Shingles

  • Medical Author:
    Steven Doerr, MD

    Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Shingles is a painful rash caused by herpes zoster virus.

Shingles (herpes zoster) facts

  • Shingles, also called herpes zoster, is a painful skin rash.
  • Shingles is caused by reactivation of the varicella zoster virus, the same virus that causes chickenpox.
  • Older adults and individuals with a weakened immune system are at greatest risk for developing shingles.
  • Shingles symptoms and signs include
    • one-sided stabbing pain,
    • tingling, itching, burning, or stinging sensation that precedes the appearance of the rash by a few days,
    • headache,
    • fever and chills,
    • nausea,
    • body aches, and
    • fluid-filled blistering red rash, typically on the torso or face.
  • Shingles is most often diagnosed by your doctor solely based on the appearance of the characteristic rash.
  • Shingles can be treated with antiviral medication and pain medication.
  • The prognosis for shingles is generally favorable, though some individuals can experience complications. The most common complication is postherpetic neuralgia, which is persistent nerve pain after the rash disappears.
  • There is a vaccine available to help prevent shingles for certain individuals.

Quick GuideShingles Rash Pictures, Symptoms, Vaccine Facts

Shingles Rash Pictures, Symptoms, Vaccine Facts
Vaccine picture

Shingles Vaccine

Zoster Shingles Vaccine Side Effects

The most common adverse effects are:

  • headaches,
  • injection site swelling,
  • itching,
  • swelling,
  • pain,
  • warmth,
  • bleeding, and
  • bruising.

Some individuals may experience shingles or chickenpox-like rashes within 42 days after receiving zoster vaccine. Transmission of VZV virus from vaccinated individuals to other individuals occurs rarely.

Shingles rash is a red, blistering rash that usually affects one side of the body.

What is shingles? What does shingles look like?

Shingles is a disease characterized by a painful, blistering skin rash that affects one side of the body, typically the face or torso. This condition may also be referred to as herpes zoster, zoster, or zona. There are approximately 1 million estimated new cases per year in the U.S., with almost one out of every three people developing shingles at some point in their lifetime. Though most people who develop shingles will only have a single episode, there are some who develop recurrent cases of shingles. Shingles is more common in older individuals and in those with weakened immune systems.

The characteristic rash of shingles typically appears after an initial period of burning, tingling, itching, or stinging in the affected area. After a few days, the rash then appears in a stripe or band-like pattern along a nerve path (called a dermatome), affecting only one side of the body without crossing the midline. The rash erupts as clusters of small red patches that develop into blisters, which may appear similar to chickenpox. The blisters then break open and slowly begin to dry and eventually crust over.

Shingles is caused by the herpes zoster virus that also causes chickenpox.

What causes shingles?

Shingles is caused when the varicella zoster virus (VZV) reactivates, the same virus that causes chickenpox (varicella). The varicella zoster virus belongs to the Herpesviridae family. Only those who have previously had chickenpox and those who have received the varicella vaccine can develop shingles later in life. Initial exposure to the varicella zoster virus, which typically occurs in children or adolescents, leads to the development of varicella. After the episode of chickenpox has resolved, the virus remains in a dormant state in the nervous system in certain nerve cells of the body located in the spine. While in this inactive state, you will not experience any symptoms from the varicella zoster virus. However, in certain individuals and for reasons that are not completely clear, the varicella zoster virus may reactivate years later and travel along nerve paths to cause shingles. The location and pattern of the ensuing rash reflects the region of the affected nerves.

Though similar in name, herpes zoster is not the same disease as herpes simplex (which is caused by the herpes simplex virus causing cold sores, fever blisters, or genital herpes).

Take the Shingles Quiz
Seniors and those with weak immune systems are most at risk for shingles disease.

What are risk factors for shingles?

