Health A to Z
Shingles, also known as herpes zoster, is an infection of a nerve and the skin around it. It's caused by the varicella-zoster virus, which also causes chickenpox.
It's estimated around one in every four people will have at least one episode of shingles during their life.
This page covers:
New blisters may appear for up to a week, but a few days after appearing they become yellowish in colour, flatten and dry out.
Scabs then form where the blisters were, which may leave some slight scarring and loss of skin pigment.
The pain may be a constant, dull or burning sensation, and its intensity can vary from mild to severe.
You may have sharp stabbing pains from time to time, and the affected area of skin will usually be tender.
In some cases shingles may cause some early symptoms that develop a few days before the painful rash first appears.
These early symptoms can include:
An episode of shingles typically lasts around two to four weeks. It usually affects a specific area on just one side of the body.
It doesn't cross over the midline of the body, an imaginary line running from between your eyes down past the belly button.
Any part of your body can be affected, including your face and eyes, but the chest and tummy (abdomen) are the most common areas.
Shingles isn't usually serious, but see your GP as soon as possible if you recognise the symptoms. They'll usually be able to diagnose shingles based on your symptoms and the appearance of the rash.
Early treatment may help reduce the severity of your symptoms and the risk of developing complications.
It's uncommon for someone with shingles to be referred to hospital, but your GP may consider seeking specialist advice if:
Most people have chickenpox in childhood, but after the illness has gone the varicella-zoster virus remains inactive (dormant) in the nervous system.
The immune system keeps the virus in check, but it can be reactivated later in life and cause shingles.
It's possible to have shingles more than once, but it's very rare to get it more than twice.
It's not known exactly why the shingles virus is reactivated at a later stage in life, but most cases are thought to be caused by having lowered protection against infections and diseases (immunity).
This may be the result of:
However, young people who are otherwise healthy can also sometimes develop shingles.
It's not possible to catch shingles from someone with the condition or from someone with chickenpox.
However, you can catch chickenpox from someone with shingles if you haven't had chickenpox before, but this is uncommon.
The blisters of shingles contain live virus. If a person who has never had chickenpox makes direct contact with an open blister or something with the fluid on it, they can contract the virus and develop chickenpox.
If you have shingles, you're contagious until the last blister has dried and scabbed over.
To help prevent the virus being passed on, avoid sharing towels or flannels, swimming or playing contact sports. You should also avoid work or school if your rash is oozing fluid (weeping) and can't be covered.
Chickenpox can be particularly dangerous for certain groups of people. If you have shingles, avoid:
Although there's no cure for shingles, treatment is available to relieve the symptoms until the condition resolves. Most cases of shingles last around two to four weeks.
Treatment for shingles can include:
Read more about treating shingles.
Shingles can sometimes lead to complications, such as postherpetic neuralgia. This is where severe nerve pain lasts for several months or more after the rash has gone.
Complications like this are usually in elderly people who have had the condition and those with a weakened immune system.
Read more about complications of shingles.
It's not always possible to prevent shingles, but a vaccine called Zostavax can reduce your chances of developing the condition.
If you still develop shingles after having this vaccine, it may be milder and last for a shorter time than usual.
The vaccine is available on the NHS to some people in their 70s.
Some cases of shingles can affect one of the eyes and are known as ophthalmic shingles.
This occurs when the virus is reactivated in part of the trigeminal nerve, a nerve that controls sensation and movement in your face.
Symptoms can include:
Treatment for shingles can help ease your symptoms until the condition improves. In many cases shingles gets better within around two to four weeks.
However, it's still important to see your GP as soon as possible if you recognise the symptoms of shingles.
Early treatment may help reduce the severity of the condition and the risk of potential complications.
If you develop the shingles rash, there are a number of things you can do to help relieve your symptoms, such as:
Calamine lotion has a soothing, cooling effect on the skin and can be used to relieve the itching.
If you have any weeping blisters, you can use a cool compress – a cloth or flannel cooled with tap water – several times a day to help soothe the skin and keep blisters clean.
It's important to only use the compress for around 20 minutes at a time and stop using them once the blisters stop oozing.
Don't share any cloths, towels or flannels if you have the shingles rash.
You only need to stay away from work or keep your child off school while:
If the rash is only on your body and can be covered by clothing, there's little risk of passing the infection on to others.
As well as painkilling medication, some people with shingles may also be prescribed a course of antiviral tablets lasting seven days.
Commonly prescribed antiviral medicines include aciclovir, valaciclovir and famciclovir.
