Shingles

Shingles is a disease that triggers a painful skin rash. It is caused by the varicella-zoster virus, the same virus that causes chickenpox.

Overview

Shingles is a disease that triggers a painful skin rash. It is caused by the varicella-zoster virus, the same virus that causes chickenpox. After recovering from chickenpox, which usually happens during childhood, the virus continues to live in some of the nerve cells.

For many adults, the virus stays inactive and never leads to shingles. But about one in three adults will develop shingles during their lifetime. A safe and effective vaccine can help provide protection.

Signs and Symptoms

Shingles usually develops in a small area because the reactivated virus most commonly travels along a single nerve. The most common location is a band around one side of the body (generally on the chest, back, and stomach area).

Most people with shingles have one or more of the following symptoms:

  • Fluid-filled blisters
  • Burning or shooting pain
  • Tingling, itching, or numbness of the skin

Less commonly, patients with shingles may also have:

  • Chills
  • Fever
  • Headache
  • Upset stomach

For some people, symptoms are mild—and may just be some itchiness. Others develop more severe symptoms, like intense or long-lasting pain.

How Long Shingles Lasts

Most cases of shingles last three to five weeks. Shingles usually follows this timeline:

  1. The first sign is often burning or tingling pain, sometimes with numbness or itching on one side of the body.
  2. One to five days later, a red rash appears.
  3. A few days after that, the rash turns into fluid-filled blisters.
  4. About one to 10 days later, the blisters dry up and crust over.
  5. A couple of weeks later, the scabs clear up.

When to seek care

If you notice blisters on your face, see your doctor immediately. Blisters near or in the eye can cause lasting eye damage and blindness. People can also experience hearing loss or a brief paralysis of the face. In rare cases, people can experience inflammation of the brain (encephalitis) or spinal cord (myelitis).

Postherpetic Neuralgia

After the shingles rash goes away, some people are left with ongoing pain called postherpetic neuralgia. The pain is felt in the area where the rash was. The older people are when they get shingles, the greater their chances of developing postherpetic neuralgia.

This pain can lead to depression, anxiety, sleeplessness, and weight loss. Some people find it hard to carry out daily activities—such as dressing, cooking, and eating. While there is no cure, people can manage pain. For most people, pain will lessen over time.

Eye Complications

When shingles affects the cornea (the clear front layer of the eye), it can cause inflammation and scarring. An eye doctor can prescribe antiviral medicine to help shingles go away faster and prevent damage to the cornea. If you get shingles on your face or in your nose or eyes, it’s important to get an eye exam to check for cornea problems.

Herpes Zoster Oticus (Ramsay Hunt Syndrome)

Herpes zoster oticus is a common complication of shingles. It’s caused by the spread of the varicella-zoster virus to nerves associated with the face, hearing, and balance. It’s characterized by:

  • Intense ear pain
  • A rash around the ear, mouth, face, neck, or scalp
  • Paralysis of the facial nerve

Other symptoms may include:

  • Hearing loss
  • Vertigo (abnormal sensation of movement)
  • Tinnitus (abnormal sounds)
  • Loss of taste
  • Dry mouth and eyes

Some cases don’t require treatment. Doctors may prescribe antiviral drugs or corticosteroids for treatment. The drug diazepam (Valium) or meclizine can treat vertigo.

Causes and Risk Factors

Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. Everyone who has had chickenpox is at risk for developing shingles. Researchers don’t fully understand what makes the virus become active again in some people but not others.

Certain factors make shingles more likely:

  • Older age: The risk of developing shingles increases with age. About half of all shingles cases are in adults 60 or older. The chance of getting shingles becomes much greater by age 70.
  • A weakened immune system: Age can weaken the immune system. Other things that can weaken it include HIV, cancer, cancer treatments, organ transplant medicines, medicines used to treat certain medical conditions (such as autoimmune diseases), and chronic diseases (such as diabetes and arthritis). Even stress or a cold can weaken the immune system for a short time.

Most people have shingles only once, but it’s possible to have it more than once.

Prevention Guidance

The Shingles Vaccine

The current shingles vaccine (brand name Shingrix) is a safe, easy, and effective way to prevent shingles. It’s more than 90% effective at preventing the disease. Most adults 50 and older should get vaccinated with Shingrix, which is given in two doses. You can get the shingles vaccine at a doctor’s office and at some pharmacies.

You should get the shingles vaccine if you:

  • Have already had chickenpox or shingles
  • Received the prior shingles vaccine called Zostavax (your doctor or pharmacist can recommend when to get the current shingles vaccine)
  • Received the varicella (chickenpox) vaccine
  • Do not remember whether you had chickenpox

You should not get vaccinated if you:

  • Currently have shingles
  • Are sick or have a fever
  • Had an allergic reaction to a previous dose of the shingles vaccine
  • Are currently pregnant (wait to get Shingrix)

If you are unsure if the vaccine is right for you or have other health concerns, talk with your doctor.

The shingles vaccine may cause side effects, but these are mostly mild. The most common side effect is a sore arm. Some people may develop flu-like symptoms. These side effects are significantly less severe than the pain and possible long-term effects of shingles.

Side effects should go away on their own in about two to three days. If side effects are uncomfortable, your doctor or pharmacist may recommend taking over-the-counter pain medicine (such as ibuprofen or acetaminophen).

Limit the Spread of the Virus

If you develop shingles, you can limit spreading the virus to other people by:

  • Staying away from anyone who has not had chickenpox or the chickenpox vaccine, or who might have a weakened immune system
  • Keeping the rash covered
  • Not touching or scratching the rash
  • Washing your hands often

Diagnosis

If you think you might have shingles, talk to your doctor as soon as possible. It’s important to see your doctor no later than three days after the rash starts. Doctors can diagnose most cases from a visual examination. If you have a condition that weakens the immune system, your doctor may order a shingles test.

Treatment and Management

Although there is no cure for shingles, early treatment with antiviral medicines can help the blisters clear up faster and limit severe pain. It’s important to see your doctor no later than three days after the rash starts.

Coping With Shingles

If you have shingles, the following tips may help you feel better:

  • Wear loose-fitting, natural-fiber clothing.
  • Take an oatmeal bath or use calamine lotion to soothe your skin.
  • Apply a cool washcloth to your blisters to ease the pain and help dry the blisters.
  • Keep the area clean and try not to scratch the blisters so they don’t become infected or leave a scar.
  • Do things that take your mind off your pain such as watching TV, reading, talking with friends, listening to relaxing music, or working on a hobby (such as crafts or gardening).
  • Get plenty of rest and eat well-balanced meals.
  • Try light physical activity, such as stretching or walking.
  • Avoid stress as much as possible, as it can make the pain worse.
  • Share your feelings about your pain with family and friends and ask for their support.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on shingles.

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Community Support

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Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH supports research on the causes, prevention, diagnosis, and treatment of infectious diseases such as shingles.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.

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