Shingles

Cause

Shingles occurs when the virus that causes chickenpox starts up again in your body.

After you've had chickenpox, the virus "sleeps" (is dormant) in your nerve roots. In some people, it stays dormant forever. In others, the virus "wakes up." In this case, you may get a rash that occurs only in the area of the affected nerve.

The virus can become active again when disease, stress, or aging weakens the immune system. Some medicines may trigger the virus. It's not clear why this happens.

After the virus becomes active again, it can cause only shingles, not chickenpox. Anyone who has had even a mild case of chickenpox can get shingles. This includes children.

You can't catch shingles from someone who has shingles. But if you haven't had chickenpox or haven't gotten the chickenpox vaccine, you can get chickenpox if you come into contact with the fluid in the shingles blisters.

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What Increases Your Risk

Things that increase your risk for getting shingles include:

• Having had chickenpox. You must have had chickenpox to get shingles.
• Being older than 50.
• Having a weakened immune system due to another disease, such as diabetes or HIV infection.
• Experiencing stress or trauma.
• Having cancer or receiving treatment for cancer.
• Taking medicines that affect your immune system, such as steroids or medicines that are taken after having an organ transplant.

If a pregnant woman gets chickenpox, her baby has a high risk for shingles during his or her first 2 years of life. And if a baby gets chickenpox in the first year of life, he or she has a higher risk for shingles during childhood.^{footnote 1}

Prevention

Anyone who has had chickenpox may get shingles later in life. If you've never had chickenpox or the chickenpox vaccine, avoid contact with people who have shingles or chickenpox. Fluid from shingles blisters is contagious. It can cause chickenpox (but not shingles).

A shingles vaccine may help prevent shingles. It is recommended for adults ages 50 and older and adults 19 and older who have a weakened immune system.

If you have shingles, avoid close contact with people until after the rash blisters heal. It's most important to avoid contact with people who are at special risk from chickenpox. This includes pregnant people, infants, and anyone who has never had chickenpox, is currently ill, or has a weak immune system. Also cover any fluid-filled blisters that are on a part of your body that isn't covered with clothes. Choose a type of bandage that absorbs fluid and protects the sores.

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Symptoms

Shingles symptoms happen in stages. At first you may have a headache or be sensitive to light. You may also have flu-like symptoms without a fever.

Later you may feel itching, tingling, or pain in a certain area. That's where a small area of rash may occur a few days later. It can appear anywhere on the body, but on only the left or the right side of the body. Piercing pain may occur along with the skin rash.

The rash turns into clusters of blisters. The blisters fill with fluid and then crust over. It takes 2 to 4 weeks for the blisters to heal, and they may leave scars. Some people get no rash at all.

Sometimes postherpetic neuralgia (PHN) develops. Symptoms can include a painful rash or sensitivity to touch. PHN may last for months or years.

What Happens

Some people will have other problems from shingles. These can include:

• Postherpetic neuralgia (PHN). This is pain that does not go away for months or even years after shingles heals.
• Disseminated zoster. This is a blistery rash that spreads over the body and can affect the heart, lungs, liver, pancreas, joints, and intestinal tract.
• Cranial nerve problems. If shingles affects the nerves that start in the brain (cranial nerves), problems may include:
  • Inflammation, pain, and loss of feeling or vision in one or both eyes.
  • Intense ear pain and a rash around the ear, mouth, face, neck, and scalp.
  • Inflammation, and possibly blockage, of blood vessels, which may lead to stroke.
• Bacterial infection of the blisters.
• Muscle weakness in the area of the infected skin before, during, or after the episode of shingles.

Delaying or not getting medical treatment may increase your risk for problems.

When to Call a Doctor

Call your doctor now if you:

• Have a rash or blisters on your face, especially near an eye or on the tip of your nose. This can be a warning of eye problems. Treatment can help prevent permanent eye damage.
• Think you have shingles. Early treatment with antiviral medicines may help reduce pain and prevent complications of shingles, such as disseminated zoster or postherpetic neuralgia (PHN).

If you still feel intense pain for more than 1 month after the skin heals, see your doctor to find out if you have PHN. Getting your pain under control right away may prevent nerve damage that may cause pain that lasts for months or years.

