Shingles: Everything You Should Know

Shingles is an infection caused by the varicella-zoster virus, which is the same virus that causes chickenpox. Even after the chickenpox infection is over, the virus remains dormant or inactive in your nervous system for years before reactivating as shingles.

Shingles is also referred to as herpes zoster. This type of viral infection is characterized by a red skin rash that can cause pain and burning. Shingles usually appears as a stripe of blisters on one side of the body, typically on the torso, neck, or face.

Most cases of shingles clear up within 3 to 5 weeks. According to the Centers for Disease Control and Prevention (CDC), approximately one in three people in the United States will have shingles at some point in their life. The condition can occur in the same person more than once, especially if they have risk factors, but this is uncommon.

Keep reading to learn more about shingles, including symptoms, treatments, and complications.

The first symptoms of shingles are usually pain and burning, according to the CDC. The pain is typically on one side of your body, and along a certain area of the skin called a dermatome. A red rash often follows. However, the rash does not always appear red. Depending on skin tone, the rash can appear dark pink, dark brown, or purplish.

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The National Institute on Aging (NIA) says that characterizations of a shingles rash include:

• rash that appears on one side of the body, such as on the chest, abdomen, back, or face
• a rash on your face and ears
• itchiness
• fluid-filled blisters that break easily
• burning sensation

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Some people with shingles experience symptoms beyond pain and rash. According to the American Academy of Dermatology, these symptoms may include:

• fever
• chills
• headache
• fatigue
• muscle weakness

Rare and serious complications of shingles include:

• pain or rash that involves an eye, which should be treated immediately to avoid permanent eye damage
• loss of hearing or intense pain in one ear, dizziness, or loss of taste on your tongue, which can be symptoms of Ramsay Hunt syndrome and also require immediate treatment
• bacterial infection characterized by skin that’s red, swollen, or warm to the touch

Shingles on your face

Shingles usually occurs on one side of your back or chest, but you can also get a rash on one side of your face.

If the rash is close to or in your ear, it can cause an infection that could lead to:

• loss of hearing
• issues with your balance
• weakness in your facial muscles

Shingles inside your mouth can be very painful. It may be difficult to eat and may affect your sense of taste.

A shingles rash on your scalp can cause sensitivity when you comb or brush your hair. Without treatment, shingles on the scalp can lead to permanent bald patches.

Shingles of the eye

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For some people, shingles occurs in and around the eye. This is referred to as ophthalmic herpes zoster or herpes zoster ophthalmicus.

A blistering rash may appear on your eyelids, forehead, and sometimes the tip or side of your nose.

You may experience symptoms like:

• burning or throbbing in your eye
• redness and tearing
• swelling
• blurred vision

After the rash disappears, you may still have pain in your eye due to nerve damage. The pain eventually gets better for most people.

Without treatment, shingles of the eye can lead to serious problems, including long-term vision loss and permanent scarring due to swelling of the cornea.

Seek urgent care

If you suspect you have shingles in and around your eye, contact a doctor right away.

Shingles on your back

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While shingles rashes usually develop around one side of your waistline, a stripe of blisters may appear along one side of your back or lower back.

Shingles on your buttocks

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You can get a shingles rash on your buttocks. Shingles usually only affects one side of your body, so you may have a rash on one buttock but not the other.

As with other areas of the body, shingles on your buttocks may cause initial symptoms like tingling, itching, or pain.

After a few days, a red rash or blisters may develop. Some people experience pain but don’t develop a rash.

According to the NIA, most shingles cases last from 3 to 5 weeks. After the varicella-zoster virus initially reactivates, your skin may:

• tingle
• burn
• feel numb
• itch

Shingles usually develops on one side of your body, often on your waist, back, or chest.

Within about 5 days, you may see a red rash in that area. Small groups of oozing, fluid-filled blisters may appear a few days later in the same area. You may experience flu-like symptoms such as a fever, headache, or fatigue.

During the next 10 days or so, the blisters will dry up and form scabs. The scabs will clear after a couple of weeks. After the scabs clear, some people continue to experience pain. This is called postherpetic neuralgia.

Shingles is caused by the varicella-zoster virus, which also causes chickenpox. If you’ve already had chickenpox, you can develop shingles when this virus reactivates in your body.

The reason why shingles develop in some people but not others is unclear. It’s more common in older adults because of lower immunity to infections.

