Shingles: cause, symptoms, diagnosis & treatment

What causes shingles?

If you’ve had chickenpox, the varicella zoster virus is still alive in your body. The virus is dormant (inactive) in the roots of nerves near your spine and brain. It’s not known why shingles develop. Many shingles cases develop when a condition “triggers” the virus to become active again. Once it’s active, it moves along the nerves to the skin, causing the painful rash and blisters. You can develop shingles at any age, long after you’ve recovered from chickenpox.

What can trigger an outbreak?

Several of the conditions that can awaken the varicella zoster virus include:

A weakened immune system - the most common cause
Being over age 50 - it’s more likely in older people
Living with extra stress
Having cancer, HIV AIDS, or any disease that weakens the immune system
Having a serious physical injury
Taking long-term steroids or other medications that weaken your immune system

However, some people develop shingles for unknown reasons. If you’ve had chickenpox, that does not guarantee you’ll eventually develop shingles.

What are shingles symptoms?

Symptoms may include:

Several days or weeks before the rash appears, a burning, tingling or itching pain occurs in the area where the rash later develops. Some people also have numbness.
Pain is constant or comes and goes; it can be intense or stabbing/shooting pain.
You may have fever, fatigue, headache, enlarged lymph nodes, and upset stomach or nausea.
A red and inflamed skin rash develops a few days after the pain starts. Some people have pain but never develop a rash.
A group of fluid-filled blisters develop on the skin.
The area may be very sensitive to touch and even clothing is unbearable
Swollen lymph nodes may occur on one side of the body
Blisters often occur as a stripe that wraps around only one side of your torso, one eye, or one side of the face or neck.
Although it can develop anywhere on your body, shingles usually affect only a small section on one side of the body. Blisters and rash do not cross the body’s mid-line.
Rash and blisters crust over in about a week to 10 days. If they’re not improving by then, contact your doctor right away.

Is shingles contagious?

Yes! During an outbreak you can spread the virus to someone who’s never had or been vaccinated for chickenpox. You are contagious until all blisters have crusted over. During an outbreak, it’s important to avoid contact with newborns and pregnant women. They may not be vaccinated, and shingles is especially dangerous for them. Avoid people with weak immune systems, too.

Can shingles cause complications?

Shingles can cause serious complications long after the rash and blisters heal. Complications can include:

Pain that lasts after your skin has healed, called postherpetic neuralgia, affects about 20% of shingles patients. Some people have itching, burning and tingling for months or years. Postherpetic neuralgia can be permanent. This complication is more common in older people.
Inflammation of the brain, liver, kidneys, or lungs are very rare complications, but extremely serious, even life-threatening.
Secondary bacterial infection in the blisters. If you see spreading redness, swelling at the site, have a high fever or pus coming from the blisters, you will need antibiotics.
Eye problems or permanent loss of eyesight, if the rash develops in or around your eyes, forehead or nose. Shingles blisters can cause scarring, redness and swelling; or cause glaucoma and nerve damage.
Hearing problems, called Ramsey Hunt syndrome, are caused by shingles on or around your ears. Complications include earaches, dizziness, balance problems, hearing loss, ringing in the ear (tinnitus), or loss of ability to move parts of your face (paralysis). Ramsey Hunt syndrome is rare, but early treatment increases your chances of recovery.
Scarring from the blisters. Once blisters appear, it’s important to keep them clean and dry to avoid infection. Infections are more likely to cause scars.

How is shingles diagnosed?

Your doctor does a physical exam, and asks if you’ve had chickenpox. A sample of the fluid in your blisters may be tested if the doctor cannot diagnose shingles from the skin rash. A diagnosis is especially important if you’re about to have an organ transplant, have a weak immune system, a high risk of complications, or you’re about to begin a drug that lowers immunity.

Shingles tests include:

Antibody test uses a blood sample to check for antibodies that your immune system makes when fighting the virus. Antibodies mean you’ve had chickenpox.
Viral detection test can determine if the virus is present in the rash.

How is shingles treated?

Regular medical care. If you have shingles, or think you might have it, regular medical care is important for several reasons. First, you’ll get an accurate diagnosis, and be started on medications right away. Second, your doctor can watch for any complications that might develop. Early diagnosis and treatment of complications provides the best chance of stopping them before they cause permanent damage.
Antiviral medications (Famvir, Valtrex, Zovirax) can lessen the symptoms, make you feel better, and shorten the length of your infection. They can also help protect against complications. It’s important to start them within 72 hours of the first symptoms of pain, itching or burning.
Other medications can help with inflammation (acetaminophen, naproxen or ibuprofen), and may also help avoid the lingering pain and burning of postherpetic neuralgia.
Prevention. The best treatment is to prevent shingles with one of the two shingles vaccines. Shingrix is a newer, improved vaccine that has replaced the older vaccine, Zostavax. Zostavax was taken off the market in 2020. Shingrix is more than 90% effective in preventing shingles. It’s recommended that all healthy adults over age 50 get a Shingrix vaccine. If you had the Zostavax vaccine first, you should also have the Shingrix vaccine to increase immunity. Shingrix requires two doses; second dose two to six months after the first. Shingrix has been approved for anyone over age 18 who are at risk for shingles because of a weak immune system.

Even if you’re vaccinated but still get shingles, the vaccine will reduce the pain and burning. If you’ve already had shingles, get the vaccine to help prevent another outbreak. If you have active shingles now, wait until the rash is gone before getting vaccinated. However, if you have tested negative for immunity to chickenpox, ask your doctor if you should have the chickenpox vaccine instead.

Self-care recommendations include:

Keep the affected area clean, dry and exposed to air as much as possible.
Try not to scratch or burst the blisters. It can cause infection, possible scarring and spreads the infection to other places.
Cold compresses applied for 20 minutes, several times a day, can ease the burning and itching. If your blisters have stopped oozing, do not use cold compresses. If you’re using a topical cream on your rash, don’t use cold compresses at the same time.
Calamine lotion can cool the burning and calm the itchy rash.
Avoid rubbing anything on the skin that includes antibiotics. It can slow the healing of the blisters.
Try to cope, or get help coping, with the stress of painful shingles symptoms. Stress can make the symptoms even worse. Consider asking your doctor about taking an antidepressant.
Stay healthy while your body is fighting shingles. Eat nutritious meals, rest whenever you can, and get plenty of sleep. You won’t feel like exercising, but walking and stretching can help take your mind off the pain and stress.

Mayo Clinic (Oct. 2020). Shingles. Retrieved 8-24-21, {https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054}

WebMD. (Aug. 2021). Shingles. Retrieved 8-24-21, {https://www.webmd.com/skin-problems-and-treatments/shingles/shingles-skin}

WebMD. (n.d.). Understanding Shingles - Symptoms. Retrieved 8-24-21, {https://www.webmd.com/skin-problems-and-treatments/shingles/understanding-shingles-symptoms}

WebMD, (Sep. 2020). How Do I Know If I Have Shingles? Retrieved 8-24-21, {https://www.webmd.com/skin-problems-and-treatments/shingles/do-i-have-shingles}

WebMD. (Sep. 2020). What Problems Can Shingles Cause? Retrieved 8-24-21, {https://www.webmd.com/skin-problems-and-treatments/shingles/problems-shingles-cause}

WebMD. (Aug. 2021). What Meds Treat and Prevent Shingles? Retrieved 8-24-21, {https://www.webmd.com/skin-problems-and-treatments/shingles/understanding-shingles-treatment}

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

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Shingles