Shingles (Herpes Zoster)

What is shingles?

Shingles, or herpes zoster, is a common viral infection of the nerves, which results in a painful rash or small blisters on an area of skin. It can appear anywhere on the body, but it typically appears on only one side of the face or body. Burning or shooting pain and tingling or itching are early signs of the infection. Even after the rash is gone, the pain can continue for months, even years.

Shingles is caused by the reactivation of the varicella-zoster virus, the virus that causes chickenpox. After a person has had chickenpox, the virus lies dormant in certain nerves for many years. Herpes zoster is more common in people with weakened immune systems, and in people over the age of 50.

According to the CDC, at least one million people develop shingles in the U.S. each year.

What are the symptoms of shingles?

The following are the most common symptoms of shingles. However, each individual may experience symptoms differently. Symptoms may include:

  • Skin sensitivity, tingling, itching, and/or pain in the area of the skin before the rash appears

  • Rash, which appears after one to five days and initially looks like small, red spots that turn into blisters

  • Blisters typically scab over in seven to ten days and clear up within two to four weeks 

Other early symptoms of shingles may include:

  • Gastrointestinal upset

  • Feeling ill

  • Fever and/or chills

  • Headache

The symptoms of shingles may resemble other medical conditions or problems. Always consult your health care provider for a diagnosis.

How is shingles diagnosed?

In addition to a complete physical exam and medical history, diagnostic tests for shingles may include:

  • Rash. The rash is so characteristic of shingles that a presumptive diagnosis is often made by just looking at the rash. The rash is typically confined to one area on one side of the body or face, and appears as red spots, small fluid- or pus-filled vesicles, or scabs.

  • Skin scrapings. A procedure in which the skin is gently scraped to determine if the virus is shingles or another virus.

Complications of shingles

Active shingles symptoms usually do not last longer than three to five weeks. However, complications can occur. The two major complications that can result from shingles include:

  • Postherpetic neuralgia (PHN). The most common complication of shingles is postherpetic neuralgia (PHN). PHN is characterized by continuous, chronic pain that a person feels even after the skin lesions have healed. The pain may be severe in the area where the blisters were present, and the affected skin may be very sensitive to heat and cold.

    People who are at increased risk for PHN include those who have severe pain during active shingles, those with sensory impairment, and elderly people. Early treatment of shingles may prevent PHN. In addition, analgesics (pain relieving medications) and steroid treatment (to help reduce inflammation) may be used to treat the pain and inflammation. Other treatments include antiviral drugs, antidepressants, anticonvulsants, and topical agents.

  • Bacterial infection. A second severe complication of shingles is a bacterial infection on the skin where the lesions are located. Rarely, infections can lead to further complications, such as superficial gangrene and scarring. When an infection occurs near or on the eyes, a corneal infection can occur which can lead to temporary or permanent blindness.

Treatment for shingles

Specific treatment for shingles will be determined by your health care provider based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Shingles has to run its course; there is no cure for the disease. Treatment usually focuses on pain relief. Treatment may include painkillers to help alleviate some of the pain and antiviral drugs to help lessen some of the symptoms and minimize nerve damage. Other treatments may include:

  • Bed rest, especially during the early phase of shingles, and if fever is present

  • Topical agents

  • Cool compresses applied to affected skin areas

  • Antiviral medications (such as acyclovir, valacyclovir, and famciclovir)

  • Steroids

  • Antidepressants

  • Anticonvulsants

A vaccine to prevent shingles was approved by the FDA in 2006. The vaccine, called Zostavax, is recommended for adults 60 years of age and older who are not immunocompromised. The vaccine has been found to reduce the number of cases of shingles and the incidence of PHN in older adults.