Table of ContentsView AllTable of ContentsSymptoms and StagesCausesContagiousnessDiagnosisTreatmentPreventionOutlookNext in Shingles GuideWhat Does Shingles Feel Like?
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View All
Table of Contents
Symptoms and Stages
Causes
Contagiousness
Diagnosis
Treatment
Prevention
Outlook
Next in Shingles Guide
Although shingles is incurable, antiviral medications may speed healing and reduce pain. In addition, a vaccine can help protect against shingles andpostherpetic neuralgia, a common complication of shingles.
This article will review essential facts about shingles, including its symptoms, risk factors, and treatment. Insight into whether shingles can recur or is contagious will also be provided.
Petra Richli / Getty Images
Symptoms and Stages of Shingles
Shingles affects around 1 in 3 people in the United States during their lifetime, and the risk of developing this skin condition is highest in older adults.
The symptoms of shingles progress through two stages. The first is the preeruptive stage, the period before the rash appears.
Preeruptive Stage
At least two days before the shingles rash appears, a person may experience unusual sensations on one side of the body or face, often described as burning, tingly, or itchy.
Flu-like symptoms may occur during this stage and can include the following:
Acute Eruptive Stage
During this stage, painful blisters develop on one side of the face or body. The most common sites of rash are the chest, abdomen, and back, although shingles can occur anywhere.
Within a few days of the rash becoming visible, the blisters burst and formulcers(open sores) before scabbing over in seven to 10 days.
The rash fully clears within two to four weeks for most people. For some, scarring and skin color changes may occur.
What Does Shingles Look Like?
Atypical Shingles PresentationUncommonly, shingles may present in the following way:Disseminated zosteris when three or more dermatomes are affected, causing the shingles rash to be more widespread, resembling chickenpox.Internal shingles, also known as zoster sine herpete (ZSH), is the reactivation of the varicella virus without the characteristic rash.
Atypical Shingles Presentation
Uncommonly, shingles may present in the following way:Disseminated zosteris when three or more dermatomes are affected, causing the shingles rash to be more widespread, resembling chickenpox.Internal shingles, also known as zoster sine herpete (ZSH), is the reactivation of the varicella virus without the characteristic rash.
Uncommonly, shingles may present in the following way:
Complications of Shingles
Complications of shingles are more likely to develop in older adults and people with weakened immune systems.
Postherpetic neuralgiais the most common complication of shingles that develops in approximately 20% of people.Postherpetic neuralgia is a term used to describe abnormal burning or shock-like sensations that persists for 90 or more days after the rash appears.
Other complications of shingles include:
Rarely, disseminated zoster can lead to internal organ problems, likepneumonia(lung infection),encephalitis(inflammation of the brain), andhepatitis(inflammation of the liver).
Risks Associated With Shingles
Causes and Risk Factors of Shingles
After a person has chickenpox, the virus remains dormant in their nerve cells. Years, even decades, later, the virus may reactivate or reemerge in a single nerve root, leading to shingles in the area of skin connected to the nerve.
Several factors may increase a person’s risk of developing shingles. They all generally share a common trait of weakening, or compromising, the immune system, which makes a person more prone to chickenpox virus reactivation.
Shingles risk factors include:
Stress, including emotional distress or physical trauma, or a family history of shingles, may also make a person more vulnerable to developing shingles. However, the scientific evidence supporting these factors remains under medical debate.
What Causes Shingles?
How Chickenpox Impacts Immunity
When you have chickenpox, T-cells (immune system cells that play a critical role in fighting infection) leave the bloodstream and enter the infected skin tissue.
These T-cells remain in the skin after the chickenpox virus has been cleared. Their goal is to keep the chickenpox virus in check, preventing reactivation into shingles.
Chickenpox virus reactivation becomes more likely when T-cells are depleted or impaired.Advanced age and health-related factors (e.g., taking drugs that suppress the immune system) can trigger this depletion or decline in T-cell function.
Reinfection Risk
While not common, a person canget shingles multiple times. The recurrence of shingles is estimated to be nearly 4% in people with shingles age 45 or older.Like other shingles complications, recurrent shingles is more common in those with a suppressed immune system.
How Contagious Is Shingles?
Shingles is not contagious, so you cannot get shingles from another person.
However, you can get chickenpox from a person with shingles. This can only happen if you have never had chickenpox or received the chickenpox vaccine. Anyone who has had chickenpox can get shingles later in life.
