Shingles (Herpes Zoster)

What is shingles? 

Shingles (herpes zoster) is a painful skin rash caused by the varicella-zoster virus (VZV). This is the same virus that causes chickenpox. After a person has chickenpox, the virus remains inactive in the nerve cells. Years later, the virus can become active again. If it does, a red rash or small blisters occur, usually on one side of the body, spreading along a nerve pathway where the virus was inactive. Sometimes, even after the rash is gone, the pain may continue for a prolonged time. This is a complication called postherpetic neuralgia (PHN). People who get the chickenpox vaccine still have a small risk of herpes zoster, although it appears to be less than the risk after an actual chickenpox infection. People with a weak immune system are at greater risk of getting shingles. Almost half of the cases of shingles occur in people older than age 60.

The incidence of herpes zoster occurring in children is low, but the risk of getting this disease increases with age. Children who have weak immune systems may have the same, or more severe, symptoms as adults. Children most at risk for herpes zoster are those who had chickenpox during the first year of life or whose mothers had chickenpox very late during pregnancy. 

What are the symptoms of shingles?

Shingles most often occurs on the trunk and buttocks. It may also appear on the arms, legs, or face. These are the most common symptoms:

  • Pain, burning, tingling, or itching on one part of your face or body

  • Rash, which can appear up to 5 days after and first looks like small, red spots that turn into blisters

  • Blisters which turn yellow and dry

  • Rash which usually goes away in 2 to 4 weeks

  • Rash is usually localized to one side or part of the body

  • Fever, chills, headache, nausea 

  • PHN can cause pain for weeks, months, and rarely even years after the rash resolves 

The symptoms of herpes zoster may look like other skin conditions. Always see your healthcare provider for a diagnosis.

How is shingles diagnosed?

Your healthcare provider will ask about your medical history and do a physical exam. Diagnosis may also include:

  • Skin scrapings. Gently scraping the blisters to determine if the virus is shingles or another virus.

  • Blood tests

What is the treatment for shingles?

Immediate treatment with antiviral medicines may help lessen the duration and severity of some of the symptoms. These antiviral medicines (acyclovir, famcyclovir and valacyclovir) are more effective the sooner they are started. Ask your healthcare provider about over-the-counter pain relievers. If your pain is severe, your provider may prescribe stronger pain medicine. You and your healthcare provider will decide on the best treatment based on factors including duration and severity of the symptoms.

How can I prevent shingles?

The CDC recommends vaccination at age 60 or older for everyone. If you have questions about shingles or if you should get the shingles vaccine, talk with your healthcare provider. The vaccine is approved for use at age 50 as well, but current CDC guidelines do not recommend routine vaccination between 50 and 59 years old. The herpes zoster vaccine has been shown in clinical trials to reduce infections by one half, and to reduce PHN by two thirds.  Even if you have had shingles, you can still get the vaccine to help prevent future occurrences of the disease. The vaccine is effective for at least 6 years, but may last longer. The vaccine is made of a live but weakened virus. It should not be given to those who have a weak immune system. Check with your healthcare provider.