Table of ContentsView AllTable of ContentsCausesRisk FactorsSymptomsPreventionFrequently Asked QuestionsNext in Shingles GuideHow Shingles Is Diagnosed
Table of ContentsView All
View All
Table of Contents
Causes
Risk Factors
Symptoms
Prevention
Frequently Asked Questions
Next in Shingles Guide
Shinglesoccurs when thevaricella-zoster virus (VZV), the same virus that causes chickenpox, reactivates. Why the virus re-emerges isn’t entirely understood, but there are theories.
Shingles is most common in older people, but anyone with the varicella-zoster virus is at risk. In fact, reduced immunity is considered the biggest risk factor for shingles. Stress could alsoplay a rolefor some people.
© Verywell, 2018
Shingles is an especially unpleasant illness. It causes a painful and unsightly skin rash, as well as potential long-term complications, the most common one being a condition known as postherpetic neuralgia (PHN).
Shingles Causes
After recovering from chickenpox, the symptoms disappear, but VZV retreats to cells in the nervous system, where it can remain for decades without causing problems.
It’s not entirely understood what prompts VZV to reactivate and cause shingles. The virus is a member of the same family of microbes that causeherpes infections, such as genital herpes and cold sores, which also tend to come and go. So, it’s not surprising that VZV would behave similarly.
The big difference is that while herpes infections can recur multiple times, most people only experience shingles once (although it can come back).
The viral reactivation seems to have two main causes: a weakened immune system and stress.
Weakened Immune System
There is a clear association between shingles andweakened immunityto infection.Even though VZV is not invading the body for the first time, the immune system still is responsible for keeping it at bay.
People with weakened immune systems are at higher risk of getting shingles. Your immune system naturally weakens with age, which is why the risk of shingles increases with age. The majority of people who develop shingles are 50 years and older.
Stress
There’s some controversy surrounding the association between stress and shingles. Some studies reveal that stress causes the shingles virus to reactivate. Specifically, research shows that long-term stress increases inflammation and weakens the immune system.
Because stress weakens the immune system, and a weakened immune system is a risk factor for shingles, some experts believe that stress indirectly triggers shingles. A 2018 study found that perceived mental stress, negative life events, and a low sense of purpose may contribute to the development of shingles.
Some researchers find no link between the two conditions.
More research needs to be done to understand the connection (or lack thereof) between shingles and stress.
Shingles Risk Factors
Since compromised immunity is the most common trigger for a latent varicella virus to become active, any factor associated with a weakened immune system can increase the risk of shingles. Important risk factors for shingles include:
Note that many of these risk factors are as likely to apply to young people and children as they are to older people. So, even though shingles often is regarded as an illness of advancing age,this isn’t always the case.
Virus Reactivation and Symptoms
When the virus re-emerges, it typically reactivates in clusters of nerve cells in the peripheral nervous system called a sensory ganglion. The ganglia most likely to host varicella are those in the cervical, thoracic, and lumbar spine.
Varicella also often affects the trigeminal ganglion, which provides sensation to the face. As its name suggests, this particular clump of nerves has three branches. The one associated with eye function, the ophthalmic branch, is 20 times more likely than the other two to be affected.
Since the nervous system consists of tree-like branches of nerves, the blisters will follow the particular path of the nerves affected. That’s why a shingles rash often resembles a swath of blisters in a very specific area, rather than spread all over the body (as in chickenpox).
The area with the particular nerve cells in which the virus reawakens is where the shingles symptoms—extreme pain and rash—will be concentrated.
This photo contains content that some people may find graphic or disturbing.See PhotoDermNet /CC BY-NC-ND
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
DermNet /CC BY-NC-ND
Along with the rash, symptoms of shingles may include:
For several days before the rash appears, you may have tingling, itching, or pain in the affected area.
