What is shingles?
Anyone who has recovered from chickenpox can develop shingles.
There are an estimated 1 million cases of shingles each year in the United States, with 1 in 3 people developing shingles during their lifetime.
It is not possible to have shingles if you have never been exposed to chickenpox or the varicella virus that causes it.
Once exposed, the virus can lay dormant for years. Most adults with the dormant virus never experience an outbreak of shingles or any further problems.
However, in some individuals, it may reactivate multiple times.
Shingles is most common in people over the age of 50 years. However, the virus may reappear in people of all ages who have previously had chickenpox.
Here are some key points about shingles. More detail and supporting information is in the main article.
- Each year in the U.S., there are an estimated 1 million cases of shingles.
- Around 1 in 3 people will develop shingles during their lifetime.
- Shingles is a painful infection of the nerve supplying an area of skin and is accompanied by a localized skin rash.
Symptoms of shingles include pain, tender skin, and a rash, usually on one side of the body.
Pain is the most common symptom of shingles.
This can be a constant dull, burning, or gnawing pain, or sharp, stabbing pain that comes and goes.
There may also be a blistering skin rash.
This usually appears in one or more distinct bands, called dermatomes. It may also appear on the face in a band, or break out on a quarter of the face.
These dermatomes correspond to a single sensory nerve. This is why infection causes isolated skin lesions, rather than a body-wide rash, and nerve pain.
Typically, shingles takes the following course:
- Acute pain, tingling, numbness, and itching on a specific part of the skin, on a single side of the body.
- Between 1 and 5 days after the pain begins, a rash appears.
- Red blotches emerge that develop into itchy fluid-filled blisters.
- The rash looks like chickenpox but only on the band of skin supplied by the affected nerve.
- The rash may involve the face, eyes, mouth, and ears in some cases.
- Sometimes, the blisters merge, forming a solid red band that looks like a severe burn.
- In rare cases (among people with weakened immune systems) the rash may be more extensive and look similar to a chickenpox rash.
- If shingles affects the eye, this is called optical shingles. The virus invades an ophthalmic nerve and causes painful eye inflammation and temporary or permanent loss of vision.
- New blisters may appear for up to a week.
- Inflammation might be caused in the soft tissue under and around the rash.
- People with lesions on the torso may feel spasms of pain at the gentlest touch.
- The blisters will gradually dry up and form scabs or crusts within 7-10 days. At this point, the rash is no longer considered infectious.
- Minor scarring may occur where the blisters have been.
- A shingles episode normally lasts 2-4 weeks.
In some cases, there is a rash but no pain, or no visible rash but a band of pain.
Other symptoms include:
- muscle pain and weakness
- upset stomach
- difficulties with urination
- joint pain
- swollen glands (lymph nodes)
If the rash affects areas of the face, symptoms may include:
- difficulty moving some facial muscles
- drooping eyelids
- hearing loss
- loss of eye motion
- problems with taste
- vision problems
Most people do not experience any complications with shingles, but there is the potential for the following long-lasting effects:
- postherpetic neuralgia (PHN), affecting 10 to 20 percent of people with shingles
- peripheral motor neuropathy occurs in 5 to 10 percent of cases
- skin infection
- encephalitis, or inflammation of the brain
- transverse myelitis, or inflammation of the spinal cord
- white patches due to loss of pigment in the rash area
- Ramsay Hunt syndrome
- eye problems
Before the blisters develop and after the crusts form, the person is not contagious.
Shingles cannot be passed from one individual to another.
However, the varicella-zoster virus can be spread from a person with shingles at the active stage to someone who has never had chickenpox.
In these cases, the infected individual would get chickenpox, not shingles.
Shingles is not spread through coughing or sneezing, but through direct contact with fluid from the blisters. Before the blisters develop and after the crusts form, the person is not contagious.
Shingles is less contagious than chickenpox. The risk of spreading the virus is low if the rash is covered.
There is currently no way to eliminate the shingles virus from the body.
However, there are ways to ease symptoms.
- Keep the rash dry and clean to reduce the risk of infection.
- Wear loose-fitting clothing for comfort.
- Avoid rub-on antibiotic creams or adhesive dressings, as they can slow the healing process.
- If the rash needs to be covered, a non-adherent dressing should be used to prevent aggravating the skin.
- Products such as Calamine lotion, which are available online, can soothe and relieve the itching.
- Antihistamines can sometimes help prevent itching at night.
A doctor may prescribe painkilling medication.
In some cases, antiviral medicine may be prescribed to help stop the virus multiplying, and to reduce severity and duration.
Vaccines can prevent both chicken pox and shingles.
Immunization with the varicella vaccine (chickenpox vaccine) is now recommended and routine in the U.S. It is a two-dose vaccine, given once between the age of 12 and 15 months and again between 4 and 6 years.
The Centers for Disease Control and Prevention (CDC) recommends the Zostavax vaccine for people aged 60 years and above. This age group has the highest risk of getting shingles and of experiencing a complication.
Since vaccination started in children, the number of shingles cases has dropped significantly.
Some people should not have the shingles vaccine, or they should discuss it first with their physician.
- anyone who has ever had a severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine
- anyone with a weakened immune system
- women who are or might be pregnant
Varicella-zoster (shingles) virus belongs to a group of viruses called herpesviruses.
Shingles is caused by the same virus that is responsible for chickenpox. After recovering from chickenpox, the virus remains in the body. It lies dormant in the central nervous system (CNS).
The varicella-zoster virus belongs to a group of viruses called herpes viruses. This is why shingles is also known as herpes zoster.
All herpes viruses can hide in the nervous system, where they can remain almost indefinitely.
Under the right conditions, the herpes zoster virus can "reactivate," or wake up from hibernation, and travel down nerve fibers to cause a new active infection.
In most cases, it is not clear why the varicella-zoster virus begins multiplying to cause shingles.
One suggestion is that shingles occurs when something weakens the immune system, prompting the virus to reactivate.
Possible triggers include:
- older age
- some diseases, including certain cancers and HIV or AIDS.
- cancer treatments, such as chemotherapy and radiation therapy, as these lower a person's resistance to disease
- stress or trauma
- medications, and especially immunosuppressive drugs, used by patients after an organ transplant
- children who had chickenpox in infancy or whose mothers had chickenpox late in pregnancy
Shingles typically resolves within 2 to 4 weeks, and most young, healthy individuals make a full recovery.
Approximately 1-4 percent of people who develop shingles require hospitalization for complications, and 30 percent of those have impaired immune systems.
It is estimated that there are about 96 deaths per year directly related to the varicella-zoster virus. Most which occur in older adults and those who are immunocompromised.