Shingles

What is shingles?

Shingles (herpes zoster) is a viral infection that causes an outbreak of a painful rash or blisters on the skin. It's caused by the varicella-zoster virus, which is the same virus that causes chickenpox. The rash most often appears as a band of rashes or blisters in one area of your body.

Where does shingles come from?

When you have chickenpox as a child, your body fights off the varicella-zoster virus and the physical signs of chickenpox fade away, but the virus always remains in your body. In adulthood, sometimes the virus becomes active again. This time, the varicella-zoster virus makes its second appearance in the form of shingles.

How common is shingles?

About 1 million cases of shingles are diagnosed every year in the U.S. The risk of shingles increases as you get older, with about half the cases occurring in people over the age of 50. Shingles develops in about 10% of people who have had chickenpox at an earlier time in their lives.

Who is at risk for getting shingles?

People who have had chickenpox who are more likely to develop shingles include those:

• With a weakened immune system (such as people with cancer, HIV, organ transplant recipients or those receiving chemotherapy).
• Over the age of 50.
• Who have been ill.
• Who have experienced trauma.
• Who are under stress.

The chickenpox virus doesn’t leave your body after you have chickenpox. Instead, the virus stays in a portion of your spinal nerve root called the dorsal root ganglion. For the majority of people, the virus stays there quietly and doesn't cause problems. Researchers aren't always sure why the virus gets reactivated, but this typically occurs at times of stress.

Can you get shingles more than once?

Yes, you can get shingles more than one time. One of the biggest myths about shingles is that it can only happen once. This isn’t true. You can have more than one episode. If you get shingles again, you usually don’t get the rash in the same place.

What causes shingles?

Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox.

What are the symptoms of shingles?

Early symptoms of shingles may include:

• Fever.
• Chills.
• Headache.
• Feeling tired.
• Sensitivity to light.
• Stomach upset.

Other signs and symptoms that appear a few days after the early symptoms include:

• An itching, tingling or burning feeling in an area of your skin.
• Redness on your skin in the affected area.
• Raised rash in a small area of your skin.
• Fluid-filled blisters that break open then scab over.
• Mild to severe pain in the area of skin affected.

How long does a shingles outbreak last?

It can take three to five weeks from the time you begin to feel symptoms until the rash totally disappears.

1. First, a few days before the rash appears, you may feel pain in an area on your skin. The pain is described as itching, burning, stabbing or shooting. This usually happens before the rash comes.
2. Next, the raised rash appears as a band or a patch, usually on one side of your body. The rash usually appears around your waistline or on one side of your face, neck, or on the trunk (chest/abdomen/back), but not always. It can occur in other areas including your arms and legs.
3. Within three to four days, the rash develops into red, fluid-filled, painful, open blisters.
4. Usually, these blisters begin to dry out and crust over within about 10 days.
5. The scabs clear up about two to three weeks later.

Do you always get the typical rash if you have shingles?

Occasionally, some people don’t get a rash. If you have any of the other symptoms of shingles (even without a rash), see your healthcare provider sooner rather than later. There are effective treatments you can take early for shingles. Even if you don’t have shingles, seeing your healthcare provider will help you get your condition diagnosed and treated.

Why does shingles appear mostly on one side or in one area of your body?

The virus travels in specific nerves, so you will often see shingles occur in a band on one side of your body. This band corresponds to the area where the nerve transmits signals. The shingles rash stays somewhat localized to an area. It doesn’t spread over your whole body. Your torso is a common area, as is your face.

Is shingles contagious?

Someone with shingles can’t spread shingles to another person, but they can spread chickenpox. The varicella-zoster virus is spread through direct skin-to-skin contact with the fluid that oozes from the blisters. Shingles is rarely spread by breathing in the varicella-zoster virus the way airborne viruses are spread. If your rash is in the blister phase, stay away from those who haven’t had chickenpox or the chickenpox vaccine and keep your rash covered.

How long are you contagious if you have shingles?

If you have shingles, you’re contagious until the rash is dried and crusted over. The varicella-zoster virus can only cause chickenpox in someone who has never had chickenpox or hasn’t been vaccinated against chickenpox.

How is shingles diagnosed?

Shingles can be diagnosed by the way the rash is distributed on your body. The blisters of a shingles rash usually appear in a band on one side of your body. Shingles also may be diagnosed in a laboratory using scrapings or a swab of the fluid from the blisters.

How is shingles treated?

There is no cure for shingles but there are treatments for managing the symptoms.

Antiviral medications

These drugs may ease the discomfort and make the symptoms stop sooner, particularly if you start them within 72 hours of the first sign of shingles. They may also help prevent the pain that can happen months and years later, called postherpetic neuralgia. These medications include:

• Acyclovir (Zovirax®).
• Famciclovir (Famvir®).
• Valacyclovir (Valtrex®).

Over-the-counter pain medications

These medications include the following and may be effective in relieving pain:

• Acetaminophen (Tylenol®).
• Ibuprofen (Motrin®, Advil®).

Other medications

Antibacterial drugs may be prescribed if you develop a bacterial infection due to the shingles rash. Anti-inflammatory drugs like prednisone may be prescribed if shingles affects your eyes or other parts of your face.

