Shingles
Published by Bupa's health information team, January 2010.
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. Shingles is caused by a virus called varicella zoster. This is the same virus that causes chickenpox.
- About shingles
- Animation - How shingles develops
- Symptoms of shingles
- Complications of shingles
- Causes of shingles
- Diagnosis of shingles
- Treatment of shingles
- Prevention of shingles
- Questions and answers
- Related topics
- Sources
About shingles
Shingles occurs when the virus that causes chickenpox re-activates itself in your body.
After you have had chickenpox, the virus stays in nerve cells in your spinal cord for the rest of your life. Usually, 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 is very common - one in five people are affected at some point in their life. It can affect you at any age, but it's more common in elderly people.
How shingles develops
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Symptoms of shingles
The first symptom of shingles is often oversensitivity or a painful burning sensation in the affected area, usually your chest. A rash will then develop. The rash usually appears as a band, following the route of a nerve supply to your skin. At first, it consists of small red raised spots. The spots then turn into small blisters filled with a cloudy fluid. These blisters dry up after five to seven days and gradually form scabs. The scabs drop off within two to three weeks.
The pain caused by shingles is often severe and may stay after the rash has gone.
Complications of shingles
Shingles can lead to a number of complications.
Because the virus affects your 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.
Shingles can affect the skin around your eyes (ophthalmic zoster). This can give you red and streaming eyes (conjunctivitis) and may damage your eyes or affect your vision. If you have shingles around your eyes you may need to see an ophthalmologist (a doctor who specialises in eye conditions).
Shingles can sometimes affect your ears. It can cause earache, dizziness, deafness and paralysis on one side of your face. This is called Ramsay Hunt syndrome. The pain tends to go away within 48 hours, but post-herpetic neuralgia or permanent nerve damage may occur.
Encephalitis (inflammation of your 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 you're pregnant won't harm your baby. However, if you have symptoms of chickenpox or shingles while you're pregnant, contact your GP or midwife.
Causes of shingles
Shingles occurs when the varicella zoster virus that causes chickenpox re-activates itself in your body.
There are a number of things that make re-activation of the virus more likely, including:
- being elderly
- a period of increased stress
- a long-term course of steroids
- having a condition that affects your immune system, such HIV/AIDS or leukaemia
- chemotherapy or radiotherapy (cancer treatments)
- medicines used after organ transplants (immunosuppressants)
Shingles isn't infectious in the same way as chickenpox, where the virus can be passed on to other people through 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 haven't had chickenpox or the chickenpox (varicella) vaccine. If you have shingles, try to avoid contact with babies, pregnant women and people who have a weakened immune system.
Shingles isn't triggered by contact with someone who has chickenpox.
Diagnosis of shingles
If you recognise the symptoms of shingles developing early on, contact your GP as soon as possible. Early treatment can make the symptoms less severe, and reduce your risk of complications.
Tests aren't usually needed to diagnose shingles, because the type and location of the rash is very easy to spot. However, sometimes scrapings may be taken from a blister and analysed under a microscope, or you may need a blood test to identify the virus and confirm the diagnosis.
You will need urgent medical treatment if you develop other symptoms, such as a high fever. You must also see your GP if you get shingles and are pregnant or have a weakened immune system.
Treatment of shingles
Often the symptoms of shingles are mild and you won't need any medical treatment. However, the symptoms can be controlled, especially if it's treated at an early stage.
Self-help
Keep the rash clean and dry to reduce your risk of developing a bacterial infection. Don't use sticky dressings or antibiotic creams or ointments (topical antibiotics) as these may irritate your skin. Cover your rash, so that the virus is less likely to spread. Avoid work, school or daycare if you have a rash that's weeping and can't be covered.
Medicines
Antiviral medicines, usually taken as tablets, can help to control the symptoms of shingles if you take them in the early stages of the illness. They help control the rash and minimise damage to your nerves; this reduces the likelihood of post-herpetic neuralgia.
Your GP may prescribe you an antiviral medicine, particularly 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 taking over-the-counter painkillers, but if it's 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 and, if you have any questions, ask your pharmacist or GP for advice.
Wet dressings and ice packs can also help to control the pain. You can try using capsaicin creams if other treatments don't work or aren't suitable. Talk to your GP or pharmacist for more advice.
If you develop, or are at an increased risk of, post-herpetic neuralgia, your GP may prescribe you additional medicines, for example amitriptyline, which is usually used as an antidepressant but also acts on your nerves and can help control the pain.
Prevention of shingles
There is no vaccine used in the UK to prevent shingles. A vaccine that reduces the risk of shingles has been developed and is given to people over the age of 60 in the US, but it's not used in the UK yet.
There is a vaccine available for chickenpox (to protect you from catching the varicella zoster virus in the first place) but it isn't routinely used in the UK. However, it is offered to health workers who aren't immune to chickenpox.
Pregnant women who have never had chickenpox, people with a weakened immune system and newborn babies who are exposed to the varicella zoster virus can be given an injection of antibodies that may stop chickenpox developing. The sooner this is given after you are exposed to the virus, the more likely it is to work.
Related topics
Sources
- General information - chickenpox (varicella). Health Protection Agency. www.hpa.org.uk, accessed 9 September 2009
- Factsheet on shingles. Health Protection Agency. www.hpa.org.uk, accessed 9 September 2009
- Shingles incidence. GP Notebook. www.gpnotebook.co.uk, accessed 9 September 2009
- Shingles. British Skin Foundation. www.britishskinfoundation.org.uk, accessed 9 September 2009
- Shingles. MIMS. www.mims.co.uk, accessed 9 September 2009
- Shingles management: information and advice. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 9 September 2009
- Shingles management: introduction. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 9 September 2009
- Herpes zoster. American Academy of Dermatology. www.aad.org, accessed 29 September 2009
- Post-herpetic neuralgia: management. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 9 September 2009
- Shingles in pregnancy. GP Notebook. www.gpnotebook.co.uk, accessed 9 September 2009
- Chickenpox, pregnancy and the newborn. Drug Bull 2005; 43:69-72. www.dtb.bmj.com
- Chickenpox and shingles infection. Pharm 2006; 277:453-456. www.pharmj.com
- Shingles management: treatment of pain. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 9 September 2009
- Further information about varicella (chickenpox) vaccine for health professionals. NHS Immunisation Information.www.immunisation.nhs.uk, accessed 25 September 2009
- Herpes zoster vaccine Q&As. Centers for Disease Control and Prevention. www.cdc.gov, accessed 25 September 2009
- 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 25 September 2009
- Chickenpox in pregnancy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, accessed 9 September 2009
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: January 2010
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