Treatment Overview

Shingles is treated with medicines. See your doctor right away if you think you may have shingles. There is no cure for shingles. But treatment can help your rash heal faster and be less painful. It may shorten the length of illness and prevent complications.

It's important to see your doctor right away if you have shingles near your eye or nose. Treatment can help prevent permanent eye damage.

Good home care also can help you feel better faster. Avoid scratching blisters. Apply baking soda to help dry the sores. Soak crusted sores with tap water to clean away crusts and soothe the skin.

Starting treatment

As soon as you are diagnosed with shingles, your doctor probably will start treatment with antiviral medicines. If you start taking medicines within the first 3 days of seeing the shingles rash, you have a lower chance of having later problems, such as postherpetic neuralgia (PHN).

The most common treatments for shingles include:

• Antiviral medicines, such as acyclovir, famciclovir, or valacyclovir. They can reduce the pain and the duration of shingles.
• Over-the-counter pain medicines, such as acetaminophen or ibuprofen. They can help reduce pain during an attack of shingles. Be safe with medicines. Read and follow all instructions on the label.
• Topical antibiotics, applied directly to the skin. They can stop infection of the blisters.

For severe cases of shingles, some doctors may have their patients use corticosteroids along with antiviral medicines. But steroids aren't used very often for shingles. This is because studies show that taking a steroid medicine along with an antiviral medicine doesn't help any more than just taking an antiviral medicine by itself.^{footnote 2}

Ongoing treatment

If you have pain that lasts longer than a month after your shingles rash heals, your doctor may diagnose postherpetic neuralgia (PHN). It's the most common complication of shingles. PHN can cause pain for months or years. It affects 10 to 15 out of 100 people who have had shingles.^{footnote 3} Treatment to reduce the pain of PHN includes:

• Antidepressant medicines, such as a tricyclic antidepressant (for example, amitriptyline).
• Topical anesthetics that include benzocaine. You can buy them in over-the-counter forms that you can apply directly to the skin for pain relief. Lidocaine patches, such as Lidoderm, are available only by prescription.
• Anticonvulsant medicines, such as gabapentin or pregabalin.
• Opioids, such as codeine.
• Other medicines that treat pain. One example is gabapentin enacarbil (Horizant).

Creams that contain capsaicin may provide some relief from pain. You put them on your skin. There is also a high-dose skin patch available by prescription (Qutenza) for PHN. Capsaicin may irritate or burn the skin of some people. It should be used with caution.

Treatment if shingles gets worse

In some cases, shingles causes long-term problems. Treatment depends on the specific complication.

• Postherpetic neuralgia (PHN) is persistent pain that lasts months or even years after the shingles rash heals. Certain medicines, such as anticonvulsants, antidepressants, and opioids, can relieve pain. Most cases of PHN get better within a year.
• Disseminated zoster is a blistery rash over a large portion of the body. It may affect the heart, lungs, liver, pancreas, joints, and intestinal tract. Treatment may include both antiviral medicines to prevent the virus from multiplying and antibiotics to stop infection.
• Herpes zoster ophthalmicus is a rash on the forehead, cheek, nose, and around one eye. It could threaten your sight. Get treatment from an ophthalmologist right away. Treatment may include rest, cool compresses, and antiviral medicines.
• If the shingles virus affects the nerves originating in the brain (cranial nerves), serious complications involving the face, eyes, nose, and brain can occur. Treatment depends on the nature and location of the complication.

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Self-Care

• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. Antiviral medicine helps you get better faster.
• Try not to scratch or pick at the blisters. They will crust over and fall off on their own if you leave them alone.
• Put cool, wet cloths on the area to relieve pain and itching. You can also use calamine lotion. Try not to use so much lotion that it cakes and is hard to get off.
• Put cornstarch or baking soda on the sores to help dry them out so they heal faster.
• Do not use thick ointment, such as petroleum jelly, on the sores. This will keep them from drying and healing.
• To help remove loose crusts, soak them in tap water. This can help decrease oozing, and dry and soothe the skin.
• Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.
• Avoid close contact with people until the blisters have healed. It is very important for you to avoid contact with anyone who has never had chickenpox or the chickenpox vaccine. Young babies and anyone who is pregnant or has a hard time fighting infection (such as someone with HIV, diabetes, or cancer) is especially at risk.