When to See a Healthcare ProviderIf you suspect shinglesWithin 3 days of getting the rash, to prevent lasting nerve painIf the rash and pain are near an eye, which can cause permanent eye damageIf you’re over age 60 due to an increased risk of complicationsIf you have a weakened or suppressed immune system or someone close to you does
When to See a Healthcare Provider
If you suspect shinglesWithin 3 days of getting the rash, to prevent lasting nerve painIf the rash and pain are near an eye, which can cause permanent eye damageIf you’re over age 60 due to an increased risk of complicationsIf you have a weakened or suppressed immune system or someone close to you does
Shingles Doctor Discussion GuideGet our printable guide for your next doctor’s appointment to help you ask the right questions.Download PDFEmail AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
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Shingles is best prevented with a vaccine. Called Shingrix, this vaccine is considered safe and 90% effective at preventing the disease. It’s given in two doses and is available in medical offices and some pharmacies.
You should get the shingles vaccine if:
Don’t Get the Shingles Vaccine If:You currently have shinglesYou’re sick or have a feverYou had an allergic reaction to a previous dose of this vaccine
Don’t Get the Shingles Vaccine If:
You currently have shinglesYou’re sick or have a feverYou had an allergic reaction to a previous dose of this vaccine
Avoidance is an important part of prevention, too. If you haven’t had chickenpox or a chickenpox vaccine:
How to Prevent Shingles
Learn MoreIs Shingles Contagious?
Noyou can’t get shingles if you’ve never had chickenpox.If you’ve had the chickenpox/varicella vaccine, you’re also protected from getting shingles.
The first sign is often itching, tingling, or pain in a confined area. The rash may appear there after a few days.
While it’s rare to get them more than once, it’s possible to come down with shingles multiple times. That’s why the vaccine is recommended even for people who’ve had shingles before.
How Shingles Is Diagnosed
21 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Shingles.Shrestha M, Chen A.Modalities in managing postherpetic neuralgia.Korean J Pain. 2018;31(4):235–243. doi:10.3344/kjp.2018.31.4.235Gilden D, Nagel M, Cohrs R, Mahalingam R, Baird N.Varicella zoster virus in the nervous system.F1000Res. 2015;4:F1000 Faculty Rev-1356. doi:10.12688/f1000research.7153.1Bakacs T, Sandig V, Kovesdi I.Combination therapy for the treatment of shingles with an immunostimulatory vaccine virus and acyclovir.Pharmaceuticals (Basel). 2023;16(2):226. doi:10.3390/ph16020226Perry M.Shingles in adults: what the practice nurse needs to know.Practice Nursing. 2022;33(2):54-57. doi:10.12968/pnur.2022.33.2.54Morey JN, Boggero IA, Scott AB, Segerstrom SC.Current directions in stress and human immune function.Curr Opin Psychol. 2015;5:13-17. doi:10.1016/j.copsyc.2015.03.007Takao Y, Okuno Y, Mori Y, Asada H, Yamanishi K, Iso H.Associations of perceived mental stress, sense of purpose in life, and negative life events with the risk of incident herpes zoster and postherpetic neuralgia: The SHEZ study.Am J Epidemiol. 2018;187(2):251-259. doi:10.1093/aje/kwx249Harpaz R, Leung JW, Brown CJ, Zhou FJ.Psychological stress as a trigger for herpes zoster: might the conventional wisdom be wrong?Clin Infect Dis. 2015;60(5):781-785. doi:10.1093/cid/ciu889Kawai K, Yawn BP.Risk factors for herpes zoster: a systematic review and meta-analysis.Open Forum Infect Dis. 2017;4(Suppl 1):S313–S314. doi:10.1093/ofid/ofx163.733Schwarz TF, Volpe S, Catteau G, et al.Persistence of immune response to an adjuvanted varicella-zoster virus subunit vaccine for up to year nine in older adults.Hum Vaccin Immunother. 