What Is Shingles?
You can think of shingles as a one-two punch of infections. Anyone who gets it had a case of chickenpox first, often decades earlier.
These two conditions come from the same virus, called varicella zoster.
Chickenpox causes itchy blisters that might start on your back, chest, and face and spread to the rest of your body.
Shingles is a rash with shooting pain. It shows up on one side of your body, usually in one specific area.
A shingles rash starts as a cluster of small bumps. These bumps look different than the surrounding skin and present differently on different skin tones. On darker skin, they may be pink, grayish, purple, or brown. On lighter skin, the bumps appear red.
The bumps will turn into fluid-filled blisters, which also vary in presentation. They can be red, purple, brown or grayish, depending on your skin tone. The blisters usually dry out and crust over within 7 to 10 days.
What Are the Symptoms of Shingles?
The early signs of shingles include:
- Enlarged lymph nodes
- Cluster of tiny blisters that open spontaneously
- Stabbing or shooting pain
- Tingling or burning feeling in or under your skin
Call your doctor quickly if you have any of these signs. There’s no cure for shingles. But treatment can lessen the chance of complications, including pain that lasts after the rash is gone, called postherpetic neuralgia.
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.
What Are the Risk Factors for Shingles?
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
But many people who get shingles don’t fit into any of these categories.
Are There Complications of Shingles?
Shingles can have 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.
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 pregnant women who may not have had chickenpox or the vaccine, people with weak immune systems, and newborns.
The Shingrix vaccine is considered more than 90% effective. The CDC recommends two doses of Shingrix for the prevention of shingles and its complications in healthy adults 50 or older as well as those 18 years of age and older who are or will be immunodeficient or immunosuppressed due to disease or therapy. You should get it even if you’ve had shingles before. You should also get it even if you already had the earlier Zostavax vaccine, which was removed from the market in 2020.
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.
Treatment 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)
Treatments for shingles pain can include:
- Anticonvulsant medicines like gabapentin (Neurontin)
- Cool compresses
- Medicated lotion
- Numbing medications like lidocaine
- Over-the-counter drugs like acetaminophen or ibuprofen
- Prescription painkillers like codeine
Most people who get shingles only have it once. But it can come back, usually in people with weakened immune systems.