. In Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 6th ed., pp. 837–845. New York: McGraw-Hill Medical.
October 3, 2013
E. Gregory Thompson, MD - Internal Medicine & Christine Hahn, MD - Epidemiology
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