- Risk Factors
- Signs & Symptoms
- Home Remedies
What is shingles?
Shingle 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. The word shingles come from the Latin word cingulum, which means belt. 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, some develop recurrent cases of shingles. Shingles are 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.
What causes shingles?
Shingles are caused when the varicella-zoster virus (VZV) reactivates, the same virus that causes chickenpox (varicella). Varicella-zoster belongs to the Herpesviridae family. Only those who have previously had chickenpox can develop shingles later in life, and rarely, those who have received the varicella vaccine can develop shingles later in life. Initial exposure to VZV, 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 of the varicella-zoster virus. However, in certain individuals and for reasons that are not completely clear, the varicella-zoster virus may re-emerge years later and travel along nerve fibers to cause shingles. The location and pattern of the ensuing rash reflect the region of the affected nerves.
Is shingles and herpes zoster the same?
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).
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 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: These 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.
What are signs and symptoms of shingles?
Shingles usually start 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 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.
How long are you contagious with 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 generally 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.
What types of healthcare professionals diagnose and treat shingles?
Shingles are most commonly diagnosed and treated by a primary care physician (family practitioner, pediatrician, and internist) or an emergency medicine 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.
How do healthcare professionals diagnose shingles?
Shingles can often be diagnosed by your doctor based on 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 are medical treatments for shingles?
The treatment for shingles is aimed at diminishing the effects of the virus, as well as pain management. Several medications 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 drugs (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. Several antiviral medications 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 shingles pain, over-the-counter analgesics such as acetaminophen (Tylenol) or the anti-inflammatory drug 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 only 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.
Are there any home remedies for shingles?
Care for the skin rash can be provided at home, and this can offer some symptom relief.
- Topical calamine lotion can be applied to the rash to decrease itching.
- Cool wet compresses against the painful 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, wear loose-fitting clothes, and try to keep the affected area clean to prevent 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.
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. To help prevent recurrent episodes of shingles, individuals with no contraindications can receive the zoster vaccine (Shingrix), which can prevent 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 resolve 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 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.
Subscribe to MedicineNet's General Health Newsletter
What are complications of shingles?
Though shingles often resolve without any major problems, several potential complications can arise from shingles.
- Postherpetic neuralgia (PHN): This is the most common complication of shingles. PHN 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 post-herpetic 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 help 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), and 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.
Other complications of shingles include:
- Ramsay Hunt syndrome: If shingles affect 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 or impetigo. These skin infections 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.
- 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 otherwise healthy individuals. 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, lungs, and liver.
Health Solutions From Our Sponsors
Is it possible to prevent shingles with a vaccine?
In October 2017, the United States Food and Drug Administration (FDA) approved Shingrix, a non-live vaccine to prevent shingles. The Advisory Committee on Immunization Practices (ACIP) subsequently endorsed Shingrix as the preferred vaccine for the prevention of herpes zoster and its related complications in healthy adults 50 years of age and older. Shingrix is also recommended for adults who previously received the current shingles vaccine Zostavax, which was approved by the FDA in 2006. Shingrix, a two-dose vaccine, was found to prevent shingles in more than 90% of patients who received it in clinical trials. By preventing shingles, Shingrix also decreases the incidence of postherpetic neuralgia. Not only does Shingrix provide superior efficacy across all age groups, but it is also felt to confer longer-lasting immunity than Zostavax, which has experienced temporary vaccine shortages due to supply issues. Shingrix is expected to be widely available to U.S. consumers in early 2018. During clinical trials, the most common side effects associated with Shingrix included pain, swelling, redness at the site of injection, headache, muscle aches, fever, chills, and upset stomach.
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.
Who should get the shingles vaccine?
At this time, Shingrix is recommended for healthy adults who are 50 years of age or older. Individuals should receive the vaccine whether or not they recall having had chickenpox, as data shows that more than 99% of Americans over 40 years of age have had chickenpox, even if they do not remember having it. Shingrix is also recommended for individuals who have already received the Zostavax vaccine, as Shingrix has demonstrated superior efficacy and longer-lasting protection.
Shingrix is not indicated for the prevention of primary varicella (chickenpox) infection. The CDC recommends the varicella vaccine for healthy people who do not have evidence of immunity to varicella, including children, adolescents, and adults.
IMAGESSee pictures of shingles and other viral skin conditions See Images
Health Solutions From Our Sponsors
United States. Centers for Disease Control and Prevention. "Vaccines and Preventable Diseases: What Everyone Should Know About Shingles Vaccine." <https://www.cdc.gov/vaccines/vpd/shingles/public/index.html>. Jan. 24, 2022.