2018;14(6):1370-1377. doi:10.1080/21645515.2018.1442162National Institutes of Health, Office of AIDS Research.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV.Hansson E, Forbes HJ, Langan SM, Smeeth L, Bhaskaran K.Herpes zoster risk after 21 specific cancers: population-based case-control study.Br J Cancer. 2017;116(12):1643–1651. doi:10.1038/bjc.2017.124Pavlopoulou ID, Poulopoulou S, Melexopoulou C, Papazaharia I, Zavos G, Boletis IN.Incidence and risk factors of herpes zoster among adult renal transplant recipients receiving universal antiviral prophylaxis.BMC Infect Dis. 2015;15:285. doi:10.1186/s12879-015-1038-1Ghabriel MN, Ghabriel MN.The neuroanatomical basis of unfamiliar presentations of herpes zoster: a review and a case report.Clin Med Rev Case Rep.10:421. doi:10.23937/2378-3656/1410421Sampathkumar P, Drage LA, Martin DP.Herpes zoster (shingles) and postherpetic neuralgia.Mayo Clin Proc. 2009;84(3):274–280. doi:10.1016/S0025-6196(11)61146-4Centers for Disease Control and Prevention.Shingles symptoms and complications.American Academy of Dermatology Association.Shingles: diagnosis and treatment.National Institutes of Health, National Institute on Aging.Shingles.Cleveland Clinic.Shingles.Centers for Disease Control and Prevention.Shingles (herpes zoster.Centers for Disease Control and Prevention.Shingles vaccination.Additional ReadingBlank LJ, Polydefkis MJ, Moore RD, Gebo KA.Herpes zoster among persons living with HIV in the current antiretroviral therapy era.J Acquir Immune Defic Syndr. 2012;61(2):203-207. doi:10.1097/QAI.0b013e318266cd3cEshleman E, Shahzad A, Cohrs RJ.Varicella zoster virus latency.Future Virol. 2011;6(3):341-355. doi:10.2217/fvl.10.90Irwin MR, Olmstead R, Oxman MN.Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of Tai Chi.J Am Geriatr Soc. 2007;55(4):511-517. doi:10.1111/j.1532-5415.2007.01109.xKe CC, Lai HC, Lin CH, et al.Increased risk of herpes zoster in diabetic patients comorbid with coronary artery disease and microvascular disorders: A population-based study in Taiwan.PLoS One. 2016;11(1):e0146750. Published 2016 Jan 11. doi:10.1371/journal.pone.0146750
21 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Shingles.Shrestha M, Chen A.Modalities in managing postherpetic neuralgia.Korean J Pain. 2018;31(4):235–243. doi:10.3344/kjp.2018.31.4.235Gilden D, Nagel M, Cohrs R, Mahalingam R, Baird N.Varicella zoster virus in the nervous system.F1000Res. 2015;4:F1000 Faculty Rev-1356. doi:10.12688/f1000research.7153.1Bakacs T, Sandig V, Kovesdi I.Combination therapy for the treatment of shingles with an immunostimulatory vaccine virus and acyclovir.Pharmaceuticals (Basel). 2023;16(2):226. doi:10.3390/ph16020226Perry M.Shingles in adults: what the practice nurse needs to know.Practice Nursing. 2022;33(2):54-57. doi:10.12968/pnur.2022.33.2.54Morey JN, Boggero IA, Scott AB, Segerstrom SC.Current directions in stress and human immune function.Curr Opin Psychol. 2015;5:13-17. doi:10.1016/j.copsyc.2015.03.007Takao Y, Okuno Y, Mori Y, Asada H, Yamanishi K, Iso H.Associations of perceived mental stress, sense of purpose in life, and negative life events with the risk of incident herpes zoster and postherpetic neuralgia: The SHEZ study.Am J Epidemiol. 