Shingles
Shingles is a painful, blistering rash that follows one nerve on one side of the body. It is caused by the chickenpox virus waking up years later. Antiviral tablets help most when they are started within three days of the rash appearing.
Key facts
Shingles at a glance.
Typical signs
Painful blisters in a stripe
Common locations
One side of the body
Expected course
Skin heals in 2–4 weeks
Treatment options
Early antivirals and pain relief
What is it?
Top things to know about Shingles
- It is a reactivated virus. The chickenpox virus can lie dormant in nerves and later reactivate.
- It follows a nerve. Inflammation follows a nerve band and causes a skin eruption.
- Risk rises with weaker immunity. Age and immune-lowering treatment increase risk, but younger people can get it.
- Care has several parts. Antivirals, pain control and checking for complications are each addressed.
What it looks like
What Shingles looks like
Shingles is a reactivation of the chickenpox virus. It usually starts with burning, tingling or pain on one side of the body, followed a few days later by a band or strip of red skin with clusters of fluid-filled blisters. The rash follows the path of one nerve and does not cross the midline. Blisters crust over in 7 to 10 days. Shingles near the eye needs urgent medical care.
Shingles is usually described by where it appears.
Truncal shingles
A band around one side of the chest or back.
Facial and ocular shingles
Forehead, scalp or around the eye.
Disseminated shingles
Widespread; in weakened immunity.
Where it shows up
The marked band is one possible trunk location. Shingles usually affects one side in a nerve distribution; other sites, including the face, are possible.
Trunk
Locations on the front of the trunk.
On different skin tones
Shingles on different skin tones
On lighter skin, the shingles rash looks red with clear blisters. On brown and Black skin, the skin around the blisters may look dark brown, purple or gray instead of red. Healing can leave dark or light spots that last for months. The one-sided band pattern is the most reliable clue on every skin tone.
What happens in Shingles?
Varicella-zoster virus remains dormant in sensory nerves after chickenpox. When it reactivates, it travels toward the skin and can cause pain and grouped blisters in a one-sided nerve distribution.
- Painful blisters can appear: The rash often follows a one-sided nerve area.
- Reactivation follows a nerve: The virus travels toward the skin.
- The virus rests in a nerve ganglion: Varicella-zoster stays after chickenpox.
Causes and triggers
What causes Shingles
Causes
Why it happens
Shingles is caused by the chickenpox virus waking up years after it first infected you. The virus stays dormant in nerves and can reactivate later.
Risk factors
Raise the odds
- Age over 50
- Weakened immunity
- Cancer treatment
- Never vaccinated
Triggers
Bring it on or make it worse
- Weakened immunity (Well established)
- Immune-suppressing medicines (Well established)
- Illness (Strong link)
- Stress (Possible)
When it usually starts
When it usually starts
Shingles
Risk rises with age, particularly after age 50, but younger people can be affected.
Daily care
Daily care for Shingles
Keeping the rash covered
A loose, non-adhesive dressing until it crusts.
Loose cotton clothing
Less pressure over the band, less pain.
Plain petrolatum on broken areas
Stops cracking and lowers infection risk.
Rest, and lowering expectations
Pushing through shingles is not rewarded.
The shingles vaccine
Two doses, more than 90 percent effective after 50.
Getting vaccinated after an episode
One episode does not protect you.
Seek early treatment for suspected shingles, ideally within 72 hours
Early treatment is most effective. Eye involvement, immune suppression or new lesions can warrant treatment even after 72 hours; do not assume it is too late to seek care.
Discuss how age affects monitoring and recovery
Longer episodes and more lasting nerve pain.
Discuss immune suppression and the need for earlier assessment
Raises reactivation, spread and complications.
Avoid: Breaking or scratching the blisters
Spreads virus and turns marks into scars.
Avoid: Ignoring a rash near the eye
Forehead, eyelid or nose blisters, same day.
Avoid: Ear blisters with facial weakness
Droop, hearing change or dizziness is urgent.
