Shingles is a viral infection that affects approximately 1 in 3 adults in the United States. Around half of all shingles cases occur in adults over 60 years old.
It can occur in anyone who has had chickenpox, as both shingles and chickenpox are caused by the varicella-zoster virus (VZV). This virus remains in the body after chickenpox has cleared and can reactivate at any time, leading to shingles.
Shingles symptoms tend to develop on one side of the face or body. They often affect just a small area. The most common location is on the side of the waist, although they can occur anywhere.
Timeline of symptoms
Several days before a rash appears, shingles may cause skin sensitivity or pain. Further early symptoms include:
- general discomfort
- hot skin
Within the next 1 to 5 days, a red rash will normally form around the sensitive area. A few days later, fluid-filled blisters will develop at the site of the rash.
The blisters will ooze before drying up, typically within 10 days of appearing. At this point, scabs will form on the skin, tending to heal within 2 weeks.
There may be other symptoms accompanying the skin sensitivity and rash, including:
- malaise or feeling of being unwell
- sensitivity to light
A person’s vision may be affected if the shingles occurs near the eyes.It should be noted that shingles symptoms range from mild to severe, with some people experiencing itching and mild discomfort and others having intense pain.
Most cases of shingles resolve without causing long-term effects. However, potential complications include:
Post-herpetic neuropathy (PHN)
Post-herpetic neuropathy (PHN) is a common complication of shingles. It refers to nerve damage that causes pain and burning that persists after the shingles infection is gone.
Some sources suggest that up to 20 percent of people who get shingles develop PHN with older adults thought to be especially at risk.
Treating PHN is difficult, and the symptoms can last for years. However, most people fully recover within 12 months.
It is not known why some people who have shingles go on to develop PHN. The risk factors for PHN include:
- a weakened immune system
- having pain during the early stages of a shingles infection
- advanced age
- having severe shingles that covers a large portion of the skin
According to some research, older women who get severe pain and rash symptoms may have a 50 percent chance of developing PHN.
Other potential complications of shingles include:
- bacterial infections of the skin
- facial paralysis
- hearing loss
- loss of taste
- ringing in the ears
- vertigo, a type of dizziness
- vision problems
It is important to see a doctor as soon as a person notices the symptoms of shingles.
The National Institute on Aging recommend that people seek medical treatment no later than 3 days after the rash appears. Early treatment can limit pain, help the rash heal quicker, and may reduce scarring.
Once a doctor confirms shingles, they may suggest the following treatments:
These ease symptoms, speed up recovery, and may prevent complications. A course of antiviral medications is usually prescribed for 7 to 10 days. Options include:
- acyclovir (Zovirax)
- famciclovir (Famvir)
- valacyclovir (Valtrex)
Antiviral drugs are most effective when taken within 3 days of the rash onset, although they may still be prescribed within the first 7 days of the rash appearing.
Painkillers and antihistamines
Over-the-counter (OTC) or prescription medications may reduce pain and skin irritation. Options include:
- anti-inflammatory drugs, such as ibuprofen (Advil)
- antihistamines for itching, including diphenhydramine (Benadryl)
- corticosteroids or local anesthetics for severe pain
- numbing products, including lidocaine (Lidoderm)
Certain antidepressant drugs have been proven effective in reducing shingles pain, as well as symptoms of PHN.
Tricyclic antidepressants (TCAs) are most commonly prescribed for shingles pain, including:
- amitriptyline (Elavil)
- imipramine (Tofranil)
- nortriptyline (Aventyl, Pamelor)
It can take several weeks or months before antidepressants work for nerve pain.
Although typically used to treat epilepsy, some anticonvulsant drugs may reduce nerve pain. Again, these can take several weeks to take effect. Commonly prescribed anticonvulsants for shingles include:
- gabapentin (Neurontin)
- pregabalin (Lyrica)
Managing shingles symptoms
In addition to seeking medical treatment, people can take other steps to alleviate their symptoms and reduce discomfort. These include:
- getting enough sleep and rest
- using a wet compress on the itchy and inflamed skin and blisters
- reducing stress through a healthy lifestyle, meditation, and deep breathing exercises
- wearing loose-fitting clothing made of natural fibers, such as cotton.
- taking an oatmeal bath
- applying calamine lotion to the skin
People should avoid scratching the rash and blisters as much as they can. Breaking the skin or bursting the blisters can cause infection and further complications.
Is shingles contagious?
Shingles is not contagious but is the reactivation of a virus already present in the body.
However, a person with shingles can give chickenpox to someone who has never had the VZV infection before.
Therefore, people with shingles should avoid contact with those who have never had chickenpox until their rash has completely healed. To catch the virus, someone must have direct contact with the rash.
To avoid spreading VZV, people with shingles should:
- Avoid close contact with people who have never had chickenpox or been vaccinated for chickenpox.
- Avoid close contact with low birth-weight infants and people with a compromised immune system, such as those on HIV medication or who have had an organ transplant.
- Keep the rash covered with loose, natural clothing to avoid others coming into contact with it.
- Wash their hands frequently, especially after touching the rash or applying lotions to the skin.
Vaccinating against shingles
People over 60 should get a vaccination against shingles.
There is a vaccination available to reduce the risk of developing shingles and experiencing long-term complications, such as PHN.
The Centers for Disease Control and Prevention (CDC) recommends that adults aged 60 years and older have this vaccination, as it is believed to reduce the risk of shingles by 50 percent and PHN by 67 percent.
People who have already had shingles can have the vaccine to prevent future occurrences. Each vaccination protects for approximately 5 years.