Shingles

Published by Bupa’s Health Information Team, December 2011.

This factsheet is for people who have shingles, or would like information about it.

Shingles causes a painful, blistering rash that usually appears on one side of the body. It’s caused by the same virus that causes chickenpox.

About shingles

The varicella zoster virus that causes chickenpox can also cause shingles. After you have had chickenpox, the virus stays in your body, lying dormant or hidden in your nerve cells. At any time later in life, the virus can be reactivated, causing shingles (also known as herpes zoster).

When the virus is reactivated, it travels down nerve fibres to your skin. Painful blisters then develop on your skin usually in a strip on one side of your body over where the infected nerve fibres run.

Shingles can affect anyone who has previously had chickenpox, but you’re more likely to get it when you’re an adult, especially if you’re over 40.

Animation – how shingles develops

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Symptoms of shingles

Two or three days before you develop shingles, you may have a fever and generally feel unwell. It’s likely that you will feel a tingling or burning sensation in the affected area. This is usually on one side of the body and can be very painful. You will then develop a rash in this area, consisting of red spots. This will usually appear in a band or strip following the affected nerves.

Shingles

Your spots will then turn into small, fluid-filled blisters. These blisters usually last between seven and 10 days before drying up and turning into scabs. Your scabs will heal and drop off within two to four weeks.

       Shingles

Symptoms are usually more severe in adults than in children.

Complications of shingles

The pain caused by shingles is often severe and can sometimes stay after your rash has gone. This is called post-herpetic neuralgia. Neuralgia is a sharp, shocking pain that follows the path of a nerve and is caused by irritation or damage to the nerve. It occurs in shingles because the virus affects your nerves.

Post-herpetic neuralgia is more common as you get older, and more likely if your initial rash was severe and painful. Up to half of people who are older than 50 who get shingles will have some form of post-herpetic neuralgia. It usually goes within six months, but for some people the pain can last for years. Your GP will be able to offer you some medicine to help manage your pain. The type of medicine will depend on the severity of your pain. Always read the patient information leaflet that comes with your medicine.

Occasionally, shingles can affect other parts of your body. If you develop shingles near your eye (ophthalmic zoster), you should see your GP as soon as possible. You might need to see an ophthalmologist (a doctor who specialises in eye health, including eye surgery) as your eye can be damaged by shingles if you don’t get the right treatment soon enough.

Sometimes shingles blisters can become infected. Your GP may prescribe you antibiotics if this happens. Try to keep your rash clean and dry to prevent bacterial infections, and try not to scratch the blisters.

Causes of shingles

It’s not usually possible to say what causes the varicella zoster virus to reactivate but you’re more likely to get it if you: 

• are over 60
• are under stress
• have an illness that weakens your immune system
• are receiving chemotherapy or radiotherapy for cancer
• are taking treatments that suppress your immune system (for example, medicines taken after an organ transplant)

You can’t catch shingles from somebody who has shingles, nor can you catch shingles from someone with chickenpox. However, you can catch chickenpox from someone with shingles if you haven’t had it before.

If you have shingles, you’re infectious until your lesions have dried and crusted over. Unlike chickenpox, shingles can only be passed on by direct skin contact with the affected area. Therefore, cover the area if possible.

Try to stay away from pregnant women, especially if they can’t remember having chickenpox before or they haven’t had the chickenpox vaccine. Also, stay away from babies younger than one and people with a weakened immune system.

Diagnosis of shingles

See your GP as soon as possible if you think you have shingles. He or she will ask you to describe the location of the pain. Pain in a band on one side of your body and the appearance of the rash will suggest shingles.

Treatment of shingles

Your GP will be able to prescribe you the best treatment depending on the severity of your shingles.

Shingles will resolve on its own within a few weeks without treatment, but dermatologists (doctors who specialise in identifying and treating skin conditions) strongly recommend some form of treatment. Without it, you may get pain, numbness, itching and tingling that can last for months or even years. 

Self-help

Keep your rash clean and dry. This will reduce the risk of your blisters becoming infected. Don’t use antibiotic creams or adhesive dressings, as this can cause irritation and slow down the healing process.

You can soothe your rash with ice cubes wrapped in a flannel or a tea towel. Don’t apply ice directly to your skin as it can damage it. You can also apply a soothing lotion (such as Eurax cream) to the rash. Some people may find that aloe vera gel provides some relief but there is no firm evidence that it gives any real benefit.

Medicines

There are medicines available to help you control your symptoms and make the rash clear up more quickly.

Paracetamol and other over-the-counter painkillers will often help relieve the pain of shingles. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice. If your pain is severe, your GP may prescribe you more powerful medicines. Ask your pharmacist or GP for advice if you’re unsure about how to manage your pain.

Antiviral medicines can make your symptoms milder and not last as long. They also help to reduce complications and prevent long-term nerve pain. You should start treatment with antivirals, which are prescribed by your GP, within three days of the onset of the rash and you will usually continue for seven to 10 days.

An injection containing an anaesthetic (a medicine used to completely block pain from a specific area) or a corticosteroid is sometimes given for intense pain. Post-herpetic symptoms can sometimes be helped with a local anaesthetic patch or capsaicin creams.

Prevention of shingles

A shingles vaccine has been developed, but it’s not approved for use in the UK. In the USA, the vaccine is recommended for people older than 60.

There is a vaccine that can help prevent chickenpox. This will protect you from catching the varicella zoster virus in the first place. However, it’s only recommended for certain people, such as healthcare workers and for those in regular contact with someone who has a weak immune system.

If you have shingles, don’t go to work and stay away from schools and nurseries. This is in case you come into contact with people who haven’t had chickenpox before. Wait until your blisters have dried and crusted over, or make sure your rash is covered.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.