Keep in mind that in the above scenario, to get chickenpox from a person with shingles, there must be skin-to-skin contact with the fluid from one or more shingles blisters.The virus cannot be spread before the blisters appear or after the blisters crust and scab over.
How Shingles Can Spread
Diagnosing Shingles
Apolymerasechain reaction test (PCR) may be performed in the following circumstances:
For PCR analysis, a healthcare provider uses a sterile swab to obtain fluid from the blister or a crust/scab sample.
If a rash is absent, but you have shingles-like pain, your healthcare provider may obtain a saliva or blood sample for PCR testing, although these fluid samples may lead to false negative results.
PCR testing can also help rule out alternative diagnoses conditions likeherpes simplex virus (HSV),contact dermatitis, ordermatitis herpetiformis.
How to Treat Shingles
The standardtreatment of shinglesinvolves taking both an antiviral and pain-relieving medication.
Antiviral Medication
Antiviral medication aims to hasten the rash’s healing, decrease the severity and duration of shingles-related pain, and minimize a person’s chances of developing complications. Antiviral therapy should ideally start within 72 hours after the rash appears for optimal benefit.
Three antiviral medications used to treat shingles are:
Treatment of Shingles in PregnancyShingles can occur during pregnancy, albeit rarely, and typically causes no harm to the fetus. Shingles in pregnancy is usually treated with acyclovir.
Treatment of Shingles in Pregnancy
Shingles can occur during pregnancy, albeit rarely, and typically causes no harm to the fetus. Shingles in pregnancy is usually treated with acyclovir.
Pain Medication
The pain of shingles can be excruciating and debilitating, so medication for pain is often needed. The choice of pain-relieving medication depends on factors like the severity of the pain and your overall health and medical history.
Oral pain medication options include over-the-counter drugs like Tylenol (acetaminophen) or anonsteroidal anti-inflammatory drug(NSAID) like Advil or Motrin (ibuprofen).
If the pain is severe, an opioid like OxyContin (oxycodone) may be prescribed temporarily.
Other Medications
Other medications that may be prescribed for shingles include the following:
Home Remedies
In addition to medication, various at-home strategies can minimize the discomfort of shingles and maximize healing potential.
For example, applying a cool washcloth to the affected skin can ease pain and itching. Likewise, calamine lotion orcolloidal oatmeal baths—warm baths mixed with oatmeal ground into a fine powder—can relieve skin itching and irritation.
After bathing or applying a cool washcloth, be sure to gently dry the affected skin area. Also, try not to disturb or scratch the blisters, which can lead to an infection.
Preventing Shingles
Receiving the shingles vaccine calledShingrixis crucial for preventing shingles and the most common complication, postherpetic neuralgia.
CDC Vaccination RecommendationsThe Centers for Disease Control and Prevention (CDC) recommends that adults 50 and older get two doses of Shingrix. Individuals 19 and older with weakened immune systems should also get two doses of Shingrix.
CDC Vaccination Recommendations
The Centers for Disease Control and Prevention (CDC) recommends that adults 50 and older get two doses of Shingrix. Individuals 19 and older with weakened immune systems should also get two doses of Shingrix.
Keep in mind that you can still get the vaccine even if you had shingles or receivedZostavaxor the chickenpox vaccine. Zostavax is a shingles vaccine no longer available for use in the United States.
However, you should not get the shingles vaccine if:
When getting Shingrix—a shot in your upper arm—you may experience side effects for two or three days. These side effects can include soreness, redness, or swelling at the injection site, tiredness, muscle aches, upset stomach, fever, and headache.
Should You Get the Shingles Vaccine?
Shingles is intensely painful, but the good news is that the rash usually clears within a few weeks and rarely recurs.
Nevertheless, if you are experiencing symptoms of shingles, it’s essential to seek medical attention as soon as possible. Prompt antiviral therapy can reduce the severity and duration of your symptoms and lower your chances of developing complications.
Also, if you have already been diagnosed with shingles, don’t hesitate to contact your healthcare provider if your pain is not controlled well. Several medication options can help you get through this uncomfortable time.