United States. National Foundation for Infectious Diseases. "Shingles (Herpes Zoster)." <http://www.nfid.org/idinfo/shingles>.
United States. National Institutes of Health. National Institute on Aging. "Shingles." <https://www.nia.nih.gov/health/shingles>. Oct. 12, 2021.
Top Shingles (Herpes Zoster) Related Articles
CellulitisCellulitis is an acute spreading bacterial infection below the surface of the skin characterized by redness, warmth, inflammation, and pain. The most common cause of cellulitis is the bacteria staph (Staphylococcus aureus).
Chickenpox QuizHow is chickenpox related to shingles? Take the Chickenpox Quiz to assess your IQ of this itchy, blistering childhood skin disease.
Is It Contagious QuizIs it contagious? Take this quiz to learn about contagious diseases, how contagious diseases are spread, and myths and facts about contagions.
Cupping TherapyCupping is a form of traditional Chinese medicine that aims to improve the flow of qi (energy) in the body. Learn more about the benefits and potential side effects of the various types of cupping.
Herpes Zoster PictureHerpes zoster. Shingles is cause by herpes zoster which is a reactivation of the varicella zoster virus (VZV). VZV causes chicken pox and stays in your body for the rest of your life. When it reactivates, it results in a red rash that includes blisters and is generally painful and itches. Shingles can last days or even weeks and it can result in scarring and prolonged pain along the nerve affected. The rash usually dries out and becomes crusty. It can result in scarring and prolonged pain along the nerve affected.
Vaccination Schedule for Adults and AdolescentsImmunizations can prevent many diseases nowadays. It's important to follow the vaccination guidelines recommended on the CDC's vaccination schedule for adults and adolescents in order to stay informed about new vaccines and to learn how often and when the vaccines should be administered.
Itching (Pruritus)Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching including infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Kidney PainKidney pain has a variety of causes and symptoms. Infection, injury, trauma, bleeding disorders, kidney stones, and less common conditions may lead to kidney pain. Symptoms associated with kidney pain may include fever, vomiting, nausea, flank pain, and painful urination. Treatment of kidney pain depends on the cause of the pain.
Peripheral NeuropathyPeripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, shingles, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Peripheral neuropathy is diagnosed with exams and tests. Treatment for the condition depends on the cause. Usually, the prognosis for peripheral neuropathy is good if the cause can be successfully treated or prevented.
Skin RashThe word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
What Is the Main Cause of Shingles Rash? Signs, Symptoms, VaccineShingles occurs when the varicella-zoster virus, the same virus that causes chickenpox, re-emerges due to a weakened immune system. Tingling may occur before herpes zoster blisters appear, usually on the side of the body. The shingles vaccine can boost the immune system to lower the risk of shingles outbreaks.
Myths and Facts About ShinglesThere are some common misconceptions about this viral illness and the uncomfortable rash it can cause. Here's a guide through the myths and facts of shingles.
Skin Picture QuizCould you identify a scabies infestation? Take the Skin Diseases Pictures Quiz and learn to identify common conditions that plague human skin.
Skin Problems: Rosacea, Acne, Shingles, Covid-19 RashesLearn to spot and treat skin conditions commonly found in adults such as acne, Covid-19 rashes, eczema, shingles, psoriasis, rosacea, hives, cold sores, razor bumps, athlete's foot, and more dermatology details.
Staph (Staphylococcus) InfectionStaphylococcus or staph is a group of bacteria that can cause a multitude of diseases. Staph infections can cause illness directly by infection or indirectly by the toxins they produce. Symptoms and signs of a staph infection include redness, swelling, pain, and drainage of pus. Minor skin infections are treated with an antibiotic ointment, while more serious infections are treated with intravenous antibiotics.
Swollen Lymph Nodes (Lymphadenopathy)Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly, but may include fever, night sweats, toothache, sore throat, or weight loss. Causes of swollen lymph nodes also vary, but may include cancer, the common cold, mono, chickenox, HIV, and herpes. The treatment of swollen lymph nodes depends upon the cause.
Vaccination FAQVaccinations increase our ability to fight diseases that may be contagious or even fatal. Immunity occurs by getting the disease or through the use of a vaccine. There are two types of vaccine: inactivated vaccines and vaccines made from live, weakened viruses.
What's a Virus?Is a virus alive? Learn the definition of a virus. Viral infections like COVID-19 can occur in your eyes, mouth, skin, or anywhere else. Should you use antibiotics to treat the flu? Is this STD a bacterium or a virus? Get the answers to the most common questions about viral infections.