If you have more than one area of blisters, what can you expect if you go to the hospital?

It’s important to note that most people with shingles don’t need to be in a hospital, but if you do:

• You’ll be in a contact isolation room.
• The door will be kept closed.
• A sign on your door will remind people who have never had chickenpox or the vaccine not to enter.
• The sign will also remind staff to wear gowns and gloves when entering the room.

If you have shingles in only one area of your body that can’t be kept covered, what can you expect for your hospital stay?

• You will be in a contact isolation room.
• The sign on the door will remind staff to wear gowns and gloves when entering the room.

What are the complications of shingles?

After the shingles rash has disappeared, you might continue to have nerve pain in that same area. Postherpetic neuralgia can last for months or years and become quite severe.

More than 10% of people who get shingles develop postherpetic neuralgia. Researchers don’t know why some people get postherpetic neuralgia and others don’t. It may be that nerves become more sensitive or that the virus may be invading and damaging the central nervous system.

Other complications include:

• Other types of nerve issues like numbness or itching.
• A bacterial infection of the shingles rash.
• Eye and ear inflammation if the rash is near these organs.

How is postherpetic neuralgia treated?

Treatments include lotions or creams (such as lidocaine or capsaicin) and/or other medications not specifically used for pain, such as antidepressants or drugs for epilepsy. Regular pain relievers are not usually effective for this type of pain.

If your pain doesn’t lessen, you might try therapies like nerve blocks or steroid injections near the area where the nerves exit the spine. Your provider might suggest an implantable nerve stimulator device for severe, ongoing pain that hasn’t responded to other treatments.

Is a vaccine available to prevent shingles?

Two vaccines are available in the United States to reduce your chance of developing shingles and postherpetic neuralgia. One vaccine, Zostavax®, has been available since 2006. The second vaccine, Shingrix®, has been available since 2017. Shingrix is recommended as the preferred vaccine by the Advisory Committee on Immunization Practices, a group of medical and public health experts.

Shingrix (recombinant zoster vaccine) is given as a two-dose shot in your upper arm. You should receive the second dose (shot) two to six months after receiving the first. Shingrix has been shown to be more than 90% effective in preventing shingles and postherpetic neuralgia. Its effectiveness remains above 85% for at least four years after receiving the vaccine.

Who should be vaccinated with Shingrix?

The Shingrix vaccine is recommended for those 50 years of age and older who are in good health.

You should get the Shingrix vaccine even if:

• You’ve had shingles already.
• You’ve been previously vaccinated with Zostavax (a live zoster vaccine). If you’ve been vaccinated with Zostavax, wait at least eight weeks before getting vaccinated with Shingrix.
• You don’t know for sure if you’ve ever had chickenpox.

Ask your healthcare provider, who knows your entire health history if getting this vaccine is right for you.

Who should not be vaccinated with Shingrix?

You shouldn’t receive the Shingrix vaccine if you:

• Have ever had a severe allergy to this vaccine or any ingredient in this vaccine.
• Are breastfeeding (chestfeeding) or pregnant.
• Currently have shingles.
• Are ill and have a high fever.
• Have tested negative for immunity to varicella-zoster virus (get the chickenpox vaccine instead).

Ask your healthcare provider if the benefits of getting the vaccine outweigh any potential risks.

What serious side effects should you watch for after getting the Shingrix vaccine?

Serious side effects from vaccines are extremely rare. However, call 911 or go to the nearest emergency room right away if you experience any of the following within minutes to hours after receiving Shingrix:

• Swelling of your face or throat.
• Difficulty breathing.
• Hives.
• Fast heartbeat.
• Dizziness, lightheadedness, weakness.

If you’ve had shingles recently, how long should you wait before getting the Shingrix vaccine?

You can get the Shingrix vaccine any time after the shingles rash has gone away.

Is the Zostavax vaccine still being used?

Yes. The CDC, however, recommends Zostavax for adults age 60 and older, but not routinely for people aged 50 to 59. Zostavax is given as a single-dose shot versus the two-dose shot for Shingrix. Zostavax is less effective than Shingrix in preventing shingles (51% vs more than 90%) and postherpetic neuralgia (67% vs more than 90%).

You can consider Zostavax if you are allergic to Shingrix or if Shingrix is unavailable because of supply shortage and you want some immediate protection from a possible case of shingles and/or postherpetic neuralgia. Because it’s a weakened live vaccine, it may be dangerous if you have cancer, HIV, or take steroids, chemotherapy or other medications that suppress your immune system. Ask your healthcare provider if the Zostavax vaccine is an option for you.

Do you need to stay away from children, people who are pregnant, have cancer or anyone with a weak immune system after you get the Zostavax vaccine?

According to the CDC, it’s safe to be around babies and young children, pregnant women or anyone with a weakened immune system after you get the Zostavax vaccine. Even though the Zostavax vaccine contains a weakened live varicella-zoster virus, the CDC says there’s no documented case of a person getting chickenpox from someone who has received the Zostavax vaccine. And remember: You can’t get shingles unless you’ve already had chickenpox.