Possible risk factors for shingles include:

• a weakened immune system
• emotional stress
• aging
• undergoing cancer treatments or major surgery

One vaccine called Shingrix is currently approved by the Food and Drug Administration (FDA) to prevent shingles. The CDC recommends adults over 50 years old receive two doses of Shingrix separated by 2 to 6 months. The vaccine is over 90-percent effective.

While side effects such as allergic reactions are possible from the vaccine, they are rare. And the CDC has no documented cases of the varicella-zoster virus being transmitted from people who were vaccinated.

Shingles can occur in anyone who has had chickenpox. However, certain factors put people at an increased risk of developing shingles. According to the NIA, these include:

• being 60 years or older
• having conditions that weaken your immune system, such as HIV or cancer
• having had chemotherapy or radiation treatment
• taking medications that weaken your immune system, such as steroids or medications given after an organ transplant
• having had shingles before

According to the National Health Service, shingles is not contagious. But the varicella-zoster virus that causes it can be spread to another person who hasn’t had chickenpox, and they could develop chickenpox.

The varicella-zoster virus is spread when someone comes into contact with an oozing blister. It’s not contagious if the blisters are covered or have formed scabs.

To prevent the varicella-zoster virus from spreading if you have shingles, be sure to keep the rash clean and covered. Do not touch the blisters, and make sure to wash your hands often.

Avoid being around at-risk people, such as people who are pregnant or have weak immune systems.

It’s important to visit your doctor as soon as possible if you suspect you have shingles, especially if you’re somebody at an increased risk of developing it.

The American Academy of Dermatology recommends visiting a dermatologist or other healthcare professional within 3 days to prevent long-term complications.

Shingles typically clears up within a few weeks and does not commonly recur. If your symptoms have not lessened within 10 days, contact a doctor for a follow-up and reevaluation.

If you need help finding a primary care doctor, then check out our FindCare tool here.

Doctors usually diagnose shingles by examining your rashes and blisters. They also ask questions about your medical history.

In rare instances, your doctor may need to test a sample of your skin or the fluid from your blisters. This involves using a sterile swab to collect a sample of tissue or fluid. Samples are then sent to a medical laboratory to confirm the presence of the virus.

There’s no cure for shingles, but treating it as soon as possible can help prevent complications and speed up your recovery. Ideally, you should receive treatment within 72 hours of developing symptoms. Your doctor may prescribe medications to ease symptoms and shorten the length of the infection.

Medication

The medications prescribed to treat shingles vary, but may include the following:

Home treatment can help ease your shingles symptoms. According to the NIA, these remedies include:

• taking cool baths or showers to clean and soothe your skin
• applying wet cold compresses to the rash to reduce pain and itching
• applying calamine lotion or making a paste with water and baking soda or cornstarch to reduce itching
• eating foods with vitamin A, vitamin B12, vitamin C, and vitamin E
• taking L-lysine supplements to strengthen your immune system

The NIA says that getting vaccinated can help keep you from developing severe shingles symptoms or complications. All children should receive two doses of the chickenpox vaccine, also known as a varicella immunization. Adults who’ve never had chickenpox should also get this vaccine.

The immunization doesn’t necessarily mean that you won’t get chickenpox, but it does prevent it in 9 out of 10 people who get the vaccine.

Adults who are 50 years or older should get a shingles vaccine, also known as the varicella-zoster immunization, according to the CDC. This vaccine helps to prevent severe symptoms and complications associated with shingles.

There is one shingles vaccine available, Shingrix (recombinant zoster vaccine). The CDC notes that if you have received Zostavax, a shingles vaccine used in the past, you should still get the Shingrix vaccine. Speak with your doctor to see if you need the shingles vaccine.

While shingles can be painful and bothersome on its own, it’s important to monitor your symptoms for potential complications:

• Eye damage can occur if you have a rash or blister too close to your eye. The cornea is particularly vulnerable.
• Bacterial skin infections can easily occur from open blisters and can be severe.
• Pneumonia is possible.
• Ramsay Hunt syndrome can occur if shingles affects the nerves in your head and can result in partial facial paralysis or hearing loss if untreated. If treated within 72 hours, most people make a full recovery.
• Brain or spinal cord inflammation, such as encephalitis or meningitis, is possible. These complications are serious and life threatening.

Shingles is particularly common in older adults. The NIA says that of the 1 in 3 people who get shingles in their lifetime, about half are over 60 years old. This is because the immune systems of older people are more likely to be compromised or weakened.

