What Triggers a Shingles Outbreak?

Shingles is a viral infection that causes painful rashes on the body. Shingles is triggered by a weakened or compromised immune system.

Shingles, also known as herpes zoster, is a virus infection that causes painful rashes on the body, usually on one side of your torso. It is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox.

After you’ve had chickenpox as a child, the virus lays dormant in your body. A strong immune system usually keeps the VZV in check. It’s when your immune system becomes compromised or is weakened, however, that triggers the VZV to reactivate and cause shingles.  

While shingles are not contagious, it can spread the VZV to someone who hasn’t had it yet and give them chickenpox. If you’ve never had chickenpox, avoid those who have shingles and, conversely, if you have shingles, don’t go near anyone who hasn’t had chickenpox or has a weak immune system.

People often experience itching, tingling, and even pain in the area where shingles will develop before there is a visible rash. These can be felt up to several days prior to the rash appearing.  

Most commonly, the rash occurs in a single stripe around the waistline on one side of the body or the other. Sometimes the rash appears on the side of the face. Face shingles can affect the eyes and impair vision. People who already have weakened immune systems can develop more widespread rashes across the body that resemble a chickenpox rash.  

Other symptoms of shingles can include:

• Chills
• Fever
• Fluid-filled blisters
• Headache
• Hiccups
• Sensitive skin
• Upset stomach

For the most part, shingles symptoms tend to be mild with slight itching and discomfort. Though more severe cases are rare, they do happen, and the pain can be debilitating. 

Most cases of shingles will last between three and five weeks, and follow a general pattern: 

• The first sign is a burning or tingling sensation on the skin and can include numbness or itching
• Within a couple of days, a red rash will appear in the affected area 
• A few days after the rash appears, it will turn into fluid-filled blisters
• About seven to ten days after that, the blisters dry up and crust over
• A couple of weeks later, the scabs fade away

While most people get shingles only one time in their life, it is possible to have it more than once.

Shingles are caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox. Anyone who’s had chickenpox is susceptible to developing shingles. The Centers for Disease Control and Prevention estimate that 1 out of 3 people will develop shingles at least once in their lifetime.    

The risk of getting shingles increases as a person gets older. Scientists believe this may be because a person’s immunity naturally declines as they age. A weakened or compromised immune system is the main trigger for reactivating the virus in the body, causing the outbreak of shingles.

A doctor can usually diagnose shingles with a simple physical exam and questions about your symptoms. If the diagnosis isn’t clear, or if the person is in a high-risk category, like people with an already-weak immune system or pregnant women, the doctor will perform a shingles test. This involves taking a sample from the rash and checking it for the VZV.

There are several antiviral medications available to treat shingles and shorten its length and severity. These include acyclovir, valacyclovir, and famciclovir. It is recommended that you see a doctor and get a prescription for one of these drugs as soon as possible after developing symptoms or when the shingles rash appears.    

Over-the-counter anti-inflammatory medication is usually recommended to help relieve pain caused by shingles. Prescription-strength opioid pain medication might be prescribed if the pain is moderate or severe. Consult with your doctor for the best pain medication treatment for you.

Recombinant zoster vaccine, also known as RZV Shingrix, is recommended to prevent shingles in adults 50 and older. Zostavax used to be recommended and available in the United States, but as of November 2020, it is no longer available.