2018;187(2):251-259. doi:10.1093/aje/kwx249Harpaz R, Leung JW, Brown CJ, Zhou FJ.Psychological stress as a trigger for herpes zoster: might the conventional wisdom be wrong?Clin Infect Dis. 2015;60(5):781-785. doi:10.1093/cid/ciu889Kawai K, Yawn BP.Risk factors for herpes zoster: a systematic review and meta-analysis.Open Forum Infect Dis. 2017;4(Suppl 1):S313–S314. doi:10.1093/ofid/ofx163.733Schwarz TF, Volpe S, Catteau G, et al.Persistence of immune response to an adjuvanted varicella-zoster virus subunit vaccine for up to year nine in older adults.Hum Vaccin Immunother. 2018;14(6):1370-1377. doi:10.1080/21645515.2018.1442162National Institutes of Health, Office of AIDS Research.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV.Hansson E, Forbes HJ, Langan SM, Smeeth L, Bhaskaran K.Herpes zoster risk after 21 specific cancers: population-based case-control study.Br J Cancer. 2017;116(12):1643–1651. doi:10.1038/bjc.2017.124Pavlopoulou ID, Poulopoulou S, Melexopoulou C, Papazaharia I, Zavos G, Boletis IN.Incidence and risk factors of herpes zoster among adult renal transplant recipients receiving universal antiviral prophylaxis.BMC Infect Dis. 2015;15:285. doi:10.1186/s12879-015-1038-1Ghabriel MN, Ghabriel MN.The neuroanatomical basis of unfamiliar presentations of herpes zoster: a review and a case report.Clin Med Rev Case Rep.10:421. doi:10.23937/2378-3656/1410421Sampathkumar P, Drage LA, Martin DP.Herpes zoster (shingles) and postherpetic neuralgia.Mayo Clin Proc. 2009;84(3):274–280. doi:10.1016/S0025-6196(11)61146-4Centers for Disease Control and Prevention.Shingles symptoms and complications.American Academy of Dermatology Association.Shingles: diagnosis and treatment.National Institutes of Health, National Institute on Aging.Shingles.Cleveland Clinic.Shingles.Centers for Disease Control and Prevention.Shingles (herpes zoster.Centers for Disease Control and Prevention.Shingles vaccination.Additional ReadingBlank LJ, Polydefkis MJ, Moore RD, Gebo KA.Herpes zoster among persons living with HIV in the current antiretroviral therapy era.J Acquir Immune Defic Syndr. 2012;61(2):203-207. doi:10.1097/QAI.0b013e318266cd3cEshleman E, Shahzad A, Cohrs RJ.Varicella zoster virus latency.Future Virol. 2011;6(3):341-355. doi:10.2217/fvl.10.90Irwin MR, Olmstead R, Oxman MN.Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of Tai Chi.J Am Geriatr Soc. 2007;55(4):511-517. doi:10.1111/j.1532-5415.2007.01109.xKe CC, Lai HC, Lin CH, et al.Increased risk of herpes zoster in diabetic patients comorbid with coronary artery disease and microvascular disorders: A population-based study in Taiwan.PLoS One. 2016;11(1):e0146750. Published 2016 Jan 11. doi:10.1371/journal.pone.0146750
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
MedlinePlus.Shingles.Shrestha M, Chen A.Modalities in managing postherpetic neuralgia.Korean J Pain. 2018;31(4):235–243. doi:10.3344/kjp.2018.31.4.235Gilden D, Nagel M, Cohrs R, Mahalingam R, Baird N.Varicella zoster virus in the nervous system.F1000Res. 2015;4:F1000 Faculty Rev-1356. doi:10.12688/f1000research.7153.1Bakacs T, Sandig V, Kovesdi I.Combination therapy for the treatment of shingles with an immunostimulatory vaccine virus and acyclovir.Pharmaceuticals (Basel). 2023;16(2):226. doi:10.3390/ph16020226Perry M.Shingles in adults: what the practice nurse needs to know.Practice Nursing. 2022;33(2):54-57. doi:10.12968/pnur.2022.33.2.54Morey JN, Boggero IA, Scott AB, Segerstrom SC.Current directions in stress and human immune function.Curr Opin Psychol. 2015;5:13-17. doi:10.1016/j.copsyc.2015.03.007Takao Y, Okuno Y, Mori Y, Asada H, Yamanishi K, Iso H.Associations of perceived mental stress, sense of purpose in life, and negative life events with the risk of incident herpes zoster and postherpetic neuralgia: The SHEZ study.Am J Epidemiol. 