Shingles

Shingles Overview

You can think of shingles as the one-two punch of infections. Anyone who ever gets it had a case of the chickenpox first, often many decades earlier.

The reason these two conditions are paired up: They come from the same virus.

Chickenpox causes itchy blistersthat might start on your back, chest, and face and spread to the rest of your body. Shingles is a rash with shooting pain. It usually shows up on just one side of your body.

If you start to feel tingly and itchy on one side of your torso and then notice a rash, call your doctor. She can examine you and figure out whether you have shingles.

The virus that gets the blame for both conditions is varicella zoster.

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

After the chickenpox runs its itchy course, the virus retreats to nerve tissues near your spinal cord and brain, where it hides out.

Doctors don’t know why, but sometimes 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.

Who Gets It?

We know that a weakened immune system might wake the virus up. If you’ve had chickenpox, you’re more likely to get shingles if you:

  • Have cancer, HIV, or another disease that lower your body’s defenses
  • Are 50 or older
  • Are under a lot of stress
  • Have had a physical trauma
  • Take long-term steroids or other medicines that can weaken your immune system

But many people who get shingles do not fit in any of these categories.

What Are the Symptoms?

If you have shingles, you’ll most likely see a row of raised dots pop up on one side of your body or face. Your skin will look red in that area. You’ll get a stabbing or shooting kind of pain. You may also feel:

  • A tingling feeling in or under your skin
  • Fever, chills, and headache
  • An upset stomach

The rash eventually turns into painful, red, fluid-filled blisters. They should begin to dry out and crust over within 7 to 10 days.

Call your doctor quickly if you have any of these signs. Shingles can’t be cured once you’re infected, but treatment can lessen how long it lasts and make you feel better.

Is It Contagious?

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

You are 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 FDA approved two shingles vaccines, Shingrix and Zostavax. Shingrix is newer and is preferred over Zostavax because it is considered 90% effective. The CDC recommends people 50 and older get it, even if you’ve had shingles before. You should also get it even if you have had the Zostavax vaccine.

What Are the Symptoms of Shingles?

The symptoms of shinglesinclude:

  • Localized burning, throbbing or stabbing pain where the rash will soon appear (within days to weeks); some people describe it as more itchy. It can be constant or come and go
  • Tingling, itching, or prickling skin, followed several days later by a group of fluid-filled blisters on a red, inflamed base of skin; the blisters typically crust over in a week
  • The rash may be accompanied by fever, fatigue, or headache

Call Your Doctor About Shingles If:

  • You suspect an outbreak is beginning. If you take antiviral drugs in the early stages, you may shorten the course of the infection
  • You have the rash on your face, especially on the nose. This puts you at risk of herpes zoster in the eye, which can lead to corneal damage and vision problems
  • The affected area becomes secondarily infected with bacteria (indicated by spreading redness, swelling, a high fever, and pus); antibiotics can help halt the spread of bacterial infection but not the shingles itself
  • Your rash lasts longer than 10 days without improvement
  • The pain becomes too great to bear; your doctor may prescribe stronger painkillers or a nerve block

You have shingles and are in contact with someone who has a weakened immune system.

You develop any strange symptoms with the shingles rash, such as vertigo, buzzing in your ears, rapid onset weakness, double vision, face droop, or confusion.

If you had chickenpox as a child, you might recall the itchy, spotted rash that popped up on your face and body. The varicella zoster virus that causes chickenpox stays inside your body for many years.

Once you’re older, that same virus can wake up and cause shingles, also called herpes zoster. It gives you a rash, too, but it’s often more painful than itchy.

A blistering rash on one side of your body can be a sign you have it. See your doctor to find out for sure. Once you’ve been diagnosed, you can get treated to help relieve your rash and other symptoms.

The Telltale Signs

Your doctor will first ask whether you’ve had chickenpox and look at your symptoms. A rash is the main sign of shingles. Often your doctor can tell that you have it from your skin alone.