Coping With Shingles
15 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.Centers for Disease Control and Prevention.Shingles (herpes zoster): clinical overview.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/ofx163.733Cohen JI.Clinical practice: herpes zoster.N Engl J Med. 2013;369(3):255-263. doi:10.1056/NEJMcp1302674Zhou J, Li J, Ma L, Cao S.Zoster sine herpete: a review.Korean J Pain. 2020;33(3):208-215. doi:10.3344/kjp.2020.33.3.208Saguil A, Kane S, Mercado M, Lauters R.Herpes zoster and postherpetic neuralgia: prevention and management.Am Fam Physician. 2017;96(10):656-663Johnson RW, Alvarez-Pasquin MJ, Bijl M, et al.Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective.Ther Adv Vaccines. 2015;3(4):109-120. doi:10.1177/2051013615599151National Institute on Aging.Shingles.Laing KJ, Ouwendijk WJD, Koelle DM, Verjans GMGM.Immunobiology of varicella-zoster virus infection.J Infect Dis.2018;218(suppl_2):S68-S74. doi:10.1093/infdis/jiy403Qian J, Macartney K, Heywood AE, Sheridan S, Liu B.Risk of recurrent herpes zoster in a population-based cohort study of older adults.J Am Acad Dermatol. 2021;85(3):611-618. doi:10.1016/j.jaad.2020.06.1013Centers for Disease Control and Prevention.Shingles (herpes zoster): transmission.Wollina U.Variations in herpes zoster manifestation.Indian J Med Res. 2017;145(3):294-298. doi:10.4103/ijmr.IJMR_1622_16Centers for Disease Control and Prevention.Shingles (herpes zoster): diagnosis & testing.Koshy E, Mengting L, Kumar H, Jianbo W.Epidemiology, treatment and prevention of herpes zoster: a comprehensive review.Indian J Dermatol Venereol Leprol.2018;84(3):251-262. doi:10.4103/ijdvl.IJDVL_1021_16Hayward K, Cline A, Stephens A, Street L.Management of herpes zoster (shingles) during pregnancy.J Obstet Gynaecol. 2018;38(7):887-894. doi:10.1080/01443615.2018.1446419Centers for Disease Control and Prevention.Shingles vaccination.
15 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.Centers for Disease Control and Prevention.Shingles (herpes zoster): clinical overview.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/ofx163.733Cohen JI.Clinical practice: herpes zoster.N Engl J Med. 2013;369(3):255-263. doi:10.1056/NEJMcp1302674Zhou J, Li J, Ma L, Cao S.Zoster sine herpete: a review.Korean J Pain. 2020;33(3):208-215. doi:10.3344/kjp.2020.33.3.208Saguil A, Kane S, Mercado M, Lauters R.Herpes zoster and postherpetic neuralgia: prevention and management.Am Fam Physician. 2017;96(10):656-663Johnson RW, Alvarez-Pasquin MJ, Bijl M, et al.Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective.Ther Adv Vaccines. 2015;3(4):109-120. doi:10.1177/2051013615599151National Institute on Aging.Shingles.Laing KJ, Ouwendijk WJD, Koelle DM, Verjans GMGM.Immunobiology of varicella-zoster virus infection.J Infect Dis.2018;218(suppl_2):S68-S74. doi:10.1093/infdis/jiy403Qian J, Macartney K, Heywood AE, Sheridan S, Liu B.Risk of recurrent herpes zoster in a population-based cohort study of older adults.J Am Acad Dermatol. 2021;85(3):611-618. doi:10.1016/j.jaad.2020.06.1013Centers for Disease Control and Prevention.Shingles (herpes zoster): transmission.Wollina U.Variations in herpes zoster manifestation.Indian J Med Res. 2017;145(3):294-298. doi:10.4103/ijmr.IJMR_1622_16Centers for Disease Control and Prevention.Shingles (herpes zoster): diagnosis & testing.Koshy E, Mengting L, Kumar H, Jianbo W.Epidemiology, treatment and prevention of herpes zoster: a comprehensive review.Indian J Dermatol Venereol Leprol.2018;84(3):251-262. doi:10.4103/ijdvl.IJDVL_1021_16Hayward K, Cline A, Stephens A, Street L.Management of herpes zoster (shingles) during pregnancy.J Obstet Gynaecol. 2018;38(7):887-894. doi:10.1080/01443615.2018.1446419Centers for Disease Control and Prevention.Shingles vaccination.
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.
