Shingles: Things you need to know

Shingles is a viral infection caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox. This usually affects the ganglion of a single sensory nerve and the surface of the skin produced by the nerve.

Anyone who has had chickenpox can develop shingles later.

In addition, an estimated 1 in 3 people in the United States develop shingles during their lifetime, according to the Centers for Disease Control and Prevention (CDC).

But a person can only develop shingles if they have been exposed to chickenpox or the virus that causes it. For years, the virus can lie dormant.

Most adults with the inactive virus never develop shingles but the virus reactivates several times for others.

Shingles are most common after 50 years of age, but if a person has previously had chickenpox it may occur at any age.

Learn more about shingles in this post, including the signs, causes and treatments.

Symptoms

A lady with shingles on her face
Shingles results from the same virus that causes chicken pox.

Shingles usually reach one side of the body. Most often this is the waist, chest, belly or back. Symptoms can also appear on the face and in the eyes, mouth, and ears. Any internal organs can also get infected by the virus.

Shingles usually affect a single ganglion of the sensory nerve near the spinal cord, called the dorsal root ganglion. That is why the signs arise, rather than all over, in different parts of the body. The discomfort is the product of touching the nerves, rather than the rash itself.

Some people do, in truth, have pain but no rash. Others, however, may have a pain rash that comes with other symptoms, such as fever, chills, or headache.

Symptoms can vary in nature, depending on where on the body they appear.

Common symptoms

Some of the most common symptoms of shingles include:

  • a constant dull, burning, or gnawing pain, or a sharp, stabbing pain that comes and goes
  • a skin rash that resembles a chickenpox rash but only affects certain areas
  • fluid-filled blisters that develop as part of the rash

Symptoms on the body

A skin blistering rash can occur in one or more distinct bands of skin sensory nerves, called dermatomes.

Common locations for this include:

  • the chest
  • the abdomen
  • the back
  • around the waist

It usually occurs only on one side of the body.

The location of the symptoms will depend on which dermatome distribution the virus affects.

Facial symptoms

If the rash affects the face, symptoms usually appear on one side only — usually around one eye and the forehead.

They can include:

  • pain over the affected dermatome
  • a rash
  • muscle weakness
  • headache

Eye symptoms

If the virus affects an ophthalmic nerve it means a person has an ophthalmic herpes zoster.

This can cause discomfort, redness, swelling in and around the eye and temporary or permanent vision loss.

Ear symptoms

Shingles may also occur in or around the head, causing balance and hearing issues as well as muscle weakness on the affected side of the face.

Such improvements can be temporary or even long-term. A person who has symptoms in or around his or her ears and eyes should seek prompt medical care to minimize the risk of complications.

Mouth symptoms

If shingles affects the mouth, a person may experience:

  • facial tenderness
  • pain in the mouth
  • toothache
  • lesions in hard and soft palate tissues

The pain and discomfort of these symptoms can make it difficult to eat or drink.

Internal shingles

Shingles can affect internal organs, too. There won’t be a panic but there might be other issues.

Researchers have found signs of shingles in the digestive system, for example, which can contribute to gastrointestinal dysfunction, and in the brain arteries, which can increase the risk of stroke and dementia.

Other symptoms

There may also be other symptoms, including:

  • fever
  • fatigue
  • chills
  • headache
  • upset stomach

Symptom progression

Symptoms typically progress as follows:

  • Pain, tingling, numbness, and itching start to affect a specific part of the skin.
  • After up to 2 weeks, a rash appears.
  • Red blotches and itchy, fluid-filled blisters develop and continue to do so for 3-5 days.
  • The blisters may merge, forming a solid red band that looks similar to a severe burn. The gentlest touch may be painful.
  • Inflammation may affect the soft tissue under and around the rash.
  • After 7–10 days, the blisters gradually dry up and form scabs or crusts. As the blisters disappear, they may leave minor scarring.

Shingles usually last around 2–4 weeks. It is contagious until the blisters dry up and crust over.

Some people can only get an episode of shingles once, but in certain cases it can recur.

Pictures: What does shingles look like?

  • Nccmed-shingles-rash-caused-by-herpes
  • Nccmed-shingles-rash-on-person-s-shoulder.jpg
  • Nccmed-a-woman-with-shingles-on-her-face-image-credit-burntfingers-2015.jpg
  • Nccmed-shingles-on-a-persons-back-image-credit-yesyouisnot-2011
  • Nccmed-shingles-on-the-face

Complications

Rarely, complications can arise — especially in people with an impaired immune system.

Possible complications of shingles include:

  • postherpetic neuralgia (PHN)
  • inflammation of the brain or spinal cord, increasing the risk of stroke, encephalitis, and meningitis
  • eye and vision problems
  • weakness
  • problems with balance and hearing
  • damage to blood vessels, which could lead to stroke
  • pneumonia

According to the CDC, approximately 10–18 percent of people with shingles may experience PHN, a long-term complication in which a shingles rash’s discomfort lasts longer than the rash itself.

It is more likely to happen if a person develops shingles after 40 years of age, and the risk continues to increase with age.

In people with weak immune systems

People with a weakened immune system will have a higher risk of developing shingles and of experiencing severe symptoms and complications.