Avoid: Not covering the rash
Blister fluid gives chickenpox to anyone not immune.
Avoid: Tight clothing and adhesive dressings
Pressure worsens pain and tears blisters.
Avoid: Poor sleep during the episode
Pain and sleep loss feed each other.
Avoid: Waiting to see if it settles
Antivirals work best within 72 hours.
Avoid: Leaving severe pain untreated
Linked with worse nerve pain later.
Avoid: Topical antiviral cream
Antiviral creams sold for cold sores do not work for shingles. The virus is in the nerve, not just on the surface, so treatment has to be swallowed or given by drip. Reaching for a cream instead is one of the ways the 72-hour window gets missed.
Treatments
Treatments for Shingles
Acetaminophen and ibuprofen
The first step for shingles pain, and enough on their own for a milder episode. They work better taken regularly than only when the pain peaks. Shingles pain is nerve pain, so if these are not holding it, that is a reason to ring your doctor rather than to take more.
Calamine lotion
Dabbed on while the blisters are present, it cools the skin and takes the edge off the itching. A cool compress does much the same thing. Neither shortens the episode, and neither should be rubbed in, because breaking the blisters spreads virus and can leave scars.
Colloidal Oatmeal
An oatmeal soak can settle itching while the rash is blistering, in cool rather than hot water. It is comfort only. It does not change how long shingles lasts or whether nerve pain follows.
Petrolatum
A thin layer of plain petroleum jelly on broken or crusting areas stops them drying and cracking, which lowers the risk of bacteria getting in. It has no effect on the virus itself. Use it under a loose, non-stick dressing rather than an adhesive one, which tears blisters when it comes off.
Lidocaine 5% patch
A numbing patch worn over the area for pain that carries on after the rash has healed. It goes only on intact skin, never on blisters or open areas. It helps some people a great deal and others hardly at all, so it is worth a proper trial before deciding.
Capsaicin 8% patch
A high-strength patch applied in a clinic for lasting nerve pain, with one treatment lasting up to three months. It burns while it is on, so the skin is numbed first. It is used after simpler options, and only once the skin has fully healed.
Mupirocin
An antibiotic ointment used only if the crusts turn hot, swollen or start oozing pus, which means bacteria have moved in on top. It does nothing to the shingles virus. If the infection is spreading, antibiotic tablets are needed instead.
Valacyclovir
The usual first choice for shingles: three doses a day for seven days. Started within 72 hours of the rash it shortens the episode and lowers the chance of lasting nerve pain. It does not clear the virus from the body, and it does much less once everything has crusted over.
Famciclovir
An equally effective alternative to valacyclovir, taken three times a day for seven days. It is used when valacyclovir does not suit. The same 72-hour clock applies, and it is usually the more expensive option.
Acyclovir
The oldest of the three antiviral tablets and the cheapest. It works just as well, but it has to be taken five times a day for seven days, which is harder to keep up. The dose is lowered if your kidneys are not working well.
Gabapentin and pregabalin
Nerve pain medicines rather than ordinary painkillers. They are the main treatment for pain that carries on after the rash heals, and they are often started during the episode when pain is severe. The dose is built up slowly, and they can make you drowsy or unsteady at first.
Amitriptyline
A low dose of an old antidepressant, taken at night for nerve pain. It suits people whose shingles pain is keeping them awake. It takes a few weeks before you can judge it, and it is used carefully in older adults because of dry mouth, dizziness and confusion.
Prednisone
A short course of steroid tablets is sometimes added to antivirals for severe pain or when the facial nerve is involved. It can speed up rash healing and early pain a little. Studies have not shown that it prevents lasting nerve pain, and it is never given on its own for shingles.
Shingrix
Two injections a few months apart, more than 90 percent effective at preventing shingles in adults 50 and over. It prevents rather than treats, so it is not used during an episode. It is still recommended once an episode has cleared, because having had shingles does not protect you from having it again.