Centers for Disease Control and Prevention.Shingles (herpes zoster): clinical overview.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/ofx163.733Cohen JI.Clinical practice: herpes zoster.N Engl J Med. 2013;369(3):255-263. doi:10.1056/NEJMcp1302674Zhou J, Li J, Ma L, Cao S.Zoster sine herpete: a review.Korean J Pain. 2020;33(3):208-215. doi:10.3344/kjp.2020.33.3.208Saguil A, Kane S, Mercado M, Lauters R.Herpes zoster and postherpetic neuralgia: prevention and management.Am Fam Physician. 2017;96(10):656-663Johnson RW, Alvarez-Pasquin MJ, Bijl M, et al.Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective.Ther Adv Vaccines. 2015;3(4):109-120. doi:10.1177/2051013615599151National Institute on Aging.Shingles.Laing KJ, Ouwendijk WJD, Koelle DM, Verjans GMGM.Immunobiology of varicella-zoster virus infection.J Infect Dis.2018;218(suppl_2):S68-S74. doi:10.1093/infdis/jiy403Qian J, Macartney K, Heywood AE, Sheridan S, Liu B.Risk of recurrent herpes zoster in a population-based cohort study of older adults.J Am Acad Dermatol. 2021;85(3):611-618. doi:10.1016/j.jaad.2020.06.1013Centers for Disease Control and Prevention.Shingles (herpes zoster): transmission.Wollina U.Variations in herpes zoster manifestation.Indian J Med Res. 2017;145(3):294-298. doi:10.4103/ijmr.IJMR_1622_16Centers for Disease Control and Prevention.Shingles (herpes zoster): diagnosis & testing.Koshy E, Mengting L, Kumar H, Jianbo W.Epidemiology, treatment and prevention of herpes zoster: a comprehensive review.Indian J Dermatol Venereol Leprol.2018;84(3):251-262. doi:10.4103/ijdvl.IJDVL_1021_16Hayward K, Cline A, Stephens A, Street L.Management of herpes zoster (shingles) during pregnancy.J Obstet Gynaecol. 2018;38(7):887-894. doi:10.1080/01443615.2018.1446419Centers for Disease Control and Prevention.Shingles vaccination.
Centers for Disease Control and Prevention.Shingles (herpes zoster): clinical overview.
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
Cohen JI.Clinical practice: herpes zoster.N Engl J Med. 2013;369(3):255-263. doi:10.1056/NEJMcp1302674
Zhou J, Li J, Ma L, Cao S.Zoster sine herpete: a review.Korean J Pain. 2020;33(3):208-215. doi:10.3344/kjp.2020.33.3.208
Saguil A, Kane S, Mercado M, Lauters R.Herpes zoster and postherpetic neuralgia: prevention and management.Am Fam Physician. 2017;96(10):656-663
Johnson RW, Alvarez-Pasquin MJ, Bijl M, et al.Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective.Ther Adv Vaccines. 2015;3(4):109-120. doi:10.1177/2051013615599151
National Institute on Aging.Shingles.
Laing KJ, Ouwendijk WJD, Koelle DM, Verjans GMGM.Immunobiology of varicella-zoster virus infection.J Infect Dis.2018;218(suppl_2):S68-S74. doi:10.1093/infdis/jiy403
Qian J, Macartney K, Heywood AE, Sheridan S, Liu B.Risk of recurrent herpes zoster in a population-based cohort study of older adults.J Am Acad Dermatol. 2021;85(3):611-618. doi:10.1016/j.jaad.2020.06.1013
Centers for Disease Control and Prevention.Shingles (herpes zoster): transmission.
Wollina U.Variations in herpes zoster manifestation.Indian J Med Res. 2017;145(3):294-298. doi:10.4103/ijmr.IJMR_1622_16
Centers for Disease Control and Prevention.Shingles (herpes zoster): diagnosis & testing.
Koshy E, Mengting L, Kumar H, Jianbo W.Epidemiology, treatment and prevention of herpes zoster: a comprehensive review.Indian J Dermatol Venereol Leprol.2018;84(3):251-262. doi:10.4103/ijdvl.IJDVL_1021_16
Hayward K, Cline A, Stephens A, Street L.Management of herpes zoster (shingles) during pregnancy.J Obstet Gynaecol. 2018;38(7):887-894. doi:10.1080/01443615.2018.1446419
Centers for Disease Control and Prevention.Shingles vaccination.
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