Shingles 

 

Shingles, also known as herpes zoster, is an infection of a nerve and the skin around it. It's caused by the varicella-zoster virus, which also causes chickenpox.

It's estimated around one in every four people will have at least one episode of shingles during their life.

This page covers:

Symptoms

When to get medical advice

Causes

Is shingles contagious?

Treatments

Complications

Vaccine for shingles

Ophthalmic shingles

Symptoms of shingles

The main symptom of shingles is pain, followed by a rash that develops into itchy blisters, similar in appearance to chickenpox.

New blisters may appear for up to a week, but a few days after appearing they become yellowish in colour, flatten and dry out.

Scabs then form where the blisters were, which may leave some slight scarring and loss of skin pigment.

The pain may be a constant, dull or burning sensation, and its intensity can vary from mild to severe.

You may have sharp stabbing pains from time to time, and the affected area of skin will usually be tender.

In some cases shingles may cause some early symptoms that develop a few days before the painful rash first appears.

These early symptoms can include:

• a headache
• burning, tingling, numbness or itchiness of the skin in the affected area
• a feeling of being generally unwell
• a high temperature (fever)

An episode of shingles typically lasts around two to four weeks. It usually affects a specific area on just one side of the body.

It doesn't cross over the midline of the body, an imaginary line running from between your eyes down past the belly button.

Any part of your body can be affected, including your face and eyes, but the chest and tummy (abdomen) are the most common areas.

When to get medical advice

Shingles isn't usually serious, but see your GP as soon as possible if you recognise the symptoms. They'll usually be able to diagnose shingles based on your symptoms and the appearance of the rash.

Early treatment may help reduce the severity of your symptoms and the risk of developing complications.

Referral to hospital

It's uncommon for someone with shingles to be referred to hospital, but your GP may consider seeking specialist advice if:

• they suspect a complication of shingles, such as meningitis or encephalitis
• shingles is affecting one of your eyes – there's a risk you could develop permanent vision problems if the condition isn't treated quickly
• a diagnosis isn't certain
• you have an unusually persistent case of shingles that's not responding to treatment
• you've been diagnosed with the condition twice
• you're pregnant
• you have a weakened immune system – particularly in severe cases or cases affecting children

Causes of shingles

Most people have chickenpox in childhood, but after the illness has gone the varicella-zoster virus remains inactive (dormant) in the nervous system.

The immune system keeps the virus in check, but it can be reactivated later in life and cause shingles.

It's possible to have shingles more than once, but it's very rare to get it more than twice.

It's not known exactly why the shingles virus is reactivated at a later stage in life, but most cases are thought to be caused by having lowered protection against infections and diseases (immunity).

This may be the result of:

• old age – as you age, your immunity may decrease; shingles most commonly occurs in people over the age of 70
• physical and emotional stress – the chemicals released by your body when you're stressed can prevent your immune system working properly
• HIV and AIDS – people with HIV are much more likely to get shingles than the rest of the population because their immune system is weak
• recently having a bone marrow transplant – the conditioning you require before the transplant weakens your immune system
• recently having an organ transplant – you may need to take medication to suppress your immune system so your body accepts the donated organ
• chemotherapy – chemotherapy medication, often used to treat cancer, can temporarily weaken your immune system

However, young people who are otherwise healthy can also sometimes develop shingles.

Is shingles contagious?

It's not possible to catch shingles from someone with the condition or from someone with chickenpox.

However, you can catch chickenpox from someone with shingles if you haven't had chickenpox before, but this is uncommon.

The blisters of shingles contain live virus. If a person who has never had chickenpox makes direct contact with an open blister or something with the fluid on it, they can contract the virus and develop chickenpox.

Preventing the spread of the virus

If you have shingles, you're contagious until the last blister has dried and scabbed over.

To help prevent the virus being passed on, avoid sharing towels or flannels, swimming or playing contact sports. You should also avoid work or school if your rash is oozing fluid (weeping) and can't be covered.

Chickenpox can be particularly dangerous for certain groups of people. If you have shingles, avoid:

• women who are pregnant and haven't had chickenpox before as they could catch it from you – this may harm their unborn baby
• people who have a weak immune system – such as someone with HIV or AIDS
• babies less than one month old – unless it's your own baby, in which case your baby should have proteins that fight infection (antibodies) to protect them from the virus

Treating shingles

Although there's no cure for shingles, treatment is available to relieve the symptoms until the condition resolves. Most cases of shingles last around two to four weeks.

Treatment for shingles can include:

• covering the rash with clothing or a non-stick (non-adherent) dressing to reduce the risk of other people becoming infected with chickenpox – it's very difficult to pass the virus on to someone else if the rash is covered
• painkilling medication – such as paracetamol, ibuprofen or codeine
• antiviral medication to stop the virus multiplying – although not everyone will need this

Read more about treating shingles.

Complications of shingles

Shingles can sometimes lead to complications, such as postherpetic neuralgia. This is where severe nerve pain lasts for several months or more after the rash has gone.

Complications like this are usually in elderly people who have had the condition and those with a weakened immune system.

Read more about complications of shingles.

The shingles vaccine

It's not always possible to prevent shingles, but a vaccine called Zostavax can reduce your chances of developing the condition.

If you still develop shingles after having this vaccine, it may be milder and last for a shorter time than usual.

The vaccine is available on the NHS to some people in their 70s.

Read more about the shingles vaccination and who can have the shingles vaccine.

Ophthalmic shingles

Some cases of shingles can affect one of the eyes and are known as ophthalmic shingles.

This occurs when the virus is reactivated in part of the trigeminal nerve, a nerve that controls sensation and movement in your face.

Symptoms can include:

• a rash over your forehead, nose and around your eye
• conjunctivitis – inflammation of your eye that causes it to become red and watery, with a sticky coating on your eyelashes
• a red eye
• problems with your vision