If you have previously received the Zostavax vaccine, how long should you wait before getting the Shingrix vaccine?

If you’ve previously received the Zostavax vaccine, the CDC recommends waiting at least eight weeks before getting the Shingrix vaccine.

If you get the shingles vaccine, does this mean you’re 100% protected from getting shingles?

No. Just like most vaccines, getting vaccinated with a shingles vaccine doesn’t provide 100% protection from disease. However, getting the shingles vaccine reduces your risk of developing shingles.

Even if you do develop shingles, you’ll be more likely to have a mild case. Also, you’ll be much less likely to develop postherpetic neuralgia, a painful condition that can follow a shingles outbreak.

If you have a medical condition that suppresses your immune system, should you get the shingles vaccine?

Having a weakened immune system can increase the likelihood of getting shingles, so that’s even more of a reason to get the shingles vaccine. However, you must get the Shingrix vaccine, which is not made from a live virus. (The older — and still available — vaccine, Zostavax, is made from a weakened live virus and shouldn’t be given to people with weakened immune systems.)

What should you expect if you get shingles?

Shingles can be a very painful condition. If you think you have the symptoms of shingles, see your healthcare provider right away. Starting antiviral medications early can ease your discomfort and end symptoms earlier.

A better approach to shingles is to take action and do what you can to lessen your risk of getting it. If you've never had shingles in the past, talk to your healthcare provider about getting the shingles vaccine. If you’ve never had chickenpox, talk with your healthcare provider about getting the chickenpox vaccine.

Is shingles dangerous or even fatal?

If shingles involves your eye, it can lead to blindness. In rare cases, shingles can lead to hearing problems, pneumonia, inflammation of the brain (encephalitis) and even death.

When is it safe to return to work if you have shingles?

You can return to work when you feel well enough to return and you’re no longer contagious. This means that your blistered rash has dried up and scabbed over. This usually takes up to 10 days from the time the rash first appears.

Why doesn’t having chickenpox earlier in life provide immunity against having shingles later?

After having chickenpox, your body doesn’t rid your system of the virus. Instead, the virus stays in a portion of the spinal nerve root called the dorsal root ganglion. In most people, the virus simply stays there quietly and doesn’t cause problems. Scientists aren’t always sure why the virus gets active again, but they know stress can be a cause.

Can you still develop shingles if you’ve been vaccinated for chickenpox?

Yes. Despite being vaccinated for chickenpox, you can still get shingles. No vaccine is 100% protective, and the effectiveness of vaccines lessens with time. However, people who get the chickenpox vaccine are significantly less likely to develop shingles later in life compared with people who never received the chickenpox vaccine. One recent 12-year study found that the number of shingles cases was 72% lower in children who had received the chickenpox vaccine compared with those who didn’t.

Can you get shingles if you haven’t had chickenpox?

No. You can’t get shingles if you’ve never had chickenpox, but you can get chickenpox from someone who has shingles. If you’ve never had chickenpox and you come into direct contact with the oozing, blister-like rash of someone with shingles, the varicella-zoster virus can infect you and you would develop chickenpox.

Once you’ve had chickenpox, you could develop shingles at some point in your life. This is because the varicella-zoster virus never fully goes away after you’ve had chickenpox. It lies quietly “inactive” in your nerve tissue. Later in life, the virus may become active again and appears as shingles.

Can you get chickenpox more than once?

It’s rare to get chickenpox twice in your life. Once you’ve had chickenpox, you’re usually immune to it for the rest of your life. However, it’s not totally impossible. If you have a severely weakened immune system (because you’ve had an organ transplant, HIV or cancer, for example), you can get chickenpox a second time. If you’ve had chickenpox, you are more likely to get shingles at some point in your life than a repeat bout of chickenpox.

Are there natural ways to boost your immune system to help lessen the chances of developing shingles?

Stress is a risk factor for developing shingles, so limiting your stress can be helpful. Try meditation, yoga or other relaxation methods.

Other things you can do include:

• Eat a healthy diet.
• Maintain a healthy weight.
• Exercise regularly.
• Aim for seven to nine hours of sleep each night.
• Don’t smoke or use tobacco products.

These are all tips for an overall healthy lifestyle, not just for reducing your chance of getting shingles.

What is the difference between herpes zoster and varicella-zoster?

Herpes zoster is simply another medical name for shingles. Varicella-zoster is the virus that causes both shingles and chickenpox.

Are measles and shingles related since they both produce a rash?

Although both diseases produce a rash, measles and shingles are completely different and unrelated diseases. Shingles is caused by the varicella-zoster virus and measles is caused by the rubeola virus.

Can you get shingles from the COVID-19 vaccine?

There have been a few reports of shingles happening in people who were vaccinated against COVID-19. The varicella-zoster virus was reactivated in these people.

A note from Cleveland Clinic

If you’ve had chickenpox, you’re at risk of developing shingles later in life. Shingles causes a rash that is contagious and painful. The disease can have serious complications. The best thing you can do to reduce your risk is to get the shingles vaccine. The vaccines are safe and effective.