2018;187(2):251-259. doi:10.1093/aje/kwx249Harpaz R, Leung JW, Brown CJ, Zhou FJ.Psychological stress as a trigger for herpes zoster: might the conventional wisdom be wrong?Clin Infect Dis. 2015;60(5):781-785. doi:10.1093/cid/ciu889Kawai K, Yawn BP.Risk factors for herpes zoster: a systematic review and meta-analysis.Open Forum Infect Dis. 2017;4(Suppl 1):S313–S314. doi:10.1093/ofid/ofx163.733Schwarz TF, Volpe S, Catteau G, et al.Persistence of immune response to an adjuvanted varicella-zoster virus subunit vaccine for up to year nine in older adults.Hum Vaccin Immunother. 2018;14(6):1370-1377. doi:10.1080/21645515.2018.1442162National Institutes of Health, Office of AIDS Research.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV.Hansson E, Forbes HJ, Langan SM, Smeeth L, Bhaskaran K.Herpes zoster risk after 21 specific cancers: population-based case-control study.Br J Cancer. 2017;116(12):1643–1651. doi:10.1038/bjc.2017.124Pavlopoulou ID, Poulopoulou S, Melexopoulou C, Papazaharia I, Zavos G, Boletis IN.Incidence and risk factors of herpes zoster among adult renal transplant recipients receiving universal antiviral prophylaxis.BMC Infect Dis. 2015;15:285. doi:10.1186/s12879-015-1038-1Ghabriel MN, Ghabriel MN.The neuroanatomical basis of unfamiliar presentations of herpes zoster: a review and a case report.Clin Med Rev Case Rep.10:421. doi:10.23937/2378-3656/1410421Sampathkumar P, Drage LA, Martin DP.Herpes zoster (shingles) and postherpetic neuralgia.Mayo Clin Proc. 2009;84(3):274–280. doi:10.1016/S0025-6196(11)61146-4Centers for Disease Control and Prevention.Shingles symptoms and complications.American Academy of Dermatology Association.Shingles: diagnosis and treatment.National Institutes of Health, National Institute on Aging.Shingles.Cleveland Clinic.Shingles.Centers for Disease Control and Prevention.Shingles (herpes zoster.Centers for Disease Control and Prevention.Shingles vaccination.
MedlinePlus.Shingles.
Shrestha M, Chen A.Modalities in managing postherpetic neuralgia.Korean J Pain. 2018;31(4):235–243. doi:10.3344/kjp.2018.31.4.235
Gilden D, Nagel M, Cohrs R, Mahalingam R, Baird N.Varicella zoster virus in the nervous system.F1000Res. 2015;4:F1000 Faculty Rev-1356. doi:10.12688/f1000research.7153.1
Bakacs T, Sandig V, Kovesdi I.Combination therapy for the treatment of shingles with an immunostimulatory vaccine virus and acyclovir.Pharmaceuticals (Basel). 2023;16(2):226. doi:10.3390/ph16020226
Perry M.Shingles in adults: what the practice nurse needs to know.Practice Nursing. 2022;33(2):54-57. doi:10.12968/pnur.2022.33.2.54
Morey JN, Boggero IA, Scott AB, Segerstrom SC.Current directions in stress and human immune function.Curr Opin Psychol. 2015;5:13-17. doi:10.1016/j.copsyc.2015.03.007
Takao Y, Okuno Y, Mori Y, Asada H, Yamanishi K, Iso H.Associations of perceived mental stress, sense of purpose in life, and negative life events with the risk of incident herpes zoster and postherpetic neuralgia: The SHEZ study.Am J Epidemiol. 2018;187(2):251-259. doi:10.1093/aje/kwx249
Harpaz R, Leung JW, Brown CJ, Zhou FJ.Psychological stress as a trigger for herpes zoster: might the conventional wisdom be wrong?Clin Infect Dis. 2015;60(5):781-785. doi:10.1093/cid/ciu889
Kawai K, Yawn BP.Risk factors for herpes zoster: a systematic review and meta-analysis.Open Forum Infect Dis. 2017;4(Suppl 1):S313–S314. doi:10.1093/ofid/ofx163.733
Schwarz TF, Volpe S, Catteau G, et al.Persistence of immune response to an adjuvanted varicella-zoster virus subunit vaccine for up to year nine in older adults.Hum Vaccin Immunother. 2018;14(6):1370-1377. doi:10.1080/21645515.2018.1442162
National Institutes of Health, Office of AIDS Research.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV.