Older adults with shingles are more likely to experience complications than the general population, including more extensive rashes and bacterial infections from open blisters. They’re also more vulnerable to both pneumonia and brain inflammation, so it’s important to visit a doctor early on for antiviral treatment.

To prevent shingles, the CDC recommends that adults over 50 years old receive the shingles vaccine.

While getting shingles during pregnancy is unusual, the NHS says it is possible. If you come into contact with someone who has chickenpox or an active shingles infection, you can develop chickenpox if you have not been vaccinated or if you have never had it before.

Depending on what trimester you’re in, having chickenpox during pregnancy can result in congenital anomalies. Getting a chickenpox vaccine before pregnancy can be an important step in protecting your child.

Shingles is unlikely to cause complications during pregnancy, but it can still be unpleasant. Contact your doctor right away if you develop a rash during pregnancy.

Find out more about shingles and pregnancy.

Antiviral medications that treat shingles can be used safely during your pregnancy. Antihistamines can also help reduce itching, and acetaminophen (Tylenol) can reduce pain. Speak with your doctor before taking any medication to treat shingles during pregnancy.

Here’s a look at some of the common questions people have about shingles.

What usually triggers shingles?

Shingles develop when something triggers the dormant varicella zoster. This is usually because something compromises your immune system. The trigger isn’t always known, but the virus is more common among elderly adults due to their decreased immunity.

Other possible causes include stress, cancer treatment, viruses like HIV, organ transplants, taking immunosuppressive medications, or other medical reasons that reduce your immunity.

What are the first signs of shingles?

The first signs of shingles are usually pain and burning on one half of your body in the affected skin area.

Is shingles airborne?

The varicella-zoster virus that causes both chickenpox and shingles is airborne. It can spread if someone with shingles or chickenpox coughs or sneezes near you or shares your drinking glass or eating utensils.

You can also get it if you come in contact with a chickenpox or shingles rash, by touching something in contact with contaminated hands, or by inhaling particles from the blisters.

If you contract the virus and you haven’t had chickenpox, you will develop chickenpox. You can only get shingles if you’ve already had chickenpox and the virus is already inside your body.

Is shingles painful?

Some people with shingles only experience mild symptoms, such as tingling or itchy skin. For others, it can be very painful. Even a gentle breeze can cause pain. Some people experience intense pain without developing a rash.

The pain from shingles usually occurs in the nerves of the:

• chest
• neck
• face
• lower back
• abdomen

To help relieve the pain, a doctor may prescribe medications such as antivirals or anti-inflammatory medications.

A 2017 animal study found that shingles pain may be due to our immune mechanisms changing how our sensory neurons work after being triggered by the reactivation of the varicella-zoster virus.

Can you get shingles more than once?

Although possible, it’s rare to experience shingles more than once. In a 2019 study, researchers found the reoccurrence rate of shingles was 5.3 percent over an average of a 4.4-year follow-up period.

The researchers found that experiencing shingles that lasted more than 30 days significantly increased the risk of reoccurrence. Other risk factors were:

• being 51 to 70 years old
• having shingles lasting longer than 90 days
• being female
• having a blood cancer, an autoimmune disease, high blood pressure, or dyslipidemia (high “bad” cholesterol or low “good” cholesterol)

Can the Shingrix vaccine cause shingles?

No, the Shingrix vaccine can’t cause shingles. According to the Immunization Action Coalition, the Shingrix vaccine only contains a small amount of the herpes zoster virus and doesn’t contain a live virus.

The CDC says that about 10 percent of people who receive the vaccine experience some redness, swelling, or pain around the injection site.

What is the difference between shingles and hives?

If you have shingles, a condition that’s caused by the varicella-zoster virus, you will usually have an itchy or painful red rash with liquid-filled blisters on one side of your body. You can only develop shingles if you’ve previously had chickenpox.

Shingles is not the same as hives, which are itchy, raised welts on your skin. Hives are usually caused by an allergic reaction to a medication, food, or something in your environment.

Shingles is an infection caused by the same virus that causes chickenpox: the varicella-zoster virus. Once this virus infects someone, it remains dormant in their nervous system for a long period of time before reactivating as shingles.

This type of viral infection is referred to as herpes zoster or shingles. It is marked by a red, painful rash with burning sensations. The rash can often appear in stripes on either side of the body, usually on the torso, neck, or face.