A shingles rash:

  • Appears on one side of your body and/or face
  • Stings, burns, and/or itches
  • Starts as red bumps that form into blisters

Other conditions also cause rashes that look like shingles. Your doctor might check to see if you have:

Contact dermatitis: A skin reaction caused by an allergy to latex, metals, chemicals, or drugs

Candidal infection: It comes from a type of yeast called Candida

Dermatis herpetiformis: A rash that some people with celiac disease can get

Impetigo: A skin infection caused by bacteria

Insect bites: Sometimes, they can look like shingles

Folliculitis: The tiny holes that hairs grow out of can get inflamed

Scabies: A skin condition caused by a small bug called a mite

One way to tell shingles from these conditions is by the other symptoms that come with it. You can also have:

  • Fever
  • Headache
  • Chills
  • Nausea

Tests

Doctors rarely test for shingles unless the rash alone isn’t enough to make a diagnosis. Some people get tested because they’re at higher risk for complications. You might have a test done if you:

  • Are about to have an organ transplant
  • Have a weakened immune system
  • Are going to begin a drug that lowers your immune system

Doctors use two types of tests to diagnose chickenpox or shingles:

Antibody: When you’re exposed to varicella zoster, your immune system makes proteins to fight it. Your doctor can look for these proteins, called antibodies, in a sample of your blood. He takes the sample from a vein in your arm. These tests might be able to tell whether you have chickenpox now or have had it in the past, but the results are often hard to interpret.

Viral detection: This test can find out if varicella zoster is inside a sample of your cells. To collect the sample, your doctor can:

  • Scrape off cells and fluid from a blister
  • Pull fluid from your spine with a needle

Your doctor should have the results in 1 to 3 days. You might need to have a second test if the results aren’t clear.

Your symptoms and test results will show whether you have shingles. Once you’ve been diagnosed, you can start on treatment to help you feel better.

When you have shingles, you tend to focus on the short-term — how to get relief from the pain and discomfort you have right now. For that, you have a lot of treatment options, from medicines to alternative therapies.

Shingles is a viral infection. The main symptom is a rash, usually on one side of your body. Typically, it hurts, burns, itches, and tingles. It may also give you a fever or headache and make you feel really tired.

Most of the time, your symptoms go away in less than a month. But for some people, complications come up.

While shingles itself is almost never life-threatening, it can lead to serious problems, such as the loss of eyesight.

If you think you have shingles, check with your doctor.

Early treatment may not only limit how bad your symptoms get, but might also help you avoid long-term problems. These can include:

Postherpetic Neuralgia

Postherpetic neuralgia, or PHN, is the most common problem that shingles causes.

Your symptoms usually go away when the rash is gone. But with PHN, you may feel pain, itching, burning, and tingling for months after the rash has healed.

It’s more common in older people. Sometimes, it starts to get better after a few months. In other cases, it lasts for years and could be permanent.

Your doctor may suggest different medications or therapies to help with this neuralgia.

Eye Problems

If you have shingles in or near your eyes, forehead, or nose, see your doctor right away. Without treatment, it can lead to pain in your eyes but also to permanent loss of vision.

  • Sores and scarring on the surface
  • Swelling and redness
  • Glaucoma, a disease in which pressure builds in your eye
  • Damage to the nerves

Ramsay Hunt Syndrome

See your doctor as soon as possible if you get shingles on or around your ears. If you don’t get treated, it can lead to Ramsay Hunt syndrome, which can cause:

  • Dizziness and other balance problems
  • Earaches
  • Hearing loss
  • Loss of ability to move parts of your face
  • Ringing in your ear, called “tinnitus”

This condition is rare, but with early treatment, you have a good chance of full recovery.

Skin Problems

The shingles rash comes with blisters that break open and crust over. Keep them clean and dry so you don’t get a bacterial infection. If you do get one, you may be more likely to get scars.

If you begin to run a high fever, check with your doctor. You might have a bacterial infection.

Swelling

In very rare cases, shingles can lead to inflammation or swelling in your lungs, brain, liver, and spinal cord.

You should get regular care for shingles so your doctor can check for even these uncommon kinds of problems.

