What Is Shingles?

Shingles, also known as zoster or herpes zoster, is a viral infection caused by the varicella-zoster virus (VZV). This is the same virus that causes chickenpox.

Anyone who’s had chickenpox can get shingles. After you’ve been infected with chickenpox, VZV lies inactive in your body — mostly in spinal or cranial nerves — usually for many decades. If the virus reactivates, it can travel along nerve pathways to your skin and cause a painful rash.

Signs and Symptoms of Shingles

Shingles usually appears as a single strip of blisters around the left or right side of your body. It’s almost always unilateral, meaning it involves only one side of your body.

Shingles tends to show up most frequently on your torso, just because of the laws of probability, says Joseph Safdieh, MD, a professor of neurology at Weill Cornell Medicine in New York City.

Often, it’s not what the rash looks like, but what it feels like before and after it shows up, that signals the condition. Up to several days before the shingles rash appears, pain, itching, or tingling often occurs in the area where it will develop.

• Chills
• Fever
• Headache
• Upset stomach

You may even experience the pain but not the rash. Because the pain of shingles originates in the nerves, it may have a different quality than any other pain you have experienced before.

“Neuropathic pain is burning,” says Dr. Safdieh. “It’s both numb and painful at the same time, and can be provoked by touching the skin.” Your skin may be so sensitive that even sunlight can bring on a stabbing sensation.

Causes and Risk Factors of Shingles

• Certain cancers, such as leukemia and lymphoma
• HIV or AIDS
• Immunosuppressive medications, such as corticosteroids

You may have heard that someone got shingles because they were stressed, but there’s not much scientific evidence to confirm this connection.

If there is a link between stress and shingles, it’s probably not that the stress itself is putting a strain on your immune system; it may be that stress creates conditions that lower immunity. Keep in mind, says Safdieh, that you’re likely not sleeping or eating well when you’re stressed. “All these factors can play a role.”

How Is Shingles Diagnosed?

Once the rash appears, the signs and symptoms are usually clear enough for a doctor to make a diagnosis. Before the rash appears, or in cases where there is no rash, diagnosis is more challenging.

Herpes zoster is sometimes confused with herpes simplex, the virus that causes cold sores. Skin symptoms may also be mistaken for other rash-causing conditions, like impetigo, contact dermatitis, and psoriasis.

Treatment and Medication Options for Shingles

There’s no cure for shingles. But if you get immediate treatment, it can help speed the healing process and reduce your risk of complications.

Medication Options

• Antivirals Drugs such as valacyclovir (Valtrex) can help shorten the duration and severity of shingles. Antivirals are most effective if you start them as quickly as possible after the rash appears.
• Pain Medication Prescription or over-the-counter (OTC) drugs may help bring relief.
• Topical Creams Numbing or calming salves may help ease itching and burning.
• Corticosteroids These anti-inflammatories help reduce swelling.

Alternative and Complementary Therapies

• Oatmeal baths
• Wet compresses
• Stress-reduction techniques

Prevention of Shingles

VZV can spread from person to person through direct contact with the open sores of the shingles rash when blisters are present.

• Keep the rash covered.
• Avoid touching or scratching the rash.
• Wash your hands often.
• If possible, stay away from vulnerable people (like infants and pregnant people).

How Long Does Shingles Last?

Once the rash emerges, new blisters form over the course of three to five days, and progressively dry out and crust over. The blisters usually heal in two to four weeks.

Complications of Shingles

• Eye complications, including loss of vision, can occur
• Bacterial infection of shingles lesions
• Rare complications include the development of pneumonia, hearing problems, encephalitis (swelling of the brain), and death

The Takeaway

• Shingles is a viral infection caused by the same virus as chickenpox, and anyone who gets chickenpox can also get shingles. Unlike chickenpox, it is possible to get shingles more than once.
• Shingles usually appears as a single strip of blisters, almost always on just one side of the body. The area where the rash appears is often painful or itchy several days before, and flu-like symptoms tend to arise in the days prior to the rash. Once the rash has appeared, new blisters will form over the next three to five days, and blisters will fully heal within two to four weeks, though pain in the area can continue for several more weeks.
• To reduce your risk of getting shingles or having a recurrence, the CDC recommends getting the shingles vaccine series if you’re 50 or older, or 19 and older with a compromised immune system.