Shingles can only occur in individuals who have previously been exposed to the varicella zoster virus. Risk factors for the development of shingles include the following:

  • Increasing age: Though shingles can rarely occur in children, it is much more common in older adults, with the incidence increasing with age. This is thought to be in large part due to waning immunity as people age. Approximately 50% of all cases of shingles occur in adults 60 years of age or older.
  • Weakened immune system: Individuals with impaired immune systems have a higher probability of developing shingles. This can be seen in diseases such as cancer and HIV/AIDS, or in individuals taking certain medications. Patients taking steroids or other immunosuppressive medications, such as people who have undergone organ transplants, and individuals with certain autoimmune diseases (such as rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, and ulcerative colitis) are at increased risk for developing shingles. Psychological and emotional stressors are also thought to possibly contribute to the development of shingles, perhaps from the detrimental effects of stress on the immune system and the person's health.
Shingles disease can be spread through skin-to-skin contact of the shingles rash.

What is the contagious period for shingles?

The virus that causes shingles, the varicella zoster virus, can be transmitted from person to person by direct contact with the fluid from the active blistering rash. Therefore, susceptible individuals should avoid contact with people who have active shingles, especially pregnant women who have never had chickenpox and immunocompromised individuals. It cannot be transmitted by coughing or sneezing, and it is not contagious before the blisters appear. Once the shingles rash has dried and developed crusting, it is not considered to be contagious.

There are a few important points to consider when discussing the varicella zoster virus and transmissibility. If an individual who has never had chickenpox or the chickenpox vaccine comes in direct contact with the fluid from the shingles rash, they may go on to develop chickenpox, but they will not immediately develop shingles. It is possible, however, for them to develop shingles later in life, just as it is with others who have previously been exposed to the virus and developed chickenpox. Also, if you have previously been exposed to the varicella zoster virus and you have had chickenpox, you will not contract the virus from others with shingles.

The shingles virus can cause symptoms like headache, fever, and nausea.

What are shingles symptoms and signs?

Shingles usually starts with burning, tingling, itching, or stinging in the region where the rash will ultimately develop. Sometimes, this pain can be severe and individuals may complain of extremely sensitive skin. This discomfort typically occurs a few days before the visible rash develops. In rare instances, the characteristic shingles rash will not appear (a condition called zoster sine herpete).

Often, individuals may also experience other associated symptoms such as

A few days after the skin discomfort begins (or rarely, several weeks afterward), the characteristic rash of shingles will appear. It typically begins as clusters of small red patches that eventually develop into small blisters. These fluid-filled blisters eventually break open, and the small sores begin to slowly dry and scab over. The crusts usually fall off after several weeks, and the shingles rash typically clears up after approximately two to four weeks. Though uncommon, in cases of a severe rash, skin discoloration or scarring of the skin is possible.

The location of the shingles rash can vary. Though shingles can appear almost anywhere on the body, it most commonly affects the torso and the face (including the eyes, ears, and mouth). It is often present in the area of the ribcage or the waist. This characteristic rash is in a stripe or band-like pattern that affects only one side of the body (the right or the left), and it usually does not cross over the midline. In some cases, the rash can affect adjacent dermatomes (an area of skin that is supplied by a single spinal nerve), and rarely it can affect three or more dermatomes (a condition termed disseminated zoster). Disseminated zoster generally occurs only in individuals with a compromised immune system.

A doctor diagnoses a shingles rash.

How do health care professionals diagnose shingles?

Shingles can often be diagnosed by your doctor based upon the distinctive appearance and distribution of the characteristic shingles rash. A painful, blistering rash that is localized to defined dermatomes is a sign highly suggestive of shingles. Blood work or other testing is usually not necessary. Diagnosing shingles before the appearance of the rash or in cases of zoster sine herpete (zoster without rash) can be challenging. In cases where the diagnosis is unclear, laboratory tests are available to help confirm the diagnosis. Depending on the clinical situation, testing can be done using either blood work (to detect antibodies to the varicella zoster virus) or by specialized testing of skin lesion samples.

What types of health care professionals treat shingles?

Shingles is most commonly diagnosed and treated by a primary-care physician (family practitioner, pediatrician, and internist) or an emergency-room physician. For certain individuals who develop complications of shingles, a specialist in ophthalmology, neurology, or infectious disease may also be involved. Select patients with postherpetic neuralgia may require the care of a pain specialist.

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Medication is the best treatment for shingles.

What are medical treatments for shingles?

The treatment for shingles is aimed at diminishing the effects of the virus, as well as pain management. There are several medications that can be used, and your doctor will discuss the best treatment options for your particular situation. The vast majority of cases of shingles can be managed at home. In some cases, people with an impaired immune system or individuals with severe symptoms and/or complications may require hospital admission.