This include people who:

  • have cancer, especially leukemia or lymphoma
  • have HIV
  • have undergone an organ transplant
  • are taking medications to suppress the immune system, including chemotherapy drugs

Such individuals will seek medical attention as soon as possible if they have questions about symptoms associated with shingles.

Is shingles contagious?

Shingles can not be transmitted directly to another person. A person who has never had chickenpox, however, may contract VZV by coming into direct contact with the fluid in a person’s blisters that currently has shingles.

If this occurs and the individual has not received vaccination against chickenpox, they will first develop chickenpox and not shingles.

Shingles may not spread by coughing or by sneezing. The virus can only spread by direct contact with fluid from the blisters. Covering the blisters thus decreases the possibility of contagion.

Remember that the virus is only active when the blisters first appear until they warm up and crust over. There’s no transmission before the blisters grow and after the crusts form. In the conventional sense, if a person does not develop blisters, the virus can not spread.

Taking the following measures will help prevent the virus from spreading:

  • Cover the rash.
  • Wash the hands often.
  • Avoid touching or scratching the rash.

It is also important to avoid contact with:

  • infants who are preterm or have a low birth weight
  • pregnant women who have never had chickenpox or the vaccine for it
  • those with a weakened immune system

Treatment

A doctor may prescribe antiviral drugs to stop the virus from multiplying.

Antiviral treatment

Antiviral treatment can help:

  • reduce the severity and duration of symptoms
  • prevent complications from developing
  • lower the risk of the rash coming back

Managing symptoms

Tips for managing symptoms include:

  • using pain relief medication
  • reducing stress as much as possible
  • eating regular, nutritious meals
  • getting some gentle exercise
  • wearing loose fitting clothes, for comfort

To relieve itching, the CDC recommend:

  • applying calamine lotion
  • taking a lukewarm, oatmeal bath
  • placing a cool, damp washcloth on the blisters

Most people should recover with treatment at home, but if other symptoms occur, such as fever, a person should seek medical assistance. Due to injuries, about 1–4 percent of people would continue to spend time in hospital.

Vaccine

Undergoing vaccination can offer protection from both chickenpox and shingles.

For children: Chickenpox vaccine

Experts suggest daily vaccination in childhood with the varicella vaccine (chickenpox vaccine).

With two doses of the vaccine, chances of avoiding chickenpox are at least 90 per cent. Preventing varicose veins also avoids shingles.

The first dose for children will be administered at 12–15 months. The latter dosage is 4–6 years.

Tests have shown that the vaccine is safe while some kids can experience:

  • pain at the injection site
  • a fever and a mild rash
  • temporary joint pain and stiffness

Since vaccination started in children, the number of shingles cases has dropped.

For older adults: Shingles vaccine

Another vaccine, the herpes zoster vaccine, is available for people aged 50 years and over who have had chickenpox and are still carrying VZV. Doctors also recommend this vaccine to those who did not have chickenpox or shingles.

In the US, this virus still occurs in 99.5 percent of people born before 1980. The herpes zoster vaccine in people who already have it may help prevent shingles.

Zostavax and a newer vaccine called Shingrix are the choices available.

After two doses of Shingrix, according to the CDC, a individual will have more than 90 percent shingle safety, dropping to just over 85 per cent after four years.

Who should not have the vaccine?

People who shouldn’t have the shingles vaccine without talking to their doctor about it first include those who:

  • have an allergy to any component of the shingles vaccine
  • have a weakened immune system
  • are or might be pregnant

Causes

Shingles is the product of VZV, the same virus that causes chickenpox. The virus persists inside the body after recovery from chickenpox. It resides dormanently in the peripheral nervous system’s dorsal root ganglion.

VZV is part of a community of viruses called herpes viruses. For this reason shingles also have the name “herpes zoster.”

All herpes viruses can hide in the nervous system, where they can live in a latent state forever.

The herpes zoster virus will “reactivate” under the right circumstances, similar to waking up from hibernation, and move down the nerve fibers to cause a new active infection.

It’s typically not clear what causes this, but it can happen when anything weakens the immune system, causing the virus to reactivate.

Risk factors and triggers

Possible risk factors and triggers include:

  • older age
  • certain cancers or cancer treatment options
  • HIV
  • treatments that suppress the immune system
  • stress or trauma

Outlook

Whoever has had chickenpox can develop shingles.

Most people get a complete recovery from shingles within 3–5 weeks, but some experience severe complications. Those with compromised immune systems are the ones most at risk.

Chickenpox and shingles can be prevented from getting varicella vaccination during childhood. Certain inoculations are available for those who didn’t have the vaccination during childhood.

People aged 50 and over will talk about vaccination with their doctor.

Q:

Is it possible to have the virus without ever having symptoms of chickenpox?

A:

The virus that causes chickenpox and shingles spreads as a result of exposure to the infected fluid in the blisters that develop as a symptom of these conditions.

Those who receive the live vaccination for chickenpox will receive an injection of a weaker form of the virus. This should cause the body to make antibodies that can fight against the virus. Because of this, 90% of those who have the vaccination will not get chickenpox.

If a person comes into contact with blister fluid from someone with chickenpox or shingles, if they were vaccinated and have formed immunity against the virus, they should not develop chickenpox symptoms. Nor should they be able to catch any infection that they can spread to others, even if they have exposure to the virus when someone near them has chickenpox or shingles. Stacy Sampson, DO

Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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