Shingles: Everything You Need to Know

Shingles of the eye

The shingles virus can affect your eyes. When that happens, your symptoms can include:

• Rash on one or both eyelids
• Redness and oozing that affects the whites of your eyes (conjunctivitis)
• Blurry vision
• Pain and swelling inside your eye (iritis)
• Sensitivity to light
• Swelling of your optic nerve (optic neuritis)
• Breakdown of the surface of your cornea (keratitis)

What Causes Shingles?

When the varicella-zoster virus gets into your body, the first problem it causes is chickenpox. You may think of it as a childhood disease, but adults can get it, too.

After chickenpox runs its course, the virus moves into the nerve tissues near your spinal cord and brain, where it stays.

We don’t know why, but sometimes, years later, the virus "wakes up" and travels along nerve fibers to your skin. That’s when it lands its second punch: shingles, also called herpes zoster.

Shingles Stages

If you have shingles, it will probably take 2-6 weeks for your illness to run its course.

Shingles has three stages:

Pre-rash. This first stage is also called "preeruptive." Your skin may feel sensitive or tingly. Parts of your body might feel painful. You could have general symptoms of a virus — headache, fatigue, and a general feeling of being unwell. This stage starts about 48 hours before the rash appears.

Eruptive. In this stage, painful blisters begin to appear on your body. They may burst and crust over. You're most contagious during this stage until your blisters have dried up. It's usually the most painful stage of an outbreak, and over-the-counter pain relievers may not help. You might continue to have a headache and be tired. This stage lasts 2-4 weeks.

Chronic. If your shingles infection becomes chronic, your pain will last more than 4 weeks. Because shingles affects nerves, you may have strange sensations, such as "pins and needles" or shocks, unrelated to anything touching your skin.

Shingles Risk Factors

A weakened immune system might wake up the virus. After you’ve had chickenpox, you’re more likely to get shingles if you:

• Are 50 or older
• Are under a lot of stress
• Have cancer, HIV, or another disease that lowers your body’s defenses
• Have had a serious physical injury
• Take long-term steroids or other medicines that can weaken your immune system
• Didn't get vaccinated against chickenpox as a kid or an adult
• Are eligible but do not get the shingles vaccine
• Are going through perimenopause or menopause, which may alter your immune response

But many people who get shingles don’t fit into any of these categories.

Shingles and Pregnancy

Shingles during pregnancy is rare.

If you're pregnant and think you have shingles, talk to your doctor right away. You can take antiviral medication during pregnancy, and these drugs will shorten the course of the disease. The sooner you start taking an antiviral, the better the drug works.

Not much research has been done on shingles and pregnancy, so there's no data on whether shingles increases the risk of miscarriage or complications such as preterm birth.

Studies on shingles and birth defects are limited, but there's nothing to suggest that a shingles outbreak will increase the chances of your baby having birth defects. There's no research on whether shingles during pregnancy might cause learning or behavior problems for your child later.

Also, there's no evidence that shingles will affect your ability to conceive.

If you get shingles while you're nursing, you'll need to keep your baby away from the rash. There's no evidence that the shingles virus shows up in breast milk. But babies can get chickenpox from contact with the blisters because chickenpox and shingles are caused by the same virus. If you have a rash on your nipples, you should pump and throw away the breast milk. It's safe to nurse once the blisters have scabbed over. If you're taking antiviral drugs for your shingles, check with your doctor about nursing.

Shingles Complications 

Shingles can cause complications that last long after the rash is gone, including:

• Brain inflammation or facial paralysis if it affects certain nerves
• Eye problems and vision loss if your rash was in or around your eye
• Pain that lasts long after the outbreak, called postherpetic neuralgia. It affects up to 1 in 5 people who get shingles, and it's more common in older people
• Bacteria infecting your rash

Rare complications of shingles include:

• Lung infection
• Hearing loss
• Death

Is Shingles Contagious?

Yes. You can spread the varicella-zoster virus to people who’ve never had chickenpox and haven’t been vaccinated.

You’re contagious until all of the sores have crusted over. Until then, avoid contact with pregnant women who may not have had chickenpox or the vaccine, people with weak immune systems, and newborns.

Shingles Vaccine

The CDC recommends two doses of Shingrix, the shingles vaccine, for the prevention of shingles and its complications in healthy adults 50 or older. It's also recommended for those 19 or older whose immune systems are weakened, either by an illness or treatment for an illness.

You can get the Shingrix vaccine at your pharmacy or doctor's office. The shot goes in your upper arm. If you're a healthy adult 50 or older, you should get the second shot 2-6 months after your first vaccination. If you're younger and getting Shingrix because your immune system is weakened, you can get the second vaccine 1-2 months after the first one.