Antiviral medications (medications used to combat viral infections) are used against the varicella zoster virus. These medications help shorten the course of the illness, decrease the severity of the illness, and hasten the healing of the skin lesions. They may also help prevent the potential complications sometimes encountered with shingles. Antiviral medications are most effective when started within 72 hours of the first appearance of the rash, however, in select cases of shingles (for example, in an immunocompromised person), it can be started after 72 hours. There are several antiviral medications that can be used, including acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). In certain situations, intravenous (IV) antiviral medication may need to be administered.

Pain medication can be used to help relieve the discomfort caused by the rash, which can sometimes be severe. For some individuals with mild pain, over-the-counter analgesics such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) may be all that is needed. Individuals with more severe pain may require stronger opioid pain medication.

Over-the-counter antihistamine medication such as diphenhydramine (Benadryl) may help alleviate the localized itching.

The use of a corticosteroid medication, such as prednisone, is used in select cases of complicated shingles, such as those with eye or ear involvement, and it should be used with concurrent antiviral therapy. Prednisone is not generally recommended in cases of uncomplicated shingles.

Home remedies to relieve shingles itch include calamine lotion.

Are there any home remedies for shingles?

Care of the skin rash can be provided at home, and this can offer some symptom relief. Topical calamine lotion can be applied to the rash in order to decrease itching. Cool wet compresses against the rash can sometimes be soothing, and for some individuals, a compress with aluminum acetate solution (Burow's solution or Domeboro) may also be helpful. For some, colloidal oatmeal baths may also provide relief from the itching. It is important to maintain good personal hygiene, avoid scratching the rash, and to try to keep the affected area clean in order to prevent a secondary bacterial infection of the skin. The rash should be covered to decrease the risk of transmissibility should you come into contact with susceptible individuals.

What is the duration of a shingles outbreak?

The duration of an acute shingles outbreak may vary, but typically it will last anywhere between two to four weeks. In some individuals, it may last longer.

Quick GuideShingles Rash Pictures, Symptoms, Vaccine Facts

Shingles Rash Pictures, Symptoms, Vaccine Facts
Complications from the shingles virus may include pain.

What are complications of shingles?

Though shingles often resolves without any major problems, there are several potential complications that can arise from shingles.

  • Postherpetic neuralgia: This is the most common complication of shingles. This condition is characterized by persistent pain and discomfort in the area affected by shingles. The pain can last for months to several years after the rash has cleared up. This complication is thought to occur because of damage to the affected nerves. The pain can sometimes be severe and difficult to control, and the likelihood of developing postherpetic neuralgia increases with age. This chronic pain can sometimes lead to depression and disability. In people 60 years of age and older with shingles, postherpetic neuralgia will develop in approximately 15%-25% of cases. It rarely occurs in people under 40 years of age. Timely treatment with antiviral medication during a shingles outbreak may reduce the incidence of developing postherpetic neuralgia. If postherpetic neuralgia develops, there are various treatment options available including topical creams such as capsaicin (Zostrix), topical anesthetic lidocaine patches (Lidoderm), antiseizure medications such as gabapentin (Neurontin), pregabalin (Lyrica), tricyclic antidepressant medications, and opioid pain medications. Intrathecal glucocorticoid injections may be useful for select patients with postherpetic neuralgia who do not respond to conventional medications and treatment measures.
Picture: The Varicella zoster virus can cause shingles and postherpetic neuralgia.
Picture: How the varicella zoster virus causes shingles and postherpetic neuralgia

Take the Shingles Quiz
Facial nerve pain is often a complication of shingles.

What are complications of shingles? (Part 2)

  • Ramsay Hunt syndrome: If shingles affects the nerves of the face, this uncommon complication can lead to facial muscle paralysis, and the characteristic rash can affect the ear and the ear canal, and rarely the mouth. Symptoms may include ear pain, ringing in the ears, hearing loss, and dizziness. Though most people recover fully with treatment, some individuals may have permanent facial weakness and/or hearing loss.
  • Bacterial skin infection: A secondary bacterial infection of the skin blisters can sometimes develop, leading to cellulitis. This skin infection may be characterized by increasing redness, tenderness, and warmth in and around the area of the rash. Most of these bacterial skin infections are caused by either Staphylococcus aureus or group A Streptococcus bacteria. These bacterial infections can be treated with antibiotics.
Shingles virus can also affect the eyes.

