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Shingles

Herpes zoster - shingles

Shingles is a painful, blistering skin rash. It is caused by the varicella-zoster virus, a member of the herpes family of viruses. This is the virus that also causes chickenpox.

Causes

After you get chickenpox, your body does not get rid of the virus. Instead, the virus remains in the body but is inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes active again in these nerves after many years. Many people had such a mild case of chickenpox that they do not realize they have had the infection.

The reason the virus suddenly becomes active again is not clear. Often only one attack occurs.

Shingles can develop in any age group. You are more likely to develop the condition if:

  • You are older than age 60
  • You had chickenpox before age 1
  • Your immune system is weakened by medicines or disease

If an adult or child has direct contact with the shingles rash and did not have chickenpox as a child or get the chickenpox vaccine, they can develop chickenpox, not shingles.

Symptoms

The first symptom is usually pain, tingling, or burning that occurs on one side of the body. The pain and burning may be severe and are usually present before any rash appears.

Red patches on the skin, followed by small blisters, form in most people:

  • The blisters break, forming small sores that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks. Scarring is rare.
  • The rash usually involves a narrow area from the spine around to the front of the abdomen or chest.
  • The rash may instead involve the face, eyes, mouth, and ears.

Other symptoms may include:

  • Fever and chills
  • General ill feeling
  • Headache
  • Joint pain
  • Swollen glands (lymph nodes)

You may also have pain, muscle weakness, and a rash involving different parts of your face if shingles affects a nerve in your face. The symptoms may include:

  • Difficulty moving some of the muscles in the face
  • Drooping eyelid (ptosis)
  • Hearing loss
  • Loss of eye motion
  • Taste problems
  • Vision problems

Exams and Tests

Your health care provider can make the diagnosis by looking at your skin and asking about your medical history.

Tests are rarely needed, but may include taking a skin sample to see if the skin is infected with the virus.

Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus. But the tests cannot confirm that the rash is due to shingles.

Treatment

Your provider may prescribe a medicine that fights the virus, called an antiviral drug. This drug helps reduce pain, prevent complications, and shorten the course of the disease.

The medicines are most effective when started within 72 hours of when you first feel pain or burning. It is best to start taking them before the blisters appear. The medicines are usually given in pill form. Some people may need to receive the medicine through a vein (by IV).

Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and pain. These medicines do not work in all people.

Other medicines may include:

  • Antihistamines to reduce itching (taken by mouth or applied to the skin)
  • Pain medicines
  • Zostrix, a cream containing capsaicin (an extract of pepper) to reduce pain

Follow your provider's instructions about how to care for yourself at home.

Other measures may include:

  • Caring for your skin by applying cool, wet compresses to reduce pain, and taking soothing baths
  • Resting in bed until the fever goes down

Stay away from people while your sores are oozing to avoid infecting those who have never had chickenpox -- especially pregnant women.

Outlook (Prognosis)

Herpes zoster usually clears in 2 to 3 weeks and rarely returns. If the virus affects the nerves that control movement (the motor nerves), you may have temporary or permanent weakness or paralysis.

Sometimes the pain in the area where the shingles occurred may last from months to years. This pain is called postherpetic neuralgia.

It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe. Postherpetic neuralgia is more likely to occur in people age 60 or over.

Possible Complications

Complications may include:

  • Another attack of shingles
  • Bacterial skin infections
  • Blindness (if shingles occurs in the eye)
  • Deafness
  • Infection, including encephalitis or sepsis (blood infection) in people with a weakened immune system
  • Ramsay Hunt syndrome if shingles affects the nerves of the face or ear

When to Contact a Medical Professional

Contact your provider if you have symptoms of shingles, particularly if you have a weakened immune system or if your symptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you do not receive emergency medical care.

Prevention

Do not touch the rash and blisters on people with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine.

The shingles vaccine is different than the chickenpox vaccine. Older adults who receive the shingles vaccine are much less likely to have complications from the condition.

References

Dinulos JGH. Warts, herpes simplex, and other viral infections. In: Dinulos JGH, ed. Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 12.

Whitley RJ. Chickenpox and herpes zoster (varicella-zoster virus). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 136.

  • Herpes zoster (shingles) on the back

    Herpes zoster (shingles) on the back - illustration

    A classical pattern for shingles. The infection follows a nerve root from the spine, along a rib, to the front of the chest. The area innervated by the nerve is called a dermatome.

    Herpes zoster (shingles) on the back

    illustration

  • Adult dermatome

    Adult dermatome - illustration

    Understanding the nerve distribution along the dermatomes is helpful in determining how certain diseases, such as shingles and some other neurological conditions, target one area of the body. The letter-number combinations show the relationship between each area and its corresponding sensory nerve. The vertebrae are classified as C for cervical, T for thoracic, L for lumbar, and S for sacral. The trigeminal nerve is the fifth cranial nerve, represented by V.

    Adult dermatome

    illustration

  • Shingles

    Shingles - illustration

    Shingles, or herpes zoster, is caused by the same virus that causes chickenpox. The virus can lie dormant in the body for many years and re-emerge as shingles. Shingles appear as a painful rash. It consists of red patches of skin with small blisters (vesicles) that look very similar to early chickenpox. Shingles usually clears in 2 to 3 weeks and rarely recurs.

    Shingles

    illustration

  • Herpes zoster (shingles) - close-up of lesion

    Herpes zoster (shingles) - close-up of lesion - illustration

    A close-up picture of herpes zoster skin lesions. Four small blisters are shown with redness around them. These vesicles will break, crust over, scab, and finally heal.