These medications can't kill the shingles virus, but can help stop it multiplying. This may:
Antiviral medicines are most effective when taken within 72 hours of your rash appearing, although they may be started up to a week after your rash appears if you're at risk of severe shingles or complications.
Side effects of antiviral medication are very uncommon, but can include:
If you're over 50 years of age and have symptoms of shingles, you'll usually be prescribed an antiviral medication.
You may also be prescribed antiviral medication if you have:
If you're pregnant and have shingles, it's likely your GP will discuss your case with a specialist to decide whether the benefits of antiviral medication significantly outweigh any possible risks. Shingles won't harm your unborn baby.
If you're under 50 years of age, you're at less risk of developing complications from shingles.
You may not need antiviral medication, unless the pain can't be controlled by over-the-counter painkillers.
Antiviral medication is good at controlling pain in the first week or two of the rash.
Antiviral medication isn't usually necessary for otherwise healthy children because they tend to only experience mild symptoms of shingles and have a small risk of developing complications.
However, if your child has a weakened immune system, they may need to be admitted to hospital to receive antiviral medication directly into a vein (intravenously).
To ease the pain caused by shingles, your GP may recommend painkilling medication.
Some of the main medications used to relieve pain associated with shingles are described below.
The most commonly used painkiller is paracetamol, which is available without a prescription.
Always read the manufacturer's instructions to make sure the medicine is suitable and you're taking the correct dose.
However, NSAIDs may not be suitable if you:
Ask your GP or pharmacist if you're unsure about whether you should take NSAIDs.
For more severe pain, your GP may prescribe an opioid, such as codeine. This is a stronger type of painkiller sometimes prescribed alongside paracetamol.
Occasionally, your GP may consider seeking specialist advice before prescribing an even stronger opioid, such as morphine.
If you have severe pain as a result of shingles, you may be prescribed an antidepressant medicine.
These medications are commonly used to treat depression, but are also proven to be useful in relieving nerve pain.
The antidepressants most often used to treat shingles pain are known as tricyclic antidepressants (TCAs).
Examples of TCAs most commonly prescribed for people with shingles are amitriptyline, imipramine and nortriptyline.
Side effects of TCAs can include:
If you have shingles, you'll usually be prescribed a much lower dose of TCAs than if you were being treated for depression.
This will usually be a tablet to take at night. Your dose may be increased until your pain settles down.
It may take several weeks before you start to feel the antidepressants working, although this is not always the case.
Anticonvulsants are most commonly used to control fits (seizures) caused by epilepsy, but they're also useful in relieving nerve pain.
Gabapentin and pregabalin are the most commonly prescribed anticonvulsants for shingles pain.
Side effects of these medications can include:
As with antidepressants, you may need to take anticonvulsants for several weeks before you notice it working.
If your pain doesn't improve, your dose may be gradually increased until your symptoms are effectively managed.
Complications of shingles are more likely if you have a weakened immune system (the body's natural defence system) or are elderly.
Some of the main complications associated with shingles are described below.
Postherpetic neuralgia is the most common complication of shingles. It's not clear exactly how many people are affected, but some estimates suggest as many as one in five people over 50 could develop postherpetic neuralgia as the result of shingles.
Postherpetic neuralgia can cause severe nerve pain (neuralgia) and intense itching that persists after the rash and any other symptoms of shingles have gone.
Types of pain experienced by people with postherpetic neuralgia include:
Postherpetic neuralgia sometimes resolves after around three to six months, although it can last for years and some cases can be permanent. It can be treated with a number of different painkilling medicines.
Read about treating postherpetic neuralgia.
If one of your eyes is affected by shingles (ophthalmic shingles), there's a risk you could develop further problems in the affected eye, such as:
If not treated promptly, there's a risk that ophthalmic shingles could cause a degree of permanent vision loss.
Ramsay Hunt syndrome is a complication that can occur if shingles affects certain nerves in your head.
In the US Ramsay Hunt syndrome is estimated to affect 5 in 100,000 people every year, and may affect a similar number of people in the UK.
Ramsay Hunt syndrome can cause:
Ramsay Hunt syndrome is usually treated with antiviral medication and corticosteroids.
The earlier treatment is started, the better the outcome. Around three-quarters of people given antiviral medication within 72 hours of the start of their symptoms usually make a complete recovery.
If treatment is delayed, only about half of those treated will recover completely.
Those who don't make a full recovery may be left with permanent problems, such as a degree of permanent facial paralysis or hearing loss.
A number of other possible problems can also sometimes develop as a result of shingles, including:
Shingles is rarely life threatening, but complications like those mentioned above mean around 1 in every 1,000 cases in adults over the age of 70 is fatal.