An Overview of Shingles

Shingles, also known as herpes zoster (HZ), is a painful and unsightly rash that's caused by a reactivation of the varicella-zoster virus (VZV), which is also responsible for chickenpox. Besides the blisters and discomfort that are the main symptoms of shingles, many people go on to have persistent pain after the rash heals—a condition called ​postherpetic neuralgia (PHN). Shingles can be treated with antiviral medications and symptom-relief strategies, but even more important to managing shingles is prevention. People who receive the chickenpox vaccine will avoid shingles because they are protected from infection by varicella in the first place. For those who have had chickenpox, there are two vaccines.

Symptoms

The symptoms of shingles typically appear in two distinct stages. During the first, the prodromal stage, a person often will experience symptoms of a general infection, such as a fever, headache, and fatigue. Soon pain will develop. People have described shingles pain as burning, stinging, tingly, shooting, and more. The pain usually will be limited to one side of the body.

In the second stage of shingles, the skin where the initial pain is felt will become red and sensitive to the touch, much like a sunburn. Within a few days, fluid-filled blisters, or vesicles, will develop in the area. Eventually, these will crust over, but until they do a person is contagious—meaning someone who isn't immune to chickenpox (naturally because they've had it or because they've been vaccinated) could get chickenpox from coming into contact with the active shingles rash.

Complications from shingles include PHN, which can last for weeks or even years after a shingles outbreak, and secondary infections such as impetigo (a bacterial skin infection) and meningitis. When shingles blisters develop on the face they can cause permanent damage to eyesight or hearing. 

Causes and Risk Factors

Shingles develop ​when the varicella virus, which causes chickenpox, becomes active after lying dormant in the nervous system—often after decades. Why this happens isn't completely understood, but it's thought that the virus re-emerges when the immune system becomes weakened—a natural occurrence with age. This is one reason the people most at risk of shingles are those who are in their 50s or 60s who had chickenpox as children.

But there are other reasons someone's immunity becomes compromised—infection from human immunodeficiency virus (HIV), for example, or as a side effect of medications such as chemotherapy.

Even children can be susceptible. Fortunately, shingles is rare in kids under 10, and those who do come down with the disease tend to have milder symptoms than adults do. The children most at risk of shingles are those who had chickenpox before they were a year old or whose mothers had chickenpox during the third trimester of pregnancy. 

There's evidence that stress sometimes plays a role in triggering shingles. This could be either garden-variety tension and anxiety or a single upsetting event, such as the loss of a job or loved one. 

Diagnosis

Until the prodromal period begins and the distinctive rash appears, it can be easy to mistake shingles for a garden-variety viral infection. But once the telltale blisters begin to form on one side of the body, along with painful sensations such as burning, itching, or tingling, the diagnosis of shingles is pretty easy to make.

The exceptions might be cases in which the rash spans beyond one side of the body, looks more like another type of rash, or doesn't appear at all. Then, the blisters may need to be swabbed and the sample examined in a lab for the shingles virus. There is a blood test for cases that are even harder to pin down. 

Treatment

First and foremost when treating shingles, it's important to stop the varicella virus from multiplying: The longer it's allowed to continue causing blisters, the higher the risk of future complications. Antiviral medications—Zovirax (acyclovir), Famvir (famciclovir), or Valtrex (valacyclovir)—are most effective when taken within 72 hours of a suspected outbreak of shingles.

Beyond that, the focus in dealing with shingles is on relieving symptoms. Helpful ways to tend to the blisters and rash include:

  • Soaking in an oatmeal bath
  • Wearing loose-fitting clothing, especially over the area where the rash has erupted
  • Practicing healthy self-care—getting plenty of rest, eating well, engaging in gentle exercise (Tai Chi has been found to help some people), etc.

General pain and discomfort can be treated with over-the-counter (OTC) pain relief medications, including non-steroidal anti-inflammatory drugs (NSAIDs) such as Tylenol (acetaminophen) and Advil (ibuprofen); oral and topical antihistamines to ease itching; and other OTC topical products, like calamine lotion, lidocaine, and capsaicin.

There may be some benefit in certain alternative treatments—among them, acupuncture, transcutaneous electrical nerve-stimulation (TENS), hypnosis, and nutritional supplements called proteolytic enzymes. 

Prevention

For anyone who has never had chickenpox, the key to preventing shingles is to get the varicella vaccine. Currently, this highly effective double-dose inoculation is part of the regular childhood vaccination schedule, but it also can be given to kids over 13 and adults who've never had chickenpox. 

For people who've had chickenpox and therefore are hosting the dormant varicella virus, there are two shingles vaccines available. One of these, Zostavax (zoster vaccine live) has been available since 2006, but has been replaced as the preferred vaccine of choice by the Centers for Disease Control and Prevention (CDC) with a shot called Shingrix. Shingrix has been found to be more effective than Zostavax. 

Aside from vaccination, keeping up a generally healthy lifestyle, and in particular avoiding stress as much as possible, can help prevent a sleeping varicella virus from becoming active again.

Coping

There's no getting around it: Shingles can be a miserable disease. Not only is it painful and unpleasant to look at, it can last for weeks or even months.

Being uncomfortable for so long can take a toll, so it can help to turn to coping techniques that ease your mind along with your body. To keep your spirits up, consider meditation and also make sure you get enough sleep and physical activity.

To deal with the itching and pain of shingles, try turning to OTC treatments, such as calamine lotion and antihistamines; you might even consider hypnosis for pain. (If your pain becomes severe and you cannot find relief, speak with your doctor.)

It's important when you have shingles to not allow the disease to leave you isolated from other people. Don't hesitate to ask for help: Join a support group, discuss a plan for missing work, and delegate errands and tasks. 

Caregiving

Caring for someone who has shingles can be a challenge, especially considering the disease usually has repercussions beyond physical pain and discomfort.

For that reason, if you're the caregiver for someone with shingles, you'll likely be called upon in several ways. Medical support is key, of course: You may need to make sure the person in your care sees the doctor, as well as help them cope with symptoms and perhaps even take measures to prevent them from being contagious to others. Your job also may involve stress relief, helping out with personal tasks, and providing social support.

A Word From Verywell

There's no question shingles is a particularly unpleasant disease, one that at the very least is excruciatingly painful and, depending on where the rash is located, can make you feel self-conscious until it heals. Shingles can also have long-term and even permanent complications.

All of these problems can be prevented, however, with simple vaccinations—for chickenpox if you're a younger person who didn't have the infection as a child, or for shingles, if you did. Your doctor can help you to figure out which strategy makes the most sense for your age and medical history, so it's well worth reaching out to your healthcare provider or adding questions about shingles to your list of things to talk about at your next check-up.

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