Shingles is caused by the same virus that causes chickenpox. Shingles most often occurs in people who have had chickenpox. The virus never fully leaves the body. Some of it settles in nerve roots. Shingles happens when the virus becomes active again. It may become active because of weakening of the immune system. Once active, the virus travels along nerve paths to the skin where it can cause a rash.

Shingles can happen in people who have only had a chickenpox vaccine, but this is rare.

Shingles does not pass from one person to another. The virus itself can pass from someone with shingles. It may cause chickenpox in someone who has never had chickenpox or the vaccine.

Risk Factors

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

Symptoms

Shingles may cause:

Rash:
- 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
Fever
Headache
Tiredness
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

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. The doctor can diagnose shingles based on the rash.

Treatment

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

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

Antiviral medicine may help to control shingles. It may shorten illness time for some. 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:

Antidepressants
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.

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

Prevention

Getting vaccinated is the best way to prevent shingles. The vaccine is given to people 50 years of age and older. It is given as a shot under the skin in 2 doses that are 2 to 6 months apart.

RESOURCES:

National Institute of Neurological Disorders and Stroke
https://www.ninds.nih.gov

National Shingles Foundation
http://www.vzvfoundation.org

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

The College of Family Physicians of Canada
http://www.cfpc.ca

References:

Herpes zoster. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/herpes-zoster. Accessed July 8, 2021.

Shingles. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/shingles. Accessed July 8, 2021.

Shingles (herpes zoster). Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/shingles/index.html. Accessed July 8, 2021.

Shingles: overview. The American Academy of Dermatology website. Available at: https://www.aad.org/public/diseases/a-z/shingles-overview. Accessed July 8, 2021.

Last reviewed September 2020 by EBSCO Medical Review Board
Last Updated: 7/8/2021

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