Hansson E, Forbes HJ, Langan SM, Smeeth L, Bhaskaran K.Herpes zoster risk after 21 specific cancers: population-based case-control study.Br J Cancer. 2017;116(12):1643–1651. doi:10.1038/bjc.2017.124
Pavlopoulou ID, Poulopoulou S, Melexopoulou C, Papazaharia I, Zavos G, Boletis IN.Incidence and risk factors of herpes zoster among adult renal transplant recipients receiving universal antiviral prophylaxis.BMC Infect Dis. 2015;15:285. doi:10.1186/s12879-015-1038-1
Ghabriel MN, Ghabriel MN.The neuroanatomical basis of unfamiliar presentations of herpes zoster: a review and a case report.Clin Med Rev Case Rep.10:421. doi:10.23937/2378-3656/1410421
Sampathkumar P, Drage LA, Martin DP.Herpes zoster (shingles) and postherpetic neuralgia.Mayo Clin Proc. 2009;84(3):274–280. doi:10.1016/S0025-6196(11)61146-4
Centers for Disease Control and Prevention.Shingles symptoms and complications.
American Academy of Dermatology Association.Shingles: diagnosis and treatment.
National Institutes of Health, National Institute on Aging.Shingles.
Cleveland Clinic.Shingles.
Centers for Disease Control and Prevention.Shingles (herpes zoster.
Centers for Disease Control and Prevention.Shingles vaccination.
Blank LJ, Polydefkis MJ, Moore RD, Gebo KA.Herpes zoster among persons living with HIV in the current antiretroviral therapy era.J Acquir Immune Defic Syndr. 2012;61(2):203-207. doi:10.1097/QAI.0b013e318266cd3cEshleman E, Shahzad A, Cohrs RJ.Varicella zoster virus latency.Future Virol. 2011;6(3):341-355. doi:10.2217/fvl.10.90Irwin MR, Olmstead R, Oxman MN.Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of Tai Chi.J Am Geriatr Soc. 2007;55(4):511-517. doi:10.1111/j.1532-5415.2007.01109.xKe CC, Lai HC, Lin CH, et al.Increased risk of herpes zoster in diabetic patients comorbid with coronary artery disease and microvascular disorders: A population-based study in Taiwan.PLoS One. 2016;11(1):e0146750. Published 2016 Jan 11. doi:10.1371/journal.pone.0146750
Blank LJ, Polydefkis MJ, Moore RD, Gebo KA.Herpes zoster among persons living with HIV in the current antiretroviral therapy era.J Acquir Immune Defic Syndr. 2012;61(2):203-207. doi:10.1097/QAI.0b013e318266cd3c
Eshleman E, Shahzad A, Cohrs RJ.Varicella zoster virus latency.Future Virol. 2011;6(3):341-355. doi:10.2217/fvl.10.90
Irwin MR, Olmstead R, Oxman MN.Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of Tai Chi.J Am Geriatr Soc. 2007;55(4):511-517. doi:10.1111/j.1532-5415.2007.01109.x
Ke CC, Lai HC, Lin CH, et al.Increased risk of herpes zoster in diabetic patients comorbid with coronary artery disease and microvascular disorders: A population-based study in Taiwan.PLoS One. 2016;11(1):e0146750. Published 2016 Jan 11. doi:10.1371/journal.pone.0146750
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