Illustration of Shingles

What Is Shingles?

Shingles, also called herpes zoster, is a viral infection caused by the varicella-zoster virus. It affects the nerves, producing a painful rash with blisters.

Shingles (herpes zoster) is a viral infection that affects the nerves. It usually produces a painful rash with blisters.

The varicella-zoster virus (VZV) causes chickenpox. Then, it lays dormant in your nerve cells. Shingles happens when the virus reactivates after several years. Low immunity from infections with age or medical treatments can cause shingles. You can only develop shingles if you've had chickenpox, but not everyone who gets chickenpox develops shingles. But

Of note: The rash caused by shingles can be debilitating and painful. It may result in long-lasting nerve pain once the rash clears. The shingles vaccine, Shingrix, helps prevent infection. You should receive Shingrix if you're older than 50 or have a weak immune system. If you develop shingles, consult a healthcare provider immediately.

Types

VZV causes chickenpox and shingles. It lays dormant in your nerve cells if you've had chickenpox. Later, it can reactivate and cause shingles. Once the dormant virus reawakens and travels from nerve fibers to the skin surface above, shingles symptoms arise.

VZV is a type of herpes virus. Herpes viruses also include the herpes simplex virus (HSV). VZV does not cause cold sores or genital herpes, unlike HSV. Herpes simplex virus 1 (HSV-1), transmitted orally, causes cold sores and may cause genital herpes. Herpes simplex 2 (HSV-2) is a sexually transmitted infection (STI) that causes genital herpes.

Both viruses lay dormant in your nerve cells after infection. Suppose you contract HSV-1. You may have multiple instances of developing cold sores.

Shingles Symptoms

Usually, shingles occurs on one side of the face or torso. Red bumps appear on your chest, waist, neck, back, or buttocks. Those bumps can feel intensely painful. You may experience itching, burning, and stabbing pain.

Those symptoms occur in two stages: Preeruptive and acute eruptive.

Pre-eruptive Stage

At the beginning of the infection, you'll likely experience skin sensitivity and pain. Those symptoms typically occur within the affected skin areas supplied by nerve cells where the VZV had previously lay dormant.

The pre-eruptive stage typically lasts two days before noticeable bumps appear on the skin. You may also experience headaches, fatigue, and sensitivity to light during that time.

Acute Eruptive Stage

You'll typically notice small patches of red skin that eventually turn into painful raised bumps. Those bumps will turn into blisters and scab over within seven to 10 days.

During this stage, you are infectious. If someone comes into contact with your blisters, they may contract VZV. Suppose a person who has not had chickenpox becomes infected. In that case, they will develop chickenpox, not shingles.

The safest bet: Avoid anyone with a weak immune system, pregnant people, and infants until your blisters dry up and scab over. Typically, that happens within two to four weeks. 

Shingles is concerning if blisters appear on your face or your eyes. That may cause damage to your eyes and require immediate treatment.

Also, some people experience chronic infection if the pain lasts longer than four weeks. Some people also experience a "pins and needles" feeling. Others may notice burning and aching sensations. In those cases, the pain can feel incapacitating and last longer than 12 months.

What Causes Shingles?

Some common risk factors may influence who develops shingles. 

Shingles commonly flares up in people with weak immune systems. Those may include people with human immunodeficiency virus (HIV) and cancer. Also, people taking immune-suppressing medications may be at risk.

Stress or trauma may also play a role in contracting shingles. For example, post-traumatic stress disorder (PTSD) may increase your risk.

Your age may influence your risk of developing shingles. It primarily affects people older than 50.

How Is Shingles Diagnosed?

Visit a healthcare provider if you think you have shingles. Physical signs and symptoms help healthcare providers diagnose shingles. In most cases, the tipoff is the characteristic rash. It's usually accompanied by itching, tingling, or pain in body areas affected by a previous bout of chickenpox.

A person may have shingles with pain and itching but no rash. If that happens, testing may help pinpoint the exact cause. Tests include scraping skin cells or a blood test. High levels of VZV DNA may indicate an active shingles infection.

Healthcare providers may use tests on people with weak immune systems, pregnant people, and infants. They are more likely to experience complications than others.

Treatments for Shingles

People usually treat shingles with oral antiviral medicines. Those medicines include Zovirax (acyclovir), Famvir (famciclovir), and Valtrex (valacyclovir). You will likely take them for seven to 10 days. Those medicines aren't cures for shingles. But they can weaken the virus. They also reduce pain, expedite healing, and stave off complications.

