Shingles is a painful rash caused by the same virus that causes chickenpox. About one in three people in the United States will develop shingles in their lifetime, and the risk rises sharply after age 50. Prompt treatment can shorten the illness, and a highly effective vaccine can prevent most cases.
What causes shingles
After you have chickenpox, the varicella-zoster virus stays inactive in nerve cells near the spinal cord and brain. Years or decades later, it can reactivate and travel along a nerve to the skin, causing shingles. Reactivation becomes more likely as immunity naturally weakens with age, and in people with weakened immune systems.
Anyone who has had chickenpox can get shingles. You cannot catch shingles from someone else, but a person with active shingles blisters can spread the virus to someone who has never had chickenpox or the chickenpox vaccine, who may then develop chickenpox.
Symptoms
Shingles often begins with:
- Pain, burning, tingling, itching or numbness in one area of skin, usually on one side of the body, for one to five days before the rash appears
Then:
- A red rash that forms fluid-filled blisters, usually in a band or strip on one side of the torso, though it can occur anywhere, including the face
- Blisters crust over within 7 to 10 days, and the rash usually clears within two to four weeks
- Some people have fever, headache, chills and tiredness
Shingles near the eye: an emergency
If the rash appears on the forehead, around the eye or on the tip of the nose, see a doctor the same day. Shingles affecting the eye (herpes zoster ophthalmicus) can cause serious eye damage and vision loss without prompt treatment.
Complications
Postherpetic neuralgia (PHN) is the most common complication. It is nerve pain that lasts for months or even years after the rash heals, and it becomes more likely with age. It can be severe enough to disrupt sleep and daily life.
Other complications include:
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- Vision loss from eye involvement
- Hearing loss or facial paralysis when nerves near the ear are affected
- Skin infections
- Rarely, pneumonia, brain inflammation and an increased short-term risk of stroke
Treatment
Start antivirals early. Medicines such as valacyclovir, famciclovir or acyclovir work best when started within 72 hours of the rash appearing. They can reduce the severity and length of the illness and may lower the risk of complications. See a doctor or use a telehealth service as soon as you suspect shingles.
Pain relief may include acetaminophen, NSAIDs, cool compresses and calamine lotion. Stronger pain may need prescription medicines.
For postherpetic neuralgia, options include gabapentin or pregabalin, certain antidepressants, lidocaine patches and capsaicin patches.
Care for the rash: keep it clean and covered, avoid scratching, and stay away from pregnant women who have not had chickenpox, newborns and people with weakened immune systems until the blisters crust over.
The Shingrix vaccine
Shingrix is a non-live, recombinant vaccine that is more than 90 percent effective at preventing shingles in adults 50 and older, and protection stays strong for years. It also reduces the risk of postherpetic neuralgia.
The CDC recommends Shingrix for:
- All adults aged 50 and older, whether or not they remember having chickenpox
- Adults aged 19 and older with weakened immune systems due to disease or treatment
It is given as two doses, two to six months apart. Immunocompromised adults may receive the second dose sooner. If more than six months pass, get the second dose as soon as possible; you do not need to restart.
You should get Shingrix even if:
- You have already had shingles (wait until the rash has cleared)
- You previously had the older Zostavax vaccine (wait at least 8 weeks)
- You are not sure whether you had chickenpox
Side effects are common but usually short-lived: a sore arm, tiredness, muscle aches, headache, shivering or fever for one to three days. Many people plan the doses around a light schedule.
Cost and coverage: Shingrix is covered with no cost-sharing under Medicare Part D and by most private insurance plans as a recommended adult vaccine. Many pharmacies give it without an appointment.
The bottom line
Shingles causes a painful one-sided rash and can lead to long-lasting nerve pain, especially in older adults. If you notice the early signs, see a doctor quickly, because antivirals work best within 72 hours. If you are 50 or older, or 19 and older with a weakened immune system, ask about two doses of Shingrix.
This article is for general information and does not replace medical advice.