Shingles

Overview

After you have chickenpox, the virus stays asleep in your nerves. Years later, it can wake up and cause shingles. About 1 in 3 people in the U.S. will get shingles.

The rash usually shows up as a band of blisters on one side of the body or face. The most common problem afterward is long-lasting nerve pain where the rash was. The risk goes up with age.

Symptoms

Pain often starts a few days before the rash.

• Pain, burning, itching, or tingling in one area
• Painful rash on one side of the body or face, often in a band
• Blisters that crust over in 7 to 10 days

Less common

• Fever
• Headache
• Chills
• Upset stomach
• Rash near the eye or ear
• Sensitivity to light

How it usually goes

• 1 to 5 days before: Pain, tingling, or itching where the rash will be.
• Days 1 to 5: Rash and new blisters appear.
• 7 to 10 days: Blisters scab over.
• 2 to 4 weeks: Rash heals. Pain may linger.

When to get medical care

Causes

Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. It stays in the body and can wake up later, often when the immune system is weaker from age, stress, illness, or medicines.

You can't catch shingles from someone. But a person who hasn't had chickenpox or the vaccine can catch chickenpox from touching open shingles blisters.

Does it spread or run in families?

• Yes, it can spread from person to person.
• How it spreads: the air or touch.
• Washing hands often and staying home when sick help protect others.

Who is more likely to get it

• Age 50 and older
• A weak immune system from illness or medicines
• Having had chickenpox

Possible complications

• Nerve pain after shingles: Pain that lasts months or years
• Shingles of the ear: Can cause face weakness and hearing loss
• Skin infection: If blisters get infected

Diagnosis

A healthcare professional can usually tell it's shingles by looking at the rash.

Questions you may be asked

• When the pain, tingling, or rash started
• Where the rash is
• Whether it's near your eye or ear
• Whether you've had chickenpox or the shingles vaccine
• Health problems or medicines that weaken your immune system

The exam

They'll look at the rash and check your eye if the rash is on your face.

Tests

Tests are usually not needed. Sometimes:

• Swab of a blister: To confirm the virus when the rash doesn't look typical.

Treatment

Antiviral medicines help the rash heal faster and ease pain. They work best when started within 3 days of symptoms.

Self-care

• See a healthcare professional quickly so you can start antivirals early
• Keep the rash clean and dry, and loosely covered
• Use cool, wet cloths to ease pain and itch
• Don't scratch or break the blisters
• Avoid contact with pregnant people, newborns, and people with weak immune systems until blisters crust over

Medicines

Antivirals need a prescription.

Shingles near the eye needs care right away to protect your vision.

For nerve pain that lasts after the rash heals, your healthcare professional may suggest prescription medicines, creams, or patches.

How it compares

Prevention

Vaccination is the best way to protect yourself:

• Get 2 doses of Shingrix if you're 50 or older
• Adults 19 and older with a weak immune system should also get it
• You can get it even if you've had shingles; ask when
• Children get the chickenpox vaccine, which also lowers shingles risk later

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to an infectious disease specialist, for hard-to-treat infections.

Back to school, work, or sports

• You can work or go to school if the rash is covered.
• Until blisters crust, stay away from pregnant people, newborns, and people with weak immune systems who haven't had chickenpox.

Children, pregnancy, and older adults

• Older adults: More likely to have long-lasting nerve pain. Get vaccinated and treated early.
• Weak immune system: Shingles can be more widespread. Get care right away for any rash.
• Pregnancy: Avoid contact with anyone with shingles blisters if you haven't had chickenpox.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Some infections can pass to the baby during pregnancy or birth. Tell your provider if you've been exposed.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

Outlook

Most rashes heal in 2 to 4 weeks. Some people, more often older adults, have nerve pain that lasts months. Early treatment and vaccination lower that risk.

Getting ready for your visit

Go early; timing matters for medicine.

What to bring

• When the pain and rash started
• A list of medicines
• Your vaccine history

Questions to ask

• Should I start an antiviral?
• Is my eye at risk?
• Am I contagious, and to whom?
• Should I get the shingles vaccine after I heal?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Shingles