11 Things You Need to Know About Chickenpox and Shingles

Can you get chickenpox as an adult? And can you get shingles if you never had chickenpox? All your questions, answered.

Chickenpox and shingles are both skin conditions that cause red, bumpy or blistery rashes. They're also both caused by the same virus. And although they're intricately related, they're two totally different diseases–and if you're not careful, you could end up with both.

That's why we're answering all your shingles and chickenpox questions once and for all. Here's what you need to know.

Shingles and chickenpox are caused by the same virus

It's called the varicella zoster virus, and you usually come into contact with it during childhood. That's when chickenpox–or varicella–is most common. It's characterized by an itchy rash of pink blister-like bumps scattered all over the body, and it often causes fatigue, fever, and other common symptoms of a viral infection.

Once you've had chickenpox, the varicella zoster virus hangs around in your body. "The virus will hide there for many, many years–and then we see it show up as shingles in some people," says Margaret E. Parsons, MD, a fellow of the American Academy of Dermatology. Reactivated, the virus affects the nerves, creating a painful red rash.

Not everyone who has chickenpox ends up developing shingles–but you can't get shingles if you didn't have chickenpox first

It's not entirely understood why some people go on to get shingles while the virus lies dormant in the bodies of countless others. Around one in three American adults develop shingles. It's more common among folks over 70, people with weakened immune systems due to other health conditions or medications, and people under high amounts of stress.

You can get chickenpox as an adult

The majority of cases occur in kids–but if you never had chickenpox and you're exposed to the varicella zoster virus as an adult, you can certainly still come down with the illness. And unfortunately, you're probably in for a worse ride: "It's usually milder in kids," says Dr. Parsons, also a dermatologist in private practice at Dermatology Consultants of Sacramento. In adults, the virus can be severe, potentially even leading to pneumonia or meningitis, she says.

It’s rare to get chickenpox a second time

"It's possible, but it would be unusual," Dr. Parsons says. In fact, now that there's widespread use of a chickenpox vaccine, many kids don't get chickenpox at all, she says. The vaccine–which involves two doses–is about 90% effective at preventing the disease entirely, according to the Centers for Disease Control and Prevention (CDC).

Wait, did you say there’s a vaccine for chickenpox?

Yes! It was added to the mix of common shots for kids in the mid-1990s. The CDC guidelines recommend the first dose somewhere between 12 and 15 months with the second dose between 4 and 6 years. If you missed that boat and still haven't had chickenpox, anyone 13 and older can get their two doses anytime, as long as they're at least 28 days apart. Once a grim rite of passage, chickenpox is now "extremely uncommon," Dr. Parsons says, thanks to vaccination.

There’s also a vaccine for shingles–two, actually

Since 2006, older adults have been vaccinated with Zostavax, which aimed to prevent those who had chickenpox from falling ill with shingles too. In 2017, the FDA approved a new two-dose vaccine called Shingrix that's thought to be more effective. "I'm hoping we see even less shingles as people get the new, stronger vaccine," Dr. Parsons says.

You can still get shingles after being vaccinated–just like with the flu–but if you do, the vaccine usually decreases the severity of the illness, Dr. Parsons adds. With a generation of children growing up who aren't getting chickenpox and have antibodies against the virus because they've been vaccinated, it's possible shingles will become even more rare. "We shouldn't see much, theoretically," she says. The CDC recommends all healthy adults get vaccinated against shingles after their 50th birthday. Just be sure to get your two doses two to six months apart.

Unlike the flu vaccine, chickenpox and shingles vaccines are live

We've said it before and we'll say it again: You cannot get sick from the flu vaccine.

You could, however, get sick from the chickenpox or shingles vaccine if your immune system is already compromised. People on certain meds that suppress the immune system can't get the vaccines for that reason, Dr. Parsons says. You could also, in theory, be contagious after a chickenpox or shingles shot, she says. "I would have to get the vaccine on a Friday afternoon when I'm not seeing patients for 48 hours after."

You can get shingles multiple times, sadly

The virus can go into hiding again, only to rear its ugly head down the road. "It just goes and hides in the nerve root again," Dr. Parsons explains. "For my young adult patients who get it, I'll recommend getting the shingles vaccine sometime in the next few years." Insurance may not cover vaccination before 50, so you'll have to discuss the risks and benefits with your doctor.

Chickenpox is itchy, but shingles is painful

Despite sharing a viral cause, the two conditions have decidedly different symptoms.

A chickenpox rash starts out with pink bumps that become more blister-like. The bumps are usually all over the body and itch like crazy. "You also feel like you do when you have a cold or flu–you just really don't feel good," Dr. Parsons says. Your eyes might get watery, your body might ache, and you could spike a fever.

A shingles rash, on the other hand, looks more like a fever blister, Dr. Parsons says, and the bumps are usually clustered in groups of three to nine pink lesions. Once they blister, they ooze, then eventually dry out and crust over. A shingles rash is also usually in a band that wraps around a part of the body, like across one shoulder and down your arm, or covering your butt and down your leg, Dr. Parsons explains. The lesions crop up in spots related to where the nerves are that are inflamed by the virus. And because shingles affects the nerves, the pain may feel like burning or even start before the rash appears, she adds.

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In rare cases, it can take years for shingles pain to quiet down

People usually recover from shingles in a few weeks to a few months, but the pain of an angry, inflamed nerve can linger, occasionally as long as six months to a couple of years, Dr. Parsons says.

Early treatment with antiviral medicine can shorten the duration of your symptoms and may help prevent long-lasting pain, according to the American Academy of Dermatology.

You’re contagious until you see noticeable improvements

While it's not the most pleasant thing to do, you'll want to closely monitor both chickenpox and shingles rashes for signs you're healing. You can pass both skin conditions to others until the bumps scab over.

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