The virus that causes chickenpoxis also what causes shingles. It’s called varicella zoster. It can lie quietly in your nerves for decades after causing chickenpox but suddenly wake up and become active.

The main symptom of shingles is a painful rash that comes up on one side of your body or face. See your doctor as soon as you can if you think you might have this condition.

Your doctor may want to put you on medications to control your infection and speed up healing, cut inflammation, and ease your pain. They include:

Antiviral Medications

These medicines may slow down the progress of the shingles rash, especially if you take them within the first 72 hours of having symptoms.

They can also lower your chance of having complications. Your doctor may prescribe:

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

Talk with your doctor or pharmacist about side effects to watch for if you’re put on one these.

Painkillers

Shingles causes inflammation and pain. Your doctor can suggest over-the-counter medicines to relieve milder discomfort. They include:

  • Acetaminophen
  • Ibuprofen
  • Naproxen

These may also help you stave off postherpetic neuralgia, which is a burning pain that some people get after the rash and blisters of shingles go away.

Other Prescriptions

If you have severe pain after the rash clears or an infection during your shingles outbreak, your doctor might prescribe:

Capsaicin cream: Be careful not to get it in your eyes.

A numbing medicine: You might get lidocaine (Lidoderm, Xylocaine) for pain. It can come in a variety of forms, such as creams, lotions, patches, powders, and sprays, among others.

Antibiotics​:​ You might need these medicines if bacteria infect your skinand rashes. But if bacteria aren’t involved, then antibiotics won’t help.

Tricyclic antidepressants​: ​There are many of these medications that might help ease the pain that lingers after your skin has healed, such as amitriptyline, desipramine (Norpramin), and nortriptyline (Aventyl, Pamelor). They may also help you with depression, if you have that in addition to shingles. Your doctor can tell you what the risks and benefits are.

Home Care

There aren’t home remedies for shingles. But there are things you can do to help your skin heal.

Keep the affected area clean, dry, and exposed to air as much as possible.

The itching can be maddening at times, but try not to scratch or burst the blisters.

Ask your doctor about creams and other things you can try to give yourself some relief.

Some people find that acupuncture and other complementary treatments help with the pain that can linger after shingles. Let your doctor know first if you want to try these.

Can I Prevent Shingles?

There are two shingles vaccines. Shingrix is recommended over the older vaccine, Zostavax, because it is 90% effective in preventing a shingles outbreak

Who should get it: The CDC recommends that you get this vaccine if you’re 50 or older. If you have had the Zostavax vaccine, you can also have Shingrix.

How many shots do you need? You would need two shots for Shingrix. One initially, with a follow up in 6 months.

What it does: Shingrix reduces your chance of getting shingles by 90%. Even if you still get shingles, the vaccine may help it be less painful.

I never had chickenpox. Do I still need the shingles vaccine? Yes, you do. Shingrix is recommended for everyone age 50 and older, whether or not you remember having had chickenpox.

If I’ve had shingles, can I still get the vaccine? Yes. It may help prevent you having another bout of shingles later on. If you have shingles right now, you should wait until the rash is gone before you get vaccinated.

What are the side effects?

The most common side effects with Shingrix include pain and swelling where you got the shot, muscle pain, tiredness, headache, chills, fever, and stomach troubles. With any vaccine there is a chance of a severe allergic reaction. Also since Zostavax is a live virus vaccine, it is also possible to get a small chicken-pox like rash around the spot where you got the shot.

Who Shouldn’t Get the Shingles Vaccine?

Don’t get the Shingrix vaccine if:

  • You’re allergic to any of the ingredients
  • You have a weak immune system, either because of a condition or due to certain medicines
  • You’re pregnant or nursing
  • You have tested negative for immunity to the chicken pox virus​ ​Ask your doctor about the chicken pox vaccine instead
  • You have shingles now

Also, besides the conditions stated above, do not get the Zostavax vaccine if you have a weakened immune or you may become pregnant within the next 4 weeks following the shot.​

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