You should get Shingrix even if you:

• Have already had shingles
• Had the earlier vaccine — called Zostavax — which is no longer on the market
• Had the chickenpox vaccine
• Don't remember whether you ever had chickenpox. Most people born in the U.S. before 1980 have had it.

You shouldn't get Shingrix if you:

• Have had an allergic reaction to any substances in the vaccine or to your first dose of Shingrix
• Have shingles — you need to wait until the virus clears
• Are pregnant

You can get the Shingrix vaccine if you're sick with something minor, such as a cold. But if you have something more serious, you should wait even if you don't have a fever.

Can you get shingles after you get the vaccine?

You can still get shingles after receiving Shingrix, but the chances are greatly reduced. The vaccine is 97% effective in preventing shingles in healthy adults ages 50-69. For older adults, it's 91% effective. If you do get shingles, the vaccine can help prevent postherpetic neuralgia, the long-term pain that's the most common shingles complication.

Among people with compromised immune systems, the effectiveness rate is 61%-91%. The level of protection depends on your underlying health issues.

Does Shingrix have side effects?

The vaccine helps your immune system build up protection against the shingles virus. It's safe, but you might have side effects for 2-3 days that keep you away from your normal activities. Those effects can include:

• Tiredness
• Headache
• Muscle pain
• Shivering
• Fever
• Upset stomach and nausea

Your arm might be sore for a day or two. Some people have redness and swelling where the needle went in.

You might have side effects after the first dose, the second dose, or both. An over-the-counter pain reliever such as acetaminophen or ibuprofen can help.

It's rare, but some people get a nervous system illness called Guillain-Barré syndrome after they get the shingles vaccine.

Shingles Diagnosis

Your doctor can diagnose shingles by asking about your medical history and your symptoms and by doing a physical exam. They can also test a small sample of fluid from your blisters.

Shingles Treatment

Antivirals for shingles

Antiviral drugs can help you heal faster and cut your risk of complications. They’re most effective if you take them within 3 days of the start of a rash, so see your doctor as soon as possible. You’ll probably get one of these three medications to fight the virus:

• Acyclovir (Zovirax)
• Famciclovir (Famvir)
• Valacyclovir (Valtrex)

Shingles medication

Treatments for shingles pain can include:

• Anticonvulsant medicines such as gabapentin (Neurontin)
• Medicated lotions
• Numbing medications such as lidocaine
• Over-the-counter drugs such as acetaminophen or ibuprofen
• Prescription painkillers such as codeine
• Tricyclic antidepressants such as amitriptyline
• Topical patches that contain capsaicin, the chemical in cayenne pepper
• Injections of steroids and local anesthetics

Home and over-the-counter remedies such as cold compresses, calamine lotion, and oatmeal baths can help relieve itching caused by the rash.

Most people who get shingles have it only once. But it can come back, usually in people with weakened immune systems.

How long does it take for shingles to go away?

Most cases of shingles last 2-6 weeks.

Shingles Prevention

The Shingrix vaccine is the best way to prevent shingles.

If you've never had chickenpox or the chickenpox vaccine, you should avoid anyone who has an active case of chickenpox or shingles. Exposure to them can infect you with the varicella-zoster virus, either by contact with fluid from the blisters or particles that the blisters give off. If you get the virus, you won't get a case of shingles — you'll get chickenpox. But that puts you at risk for shingles later.

If you have shingles or chickenpox, you can take the following steps to avoid spreading the virus:

• Cover the rash.
• Avoid touching the rash, especially scratching it.
• Wash your hands frequently for at least 20 seconds.
• Avoid contact with people who might be particularly vulnerable, including pregnant women, newborns, and people with weakened immune systems.

Takeaways

Shingles and chickenpox are caused by the same virus. Once you've had chickenpox, the virus can live in your body and emerge later in a painful rash. You're more likely to get shingles if you're older than 50, dealing with an illness that weakens your immune system, or under a lot of stress. Perimenopause and menopause also increase your risk. If you have shingles, antiviral drugs can shorten the course of the illness. You can avoid it by getting two doses of Shingrix, a vaccine that is very effective in preventing shingles. It also reduces the chances of complications if you do get shingles.

Shingles FAQs

Is shingles caused by stress?

Shingles is caused by a virus, the same one that causes chickenpox. But stress is one of the things that can trigger an outbreak.

Do I need the shingles vaccine if I've already had shingles?

A previous case of shingles won't keep you from getting it again. The vaccine is the best way to prevent shingles.

Is it OK to leave shingles untreated?

Most cases of shingles clear up in 2-6 weeks. But shingles can cause complications, including vision loss, inflammation of your brain, and even death. If you have shingles, you should see a doctor. Antiviral drugs can shorten your outbreak and bring you relief.