Shingles
Published by Bupa's health information team, February 2008.
This factsheet is for people who have shingles, or who would like information about it.
Shingles causes a painful rash of small blisters that appear on one side of the body, often in a band on the chest and back. The virus that causes shingles is called varicella zoster. This is the same virus that causes chickenpox.
Shingles is very common - one in four people are affected by it at some point in their life.
- Animation - How shingles develops
- About chickenpox and shingles
- Symptoms of shingles
- Complications of shingles
- Diagnosis of shingles
- Treatment of shingles
- Prevention of shingles
- Questions and answers
- Related topics
- Sources
How shingles develops
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About chickenpox and shingles
Chickenpox is very common in children, and it tends to only cause mild illness (for more information see Related topics). Once you have had chickenpox, you usually become immune to it for life, although on rare occasions people can catch it again.
However, after you have had chickenpox, the varicella zoster virus remains in nerve cells in your spinal cord for life.
Normally, the virus lies dormant and doesn't cause any problems. But if your immune system, which normally protects your body against infection, is weakened, the virus can become active again. If this happens, it causes shingles. Shingles can be very painful.
Who is most likely to get shingles?
Shingles can affect you at any age, but it's more common in the elderly. It isn't triggered by contact with someone who has chickenpox.
There are a number of things that make reactivation of the virus more likely such as:
- being elderly
- having a condition that affects the immune system, such HIV/AIDS infection
- a period of increased stress
- excessive alcohol intake
- a long-term course of steroids
- chemotherapy or radiotherapy (cancer treatments)
- medicines used after organ transplants (immunosuppressants)
Is shingles infectious?
Shingles isn't infectious in the same way as chickenpox, where the virus can be passed on to other people by coughs and sneezes. However, the virus can be passed on by direct contact with fluid from shingles blisters, until they dry up and crust over. This can cause chickenpox in people who aren't already immune to it. People with shingles should avoid contact with people who have a lowered immunity, babies or pregnant women (see Who is most likely to get shingles?). If the rash is covered, the virus is less likely to be spread.
Symptoms of shingles
The first symptom of shingles is often over-sensitivity or a burning sensation on the skin. After a few days, a rash develops. It usually appears as a band, following the route of a nerve supply to the skin.
At first, the rash consists of small red spots and reddened skin in the same area. The spots then turn into small blisters, which dry up after a few days and gradually form scabs. Once the scabs have fallen off, a small pock-mark may be left.
Shingles is often severely painful.
Complications of shingles
Shingles can lead to a number of complications.
- Because the virus affects nerves, the pain may continue after the rash has cleared, sometimes lingering for weeks, months or even years. This is called post-herpetic neuralgia. It's more common in older people and in people who had a severe rash.
- It can affect the face around the eye (ophthalmic zoster). This can cause a red and streaming eye (conjunctivitis) and may damage your eye or affect your vision. If you have shingles around the eye you may need to see an eye specialist (ophthalmologist).
- Shingles sometimes affects the ear. It can cause earache, dizziness, deafness and paralysis on one side of the face. This is called Ramsay Hunt syndrome. The pain tends to go within 48 hours, but post-herpetic neuralgia or permanent nerve damage may occur.
- Encephalitis (inflammation of the brain) is a very rare complication of shingles. It causes fever, seizures and confusion.
- According to the Royal College of Obstetricians and Gynaecologists, developing shingles while pregnant doesn't harm the baby.
Rarely, catching chickenpox while pregnant can harm your unborn baby, depending on what stage of pregnancy you are in. For information on chickenpox see Related topics.
For more advice, or if you recognise the signs of chickenpox or shingles while pregnant, talk to your GP or midwife as soon as possible.
When to see a doctor
Often the symptoms of shingles are mild and no medical treatment is needed. However, if you recognise the symptoms of shingles developing early on, go and see your GP as soon as possible. Early treatment can make the symptoms less severe, and reduce your risk of complications.
Urgent medical treatment is required if the following symptoms of shingles develop:
- high fever
- confusion
- loss of memory
- exhaustion
- severe headache
- any symptoms affecting the eye area
You should also see your GP if you get shingles and:
- you have a weakened immune system (see Who is most likely to get shingles?)
- you are pregnant (see Complications)
Diagnosis of shingles
Tests aren't usually needed to diagnose shingles, because the type and location of the rash is very distinctive. However, a blood test to identify the virus is sometimes used to make sure.
Treatment of shingles
Shingles usually clears up on its own, although it can recur especially if you have lowered immunity. The symptoms for shingles can be controlled, especially if it is treated at an early stage.
Medicines
Antiviral medicines, which are usually taken in tablet form, can help to control the symptoms of shingles if they are used in the early stages of the illness. They help control the rash and minimise damage to the nerves; this reduces the likelihood of post-herpetic neuralgia.
Your GP may prescribe you an antiviral drug, especially if he or she sees you soon (within about 72 hours) after you first develop symptoms, if you have any complications or if you're elderly.
The pain of shingles may be relieved by over-the-counter painkillers, but if it is severe your GP might prescribe more powerful drugs for pain relief. Always follow the instructions on the patient information leaflet that comes with your medicine. Wet dressings and ice packs can also help to control the pain, and analgesic (numbing) lotions may also help. Talk to your GP or pharmacist for more advice.
If you develop, or are at an increased risk of post herpetic neuralgia (see Complications), your GP may also prescribe you additional medicines, such as amitryptiline. This is also used as an antidepressant, but it has other effects on nerves and can help control the pain.
Prevention of shingles
A vaccine is available for chickenpox, but it isn't routinely used in the UK. However, it is offered to health workers who aren't immune to chickenpox.
A vaccine that reduces the risk of shingles for people over the age of 60 has also been developed and is used in USA, but it hasn't yet been approved in the UK.
Pregnant women who have never had chickenpox, people with a weakened immune system or newborn babies who are exposed to the chickenpox or shingles virus can be given an injection of antibodies that may stop chickenpox developing. The sooner this is given after exposure to the virus, the more likely it is to work.
Related topics
Sources
- Simon, C, Everitt, H, and Kendrick, T, Oxford Handbook of General Practice. Oxford: Oxford University Press, 2005: 494, 923, 937
- Shingles and postherpetic neuralgia. Clinical Knowledge Summary.
www.cks.library.nhs.uk, accessed 4 April 2007 - Chickenpox in pregnancy. Royal College of Obstetricians and Gynaecologists.
www.rcog.org.uk, accessed 4 April 2007 - British National Formulary, BNF. Vol. 52. London: BMJ Publishing Group LTD, 2006: 635-637
- General Information - Chickenpox (Varicella). Health protection agency.
www.hpa.org.uk, accessed 17 January 2008 - US CDC advisory panel votes to recommend shingles vaccine Zostavax for vaccination of adults aged 60 and over. National electronic library for medicines.
www.nelm.nhs.uk, accessed 17 January 2008
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: February 2008
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