Shingles (herpes zoster)

Last Reviewed: January 2014

What is shingles?

Shingles, also called herpes zoster or zoster, is a painful skin rash caused by the varicella-zoster virus, the same virus that causes chickenpox. After a person recovers from chickenpox, the virus remains inactive in the body. Usually the virus does not cause any further problems; however, the virus may re-emerge years later, causing shingles.

Who gets shingles?

Anyone who has recovered from chickenpox may develop shingles, including children. However, shingles most commonly occurs in people 50 years old or older. The risk of getting shingles increases as a person gets older. People who have medical conditions that keep the immune system from working properly, like cancer, leukemia, lymphoma, and human immunodeficiency virus (HIV) infections, or people who receive drugs that weaken the immune system, such as steroids and drugs given after organ transplantation, are also at greater risk to get shingles.

How is shingles spread?

A person must have already had chickenpox in the past to develop shingles. A person can not get shingles from a person that has it. However, the virus that causes chickenpox and shingles can be spread from a person with active shingles to a person who has never had chickenpox or been vaccinated through direct contact with the rash. The person exposed would develop chickenpox, not shingles. The virus is not spread through sneezing, coughing or casual contact. A person with shingles can spread the disease when the rash is in the blister-phase. Once the rash has developed crusts, the person is no longer contagious. A person is not infectious before blisters appear or if pain persists after the rash is gone (post-herpetic neuralgia).

What are the symptoms of shingles?

Shingles usually starts as a rash on one side of the face or body. The rash starts as blisters that scab after three to five days. The rash usually clears within two to four weeks.

Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Other symptoms of shingles can include fever, headache, chills, and upset stomach.

How soon do symptoms appear?

The virus lies dormant in someone who has had chickenpox in the past. It can reactivate many years later.

What are the complications associated with shingles?

Shingles is not usually dangerous to healthy individuals although it can cause great misery during an attack. Anyone with shingles on the upper half of their face, no matter how mild, should seek medical care at once because of the risk of damage to the eye. Very rarely, shingles can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death. For about one person in five, severe pain can continue even after the rash clears up. This pain is called post-herpetic neuralgia. As people get older, they are more likely to develop post-herpetic neuralgia, and it is more likely to be severe.

Is there a treatment for shingles?

Several medicines, acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir), are available to treat shingles. These medications should be started as soon as possible after the rash appears and will help shorten the illness and decrease how severe the illness is. Pain medicine may also help with pain caused by shingles. Call your provider as soon as possible to discuss treatment options.

Does past infection make a person immune?

Usually. Most people who have shingles have only one episode with the disease in their lifetime. Although rare, a second or even third case of shingles can occur.

Is there a vaccine for shingles?

Yes. A single dose of herpes zoster vaccine called Zostavax is recommended for adults 60 years of age and older whether or not they report a prior episode of shingles. Zostavax does not treat shingles or post-herpetic neuralgia (pain that persists after the rash resolves) once it develops.

What can be done to prevent the spread of shingles?

Chickenpox must be prevented in order to prevent shingles. A vaccine for chickenpox is now available and it is hoped that immunized individuals will be less likely to develop shingles in later life.

The risk of spreading shingles is low if the rash is covered. People with shingles should keep the rash covered, not touch or scratch the rash, and wash their hands often to prevent the spread of shingles. Once the rash has developed crusts, the person is no longer contagious.