What are complications of shingles? (Part 3)

  • Eye involvement: Shingles can sometimes affect the eye, a condition termed herpes zoster ophthalmicus. In certain cases, it can lead to blindness. Individuals with a rash involving the eye, forehead, or nose should have a careful eye evaluation performed by a doctor, as prompt medical treatment may be necessary.
  • Encephalitis: Rarely, individuals with shingles may develop inflammation of the brain (encephalitis). This condition can be life-threatening if severe, especially in people with an impaired immune system.
  • Disseminated herpes zoster: This serious and potentially life-threatening condition occurs most commonly in people with an impaired immune system. It is rare in individuals who are otherwise healthy. With disseminated herpes zoster, the varicella zoster virus becomes more widespread. In addition to causing a more widespread rash, the virus can also spread to other organs of the body, including the brain, lung, and liver.

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Medication may treat recurrent shingles.

What can be done for recurrent shingles?

Though most people will experience only one episode of shingles during their lifetime, recurrence can occur in certain individuals. In order to help prevent recurrent episodes of shingles, individuals with no contraindications can receive the zoster vaccine (Zostavax), which has been shown to be effective in decreasing recurrent episodes of shingles. Otherwise, people who do experience a recurrent case of shingles should see their doctor as soon as the rash appears to promptly receive antiviral medication.

What is the prognosis of shingles?

Generally speaking, shingles typically resolves within two to four weeks in most individuals. The prognosis is excellent for younger and healthy individuals who develop shingles, with very few experiencing any complications. However, in older individuals and in those with compromised immune systems, the prognosis is more guarded, as complications and more severe outbreaks of shingles occur more commonly in these groups.

Approximately 1%-4% of people who develop shingles require hospitalization for complications, and about 30% of those hospitalized have impaired immune systems. In the U.S., it is estimated that there are approximately 96 deaths per year directly related to the varicella zoster virus, the vast majority of which occur in the elderly and in those who are immunocompromised.

A shingles vaccine is available and recommended for seniors.

Is it possible to prevent shingles with a vaccine?

In 2006, the United States Food and Drug Administration (FDA) approved a shingles vaccine (Zostavax). Currently, the FDA has approved its use for individuals age 50 years and older, and the Centers for Disease Control and Prevention (CDC) has recommended its use for individuals age 60 years and older. It is a live attenuated vaccine that boosts the immune system and only needs to be administered one time. Ongoing studies are under way to determine how long the shingles vaccine confers protection. It has been shown to significantly reduce the risk of developing shingles by about 50%-60%, as well as reducing the incidence of postherpetic neuralgia by approximately 66%.

The shingles vaccine is not recommended during pregnancy or for those with weakened immune systems from disease or immunosuppressive medications, as it is a live vaccine. It is also not recommended for cases of active shingles or for those who have already developed postherpetic neuralgia. However, even if you have had shingles in the past, the shingles vaccine can still be administered to help prevent future recurrent shingles.

The vaccination can be administered at a pharmacy or at your doctor's office. If you are vaccinated with the shingles vaccine, it is safe to be around children, pregnant women, and immunocompromised individuals, as there are no documented cases of people getting chickenpox from a recently vaccinated person.

Research funded and conducted by the National Institute of Neurological Disorders and Stroke (NINDS) on shingles and the varicella zoster virus is ongoing to better understand the behavior of this virus. Several other organizations are also involved in research to understand, treat, and prevent varicella zoster virus reactivation.

Quick GuideShingles Rash Pictures, Symptoms, Vaccine Facts

Shingles Rash Pictures, Symptoms, Vaccine Facts
Reviewed on 7/5/2017
References
REFERENCES:

United States. Centers for Disease Control and Prevention. "Shingles (Herpes Zoster)." <http://www.cdc.gov/shingles/>. Aug. 19, 2016.

United States. NIHSeniorHealth. "Shingles." <http://nihseniorhealth.gov/shingles/aboutshingles/01.html>.

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