Outlook
What to expect with Shingles
An episode runs two to four weeks, the pain sometimes longer. Most people get it once, though it can recur if the immune system is suppressed.
- 1
Before the rash · Days 1 to 5
Burning, stabbing, aching, itching or extreme sensitivity in one area on one side, with nothing to see. Some people also feel unwell.
- 2
Rash appearing · Days 1 to 3 of the rash
Pink, red or darker patches appear in a band, then small blisters cluster on them. New blisters can keep coming for about five days.
- 3
Blistering · Days 3 to 7
The blisters fill, some turn cloudy, and they may join up. The fluid is contagious to anyone who has never had chickenpox.
- 4
Crusting · Days 7 to 10
The blisters dry and crust. Once everything has crusted, the rash is no longer contagious.
- 5
Clearing · Weeks 2 to 4
Crusts fall away, leaving pink skin, or brown to gray on deeper skin tones. Deep blisters can scar permanently. In some people, mostly older adults, nerve pain continues after the skin heals - postherpetic neuralgia. It can last months, and it is why early antivirals and pain control matter.
Complications
Complications to know about
Postherpetic neuralgia
Nerve pain that carries on after the skin has healed, because the virus damaged the nerve it traveled down. It is the most common complication of shingles, and the risk climbs steeply with age. Starting antiviral tablets within 72 hours and controlling the pain properly from day one both lower the chance of it. It is treatable, so it is worth going back rather than waiting for it to fade.
Shingles in the eye
When the affected nerve serves the forehead and eye, blisters appear on the forehead, the eyelid or the tip and side of the nose, and the eye itself can be involved. It can cause lasting damage to sight. Blisters anywhere in this area are a same-day problem, and often need an eye specialist as well as antiviral tablets.
Shingles in the ear
Blisters in or around one ear, together with weakness on that side of the face, and sometimes a change in hearing, ringing or dizziness. It is uncommon. It needs urgent treatment, because the facial nerve recovers better the sooner antiviral tablets and steroids are started.
When to get help
When to get help
When to seek care
Seek prompt care when shingles is suspected because antivirals work best early. Eye or ear involvement, widespread blisters or weakened immunity needs urgent assessment.
Lookalikes
What else could it be?
Cellulitis
Shingles often hurts before grouped blisters appear in a one-sided strip. Cellulitis spreads outward as a hot, sore area rather than forming that blister pattern.
Contact Dermatitis
Contact dermatitis usually itches and follows where something brushed the skin. Shingles more often begins with pain and follows a one-sided strip.
Cold Sores
Cold sores usually form a small cluster that returns in the same place. Shingles typically covers a wider strip, with pain before the blisters appear.
Questions
Questions you might be asking.
Am I contagious?
Not with shingles - nobody catches shingles from you. But the blister fluid can give chickenpox to someone who has never had chickenpox and never been vaccinated. Keep the rash covered, wash your hands, and stay away from newborns, pregnant people who are not immune, and anyone immunosuppressed until it crusts.
Is it too late for antivirals if I am past 72 hours?
Possibly not. The evidence is strongest inside 72 hours, but treatment is often still given if new blisters are forming, if you are older, if the rash involves the face or eye, or if you are immunosuppressed. Being late is a reason to be seen today.
What is postherpetic neuralgia?
Nerve pain that continues after the rash heals, from damage to the nerve the virus traveled down. Much more common in older adults, and it can last months. It is treatable with different drugs from ordinary painkillers, so go back rather than waiting it out.
Should I get the vaccine if I have already had shingles?
Generally yes. One episode does not protect you from another, and vaccination is recommended once an episode has cleared. Ask your doctor about timing.
Why is it only on one side?
The virus travels down a single sensory nerve, and each nerve supplies a strip of skin on one side. That is also why the rash stops abruptly at the midline - one of the clearest clues.
Can I get it more than once?
Yes, though most people do not. Recurrence is more likely if your immune system is suppressed. If it has happened more than once, ask whether anything underlying should be looked into.
Sources
Sources and further reading
Related