Other remedies to alleviate pain include:

  • Pain-relief medicines and topical ointments (available over the counter or by prescription) 
  • Cool compresses 
  • Calamine lotion 
  • Vaseline
  • Loose, cotton clothes
  • Oatmeal or baking soda baths

Most cases resolve in two to six weeks. Keep in mind: Early diagnosis is essential. Antiviral medicines are less effective if you start them more than three days after a rash appears. That raises your risk of complications. Age and weak immunity also increase that risk.

How To Prevent Shingles

Shingrix, the shingles vaccine, is the best way to prevent shingles. The Food and Drug Administration approved Shingrix in 2017 for all adults over 50. Healthcare providers also recommend Shingrix for adults over 18 with weak immune systems. Shingrix is a two-part series. You'll receive the second dose two to six months after the first. 

Also, you should receive Shingrix if you:

  • Previously received Zostavax, the old shingles vaccine
  • Already had shingles 
  • Don't know whether you had chickenpox as a child

If you're unsure, your healthcare provider can test your blood for immunity to the virus. 

However, you should not receive Shingrix if you:

  • Are allergic to any ingredients in the vaccine
  • Have a severe allergic reaction after receiving the first dose
  • Have an active shingles infection
  • Are pregnant

Shingrix is over 90% effective. The vaccine protects adults 60 and older for seven years against shingles. Shingrix is the only way to protect against developing shingles and postherpetic neuralgia (PHN). PHN is one of the most common complications of shingles. It's a painful condition that can last months. 

Comorbid Conditions

Shingles may increase your risk of developing other health complications, which include the following.

Postherpetic Neuralgia (PHN)

One of the most common complications that result from shingles is PHN, which occurs in as many as 18% of cases. PHN happens when you develop nerve pain after a bout of shingles. Pain typically occurs in the same places that you develop shingles rashes.

PHN may last months to years after having shingles, and the pain may disrupt your daily activities. The complication is more common in older adults than in others.

Heart Disease

Some evidence suggests that people with shingles have increased stroke and heart attack risks. In one study published in 2017 in the Journal of the American College of Cardiology, researchers found that shingles increase the risk of shingles and heart disease by 35% and 59%, respectively. But that risk steadily decreases over time after having shingles.

Pneumonia

As many as 15% of adults who contract VZV develop pneumonia. The risk of pneumonia increases if you are pregnant, older, smoke, have chronic obstructive pulmonary disease (COPD), or have a weak immune system.

Symptoms of pneumonia, like coughing, fever, and difficulty breathing, usually occur one to six days after infection with VZV. Your healthcare provider may use antiviral drugs, delivered intravenously, to treat pneumonia.

Hearing Problems

Although rare, people with shingles may develop a hearing problem called Ramsay Hunt syndrome. Ramsay Hunt syndrome causes weak facial muscles or facial nerve paralysis. Other symptoms may include a rash on the ears or mouth, ringing ears, and hearing loss.

VZV also causes Ramsay Hunt syndrome. So, if you’ve previously had chickenpox, VZV may later reactivate to cause hearing problems. Treatment includes anti-inflammatory drugs. But some damage may be permanent.

Encephalitis

About one out of every 33,000 to 50,000 cases of shingles cause encephalitis. Encephalitis happens when the brain becomes inflamed.

If VZV infects the central nervous system (CNS), you may notice symptoms like headache, fever, or vomiting. You may have cognitive dysfunction or seizures in more severe cases of encephalitis. Antiviral drugs, delivered intravenously, are typically used to treat encephalitis.

Living With Shingles

Shingles causes itchy symptoms that last several weeks. In some cases, those symptoms may become painful and cause emotional distress. 

Luckily, there are several things that you can do to make living with shingles less stressful, which include:

  • Wear loose-fitting clothing to avoid harshly rubbing against any rashes on the body.
  • Apply calamine lotion to affected patches of skin.
  • Enjoy an oatmeal bath to alleviate painful and itchy skin.
  • Try not to scratch any affected patches of skin, which may raise your risk of infection.
  • Use a cool compress on blisters.
  • Enjoy time with family or friends, or engage in your favorite hobbies to help alleviate any stress.
  • Make sure to get a restful night’s sleep.
  • If it’s not too painful, try doing some light exercises.

A Quick Review

Shingles is a viral infection. It occurs when VZV reactivates after laying dormant in your nerve cells. Shingles commonly produces a painful rash with blisters.

The infection may be dangerous for some people. Those include people with weak immune systems, pregnant people, or infants. Vaccination, early diagnosis, and treatment are essential.

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