Herpes zoster, more commonly known as shingles, is a painful viral infection caused by varicella zoster, the same virus that causes chickenpox. After a childhood attack of chickenpox, the virus lies dormant in the nerve cells that extend from the spinal cord or the brain. Years to decades later, the virus can be reactivated, resulting in an eruption of skin lesions. (Therefore, you cannot develop shingles unless you have had an earlier case of chickenpox.) The blistery rash characteristic of shingles follows a line on one side of the body or face in an area supplied by a particular nerve.
Symptoms of shingles
• Burning pain, tingling, and extreme sensitivity in one area of skin; the pain may precede the skin lesion by one or two days.
• Mild chills and fever, malaise, headache.
• A rash of small fluid-filled, bubble-like blisters that breaks out on reddened skin. The rash forms along a band, most commonly on the torso and buttocks, but also on the arms, legs, and face. In nearly all cases the rash occurs only on one side of the body. Within about 10 days, the blisters form scabs but the pain may persist much longer.
Who is at risk for shingles?
About 30 percent of the U.S. population will experience shingles in their lifetime. While young people do develop shingles, the ailment most often occurs after age 50, with the incidence increasing with age. Most cases of shingles occur in people who are in otherwise good health, but the chance of developing shingles is greatest for people whose immune system is weakened—for example, people infected with the HIV virus or cancer patients undergoing drug or radiation treatment.
You cannot “catch” shingles from someone who has it. The virus can be transmitted to others, but only to someone who has never had chickenpox—in which case the person may develop chickenpox, not shingles. If you have shingles, you should avoid contact with small children, pregnant women, and any adults who have never had chickenpox. (In the United States, 95 percent of adults have had the disease or have been immunized against chickenpox; those who have not should be immunized, since many adults with chickenpox have more complications than children.)
For most healthy people, the lesions of shingles heal and pain diminishes within three to five weeks. However, some shingles sufferers—including as many as 50 percent of the sufferers over age 50, according to some estimates—will have debilitating pain that persists for more than one month (sometimes for many months) after lesions have healed. This pain, called post-herpetic neuralgia, or PHN, is from nerve cell damage caused by the viral infection. Shingles may also slightly increase the risk for a heart attack, stroke and mini-strokes or transient ischemic attacks (TIAs). The prognosis for shingles is problematic if the virus spreads to the brain or eyes.
What causes shingles?
No one is certain what triggers an attack of shingles,. Physical trauma (which could be anything from a wound to a fracture) may be a risk factor, especially for shingles affecting the head. Other risk factors include cancer, chronic kidney disease, and immune disorders. Researchers believe that the virus is reactivated when the immune system is unable to keep the virus in a dormant state. This is probably why older people are more likely to get the infection. Stress and illness may also weaken the immune system, as does the use of immunosuppressant drugs. The immune system factor may also explain why people with HIV infection or AIDS, Hodgkin’s disease, and other cancers—whose immune systems are suppressed due to illness or treatment for illness—are at increased risk of developing shingles.
What if you do nothing?
In most cases shingles is self-limited—the body’s immune system is ordinarily able to fight off the infection. The pain can be severe, though, and many people need medication for pain relief. Early treatment with antiviral drugs can also be important in resolving the infection sooner.
Medical intervention is critical, however, for people with damaged or suppressed immune systems. Not only are they vulnerable to shingles, but there is a danger that the disease will spread and reach vital organs like the lungs, with potentially fatal results.
Home remedies for shingles
Shingles can’t be cured, so home remedies are aimed at relieving discomfort.
• Relieve the pain. For minor discomfort, take over-the-counter (OTC) NSAIDs (aspirin, ibuprofen, or naproxen) or acetaminophen. For severe pain, your doctor can prescribe stronger medication.
• Cool it. Apply cool, wet compresses or ice packs to reduce pain. Calamine lotion may also feel soothing if applied after removing the compresses.
• Relieve the itch. Soak in a bath to which you’ve added colloidal oatmeal. You could also try Domeboro, an OTC astringent in powder form that is dissolved in water to make a wet compress that may provide relief for pain and itching. The compress should be applied every 30 to 60 minutes, four to six times a day.
• Try deep heat. Capsaicin cream, an extract made of hot peppers, has been used in pain clinics to reduce the pain of PHN victims by interrupting the transmission of pain impulses to the brain. This OTC remedy is sold for treating muscular aches and pains; consult your physician before using it. Be sure not to apply it until the lesions caused by your shingles have completely healed.
• Don’t scratch. Although it is hard to resist scratching, you increase the risk that the blisters will become infected from dirt on your fingernails.
• Clean regularly. Use mild soap and water to keep the rash area clean. This will help prevent any bacterial infections from developing.
How to prevent shingles
To be on the safe side, if you’ve never had chickenpox, it’s best to avoid contact with the active rash of anyone with shingles or chickenpox.
When to call your doctor
Contact your physician as soon as you develop symptoms of shingles—and particularly if you have any illness that compromises your immune system. The available antiviral drugs are well-tolerated and effective. The earlier the symptoms are treated, the less severe the ailment may be. Be sure to contact your physician immediately if you develop shingles on your nose or forehead—this signals possible eye involvement—or if you experience any eye pain. Eye damage from shingles can lead to blindness.
What your doctor will do
After a close examination to confirm shingles, your physician may prescribe the antiviral medication acyclovir (Zovirax), or similar agents such as famciclovir (Famvir) and valacyclovir (Valtrex), to minimize the pain of shingles, speed healing, and help prevent any complications. To be most effective, they should be prescribed within three days of the beginning of symptoms.
Other medications, including certain antidepressants, are sometimes effective for relieving PHN, and some alternative treatments for chronic pain, such as acupuncture, may also help people cope.
For more information
Also see Shingles Vaccine: Two More Benefits.
Originally published December 2016. Updated December 2017.