Shingles (Herpes Zoster)

Shingles (herpes zoster) is a painful rash caused by the same virus behind chickenpox. The virus is not fully cleared from the body and remains inactive. After a latency period, it reactivates and shingles occur. The virus moves along nerve fibers and affects the skin, resulting in a rash.
Shown is a magnified, colorized view of varicella-zoster viruses.

Pain, itching, tingling, burning -- these are all symptoms of shingles that may occur before the outbreak of the rash. It starts as small blisters on a red base, with new blisters continuing to form for three to five days. It typically appears on one side of the body or face. Other symptoms may include fever, chills, fatigue, and headache. If you think you have shingles, see a doctor as soon as possible.

What Causes Shingles?

After you've had chickenpox, the virus lives in your nervous system, "sleeping" in the nerve roots. In some people, it remains asleep (dormant) forever. In others, the virus may "wake up," reproduce, and travel along nerve fibers to the skin's surface. The result: shingles.

Who's at Risk for Shingles?

Anyone who has had chickenpox is at risk of developing shingles, although the most important risk factor for developing shingles is age. Shingles occurs most commonly in people over the age of 60. People with weakened immune systems from certain health conditions or medications are also at greater risk for shingles. There are an estimated 1 million cases of shingles each year in the U.S.

How Long Does Shingles Last?

The cluster of blisters that forms with shingles fill with fluid, pop, then start to ooze. Eventually the affected areas crust over and heal like the rash shown here. In most people the lesions crust by 7-10 days. Once all of the blisters are crusted over, the person is no longer contagious.

Is Shingles Contagious?

The virus that causes shingles is contagious. The virus can spread to anyone who hasn't had chickenpox through direct contact with the rash that has not crusted. Instead of developing shingles, the newly infected person develops chickenpox. Once they've had chickenpox, they have the potential to develop shingles later in life.

What are Complications from Shingles?

Generally, shingles heals well, resulting in few problems. Occasionally blisters can become infected, requiring treatment with antibiotics. The most common complication of shingles is postherpetic neuralgia, where damaged nerves cause persistent pain even after the rash is gone. A more worrisome complication is when shingles affects the forehead and nose, which may spread to the eye and lead to loss of vision.

How is Shingles Treated?

There is no cure for shingles, but treatment may help you get well sooner and prevent problems. Cool compresses and anti-itching lotions like calamine may provide relief, as will bathing the affected area and cleaning with soap and water. Steroids, antiviral medicines, and pain medicines can also help ease recovery. Most people with intact immune systems recover completely from shingles although recurrences are possible.

Is There a Shingles Vaccine?

In 2006, the FDA approved the first vaccine to prevent shingles in adults. Recommended for adults 50 years and older who've already had chickenpox, the vaccine, Zostavax, is given as one shot and is not the same as the vaccine to prevent chickenpox. The vaccine reduces the risk of shingles by 50%, and reduces the incidence of postherpetic neuralgia by two-thirds. The vaccine does not treat shingles that has already developed.