(Herpes Zoster; Post-herpetic Neuralgia)
Shingles is an infection of the nerves and skin. It can be painful.
Shingles is caused by the same virus that causes chickenpox. Shingles most often occurs in people who have had chickenpox. It can happen in people who have had a chickenpox vaccine but this is rare. The virus does not fully leave the body. Some of it settles in nerve roots. Shingles happens when the virus becomes active again. It travels along nerve paths to the skin.
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Shingles can occur in anyone. It is more common in people aged 50 years and older. Other factors that may increase the chances of shingles include:
- Health issues involving immune system, such as HIV infection, lymphoma, or leukemia
- Autoimmune diseases such as rheumatoid arthritis or systemic lupus erythematosus
- Radiation therapy
The infection does not pass from one person to another often. The virus can pass from someone with shingles. It may cause chickenpox in someone who has never had chickenpox or the chickenpox vaccine.
Shingles may cause:
- Red with a slightly raised band or patch
- Often has many small fluid-filled blisters that dry out and crust within several days
- Often stays on one side of the body
- Affects mostly the torso and face
- Skin may be sensitive and painful at the site of the rash—pain may be severe and continue after the rash is gone
- Tingling or itchiness on the skin—may start a few days before the rash
- Eyes may be affected
- If face, ear, or mouth are involved it may lead to:
- Problems moving one side of your face
- Hearing loss, ringing in your ears
- Sensation of spinning, nausea and vomiting
- Loss of taste
- Uncontrolled eye movements
You will be asked about your symptoms and past health. A physical exam will be done. The doctor can diagnose shingles based on the rash.
Shingles cannot be cured. Treatment can help to ease discomfort until it passes. Some treatment may also help to shorten illness and prevent more problems.
Home care will help to ease pain. Wet compresses and oatmeal baths may help. The doctor may also recommend medicine such as:
- Calamine lotion
- Over-the-counter pain relievers
- Topical pain relievers that are applied to the skin
Antiviral medicine may help to control shingles. It may shorten illness time. This medicine is most helpful in healthy people if it is started within 72 hours of first symptoms. It may also be used at any time if the rash is large or is on the face.
Antiviral medicine will almost always be used for people with immune system problems.
Treatment for Post-herpetic Neuralgia
The rash usually disappears within 3 weeks. In some cases, the pain continues for months or even years after the rash has healed. This is called post-herpetic neuralgia (PHN). PHN can be severe and difficult to treat. It may be treated with a combination of medical treatments such as:
- Antiseizure medications
- Prescription pain relievers
- Topical pain relievers
- Lidoderm patch
- Nerve blocks
- Transcutaneous electrical nerve stimulation (TENS)—a device that generates low-level pulses of electrical current on the skin's surface
Complication Treatment and Prevention
Shingles near the eye can cause permanent damage to vision. Medical care is important to prevent complications like scarring and blindness. Antiviral medicine and steroids will be used to slow rash progress.
The infection can also cause problems to the nerves of the ear and face. Antiviral medicine and steroids may be used slow rash progress if there is muscle weakness on one side of the face.
If you do have shingles, take these steps to prevent giving chickenpox to others:
- Keep all blisters covered with a bandage until they are dry and crusted over.
- If you are a healthcare worker, check with your company's guidelines before returning to work. Most cannot return to work until the blisters are crusted over.
Avoid contact with people who are at risk of getting severe varicella, such as:
- Pregnant women
- Premature infants
- People who have a compromised immune system
Keep Other Healthy
To prevent giving chickenpox to others while shingles is active:
- Keep all blisters covered with a bandage. Keep them covered until they are dry and crusted over.
- Check with your company's guidelines before returning to work if you are a health worker. Most cannot return to work until the blisters are crusted over.
Avoid contact with people who are at risk of getting severe chickenpox infections, such as:
- Pregnant women
- Premature infants
- People who have immune system illnesses
There are now 2 vaccines that reduce the risk of shingles. They can also reduce the risk and severity of PHN if shingles occurs. One type of vaccine has a live virus and the other does not. Most will have the dead virus vaccine. It is given in 2 doses which are given 2 to 6 months apart. The live HSV is advised for people 60 years and older. It is given in a single dose in adults with healthy immune systems. Talk to your doctor about your choices.
National Institute of Neurological Disorders and Stroke
National Shingles Foundation
The College of Family Physicians of Canada
Herpes zoster. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T113997/Herpes-zoster. Updated August 7, 2019. Accessed September 10, 2019.
Shingles. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/shingles. Updated September 2017. Accessed September 10, 2019.
Shingles: overview. American Academy of Dermatology website. Available at: https://www.aad.org/public/diseases/contagious-skin-diseases/shingles. Accessed September 10, 2019.
Shingles (herpes zoster). Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/shingles. Updated June 26, 2019. Accessed September 10, 2019.
6/9/2014 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T113997/Herpes-zoster: Forbes H, Bhaskaran K, Thomas SL, et al. Quantification of risk factors for herpes zoster: population based case-control study. BMJ. 2014;348:g2911.
Last reviewed September 2019 by EBSCO Medical Review Board Marcie L. Sidman, MD Last Updated: 9/11/2019