    Herpes zoster (shingles) - close-up of lesion

    illustration

  • Herpes zoster (shingles) on the neck and cheek

    Herpes zoster (shingles) on the neck and cheek - illustration

    This is a picture of herpes zoster (shingles) on the neck and cheek. Shingles are caused by the same virus that causes chickenpox. Outbreaks of shingles often follow the distribution of nerves in the skin. This distribution pattern is called a dermatome (see the dermatomes picture).

    Herpes zoster (shingles) on the neck and cheek

    illustration

  • Herpes zoster (shingles) on the hand

    Herpes zoster (shingles) on the hand - illustration

    Shingles occurs more commonly on the chest and back, but can involve the arms and legs. The small blisters on this person's hand represent involvement of the dermatome innervated by the 7th cervical nerve. (See the Dermatomes picture.)

    Herpes zoster (shingles) on the hand

    illustration

  • Herpes zoster (shingles) disseminated

    Herpes zoster (shingles) disseminated - illustration

    Herpes zoster (shingles) normally occurs in a limited area that follows a dermatome (see the dermatome picture). In individuals with damaged immune systems, herpes zoster may be widespread (disseminated), causing serious illness. Herpes zoster is caused by the same virus that causes chickenpox.

    Herpes zoster (shingles) disseminated

    illustration

  • Herpes zoster (shingles) on the arm

    Herpes zoster (shingles) on the arm - illustration

    This is a picture of herpes zoster (shingles) on the arm. Shingles are caused by the same virus that causes chickenpox. Outbreaks of shingles follow the distribution of nerves in the skin. This distribution pattern, seen here on the arm, follows a dermatome.

    Herpes zoster (shingles) on the arm

    illustration

  • Herpes zoster (shingles) on the chest

    Herpes zoster (shingles) on the chest - illustration

    This is a picture of herpes zoster (shingles) on the chest. Shingles are caused by the same virus that causes chickenpox. Outbreaks of shingles often follow the distribution of nerves in the skin. This distribution pattern is called a dermatome. The linear distribution of the nerve in the skin is very easily seen in this photograph.

    Herpes zoster (shingles) on the chest

    illustration

    • Herpes zoster (shingles) on the back

      Herpes zoster (shingles) on the back - illustration

      A classical pattern for shingles. The infection follows a nerve root from the spine, along a rib, to the front of the chest. The area innervated by the nerve is called a dermatome.

      Herpes zoster (shingles) on the back

      illustration

    • Adult dermatome

      Adult dermatome - illustration

      Understanding the nerve distribution along the dermatomes is helpful in determining how certain diseases, such as shingles and some other neurological conditions, target one area of the body. The letter-number combinations show the relationship between each area and its corresponding sensory nerve. The vertebrae are classified as C for cervical, T for thoracic, L for lumbar, and S for sacral. The trigeminal nerve is the fifth cranial nerve, represented by V.

      Adult dermatome

      illustration

    • Shingles

      Shingles - illustration

      Shingles, or herpes zoster, is caused by the same virus that causes chickenpox. The virus can lie dormant in the body for many years and re-emerge as shingles. Shingles appear as a painful rash. It consists of red patches of skin with small blisters (vesicles) that look very similar to early chickenpox. Shingles usually clears in 2 to 3 weeks and rarely recurs.

      Shingles

      illustration

    • Herpes zoster (shingles) - close-up of lesion

      Herpes zoster (shingles) - close-up of lesion - illustration

      A close-up picture of herpes zoster skin lesions. Four small blisters are shown with redness around them. These vesicles will break, crust over, scab, and finally heal.

      Herpes zoster (shingles) - close-up of lesion

      illustration

    • Herpes zoster (shingles) on the neck and cheek

      Herpes zoster (shingles) on the neck and cheek - illustration

      This is a picture of herpes zoster (shingles) on the neck and cheek. Shingles are caused by the same virus that causes chickenpox. Outbreaks of shingles often follow the distribution of nerves in the skin. This distribution pattern is called a dermatome (see the dermatomes picture).

      Herpes zoster (shingles) on the neck and cheek

      illustration

    • Herpes zoster (shingles) on the hand

      Herpes zoster (shingles) on the hand - illustration

      Shingles occurs more commonly on the chest and back, but can involve the arms and legs. The small blisters on this person's hand represent involvement of the dermatome innervated by the 7th cervical nerve. (See the Dermatomes picture.)

      Herpes zoster (shingles) on the hand

      illustration

    • Herpes zoster (shingles) disseminated

      Herpes zoster (shingles) disseminated - illustration

      Herpes zoster (shingles) normally occurs in a limited area that follows a dermatome (see the dermatome picture). In individuals with damaged immune systems, herpes zoster may be widespread (disseminated), causing serious illness. Herpes zoster is caused by the same virus that causes chickenpox.

      Herpes zoster (shingles) disseminated

      illustration

    • Herpes zoster (shingles) on the arm

      Herpes zoster (shingles) on the arm - illustration

      This is a picture of herpes zoster (shingles) on the arm. Shingles are caused by the same virus that causes chickenpox. Outbreaks of shingles follow the distribution of nerves in the skin. This distribution pattern, seen here on the arm, follows a dermatome.

      Herpes zoster (shingles) on the arm

      illustration

    • Herpes zoster (shingles) on the chest

      Herpes zoster (shingles) on the chest - illustration

      This is a picture of herpes zoster (shingles) on the chest. Shingles are caused by the same virus that causes chickenpox. Outbreaks of shingles often follow the distribution of nerves in the skin. This distribution pattern is called a dermatome. The linear distribution of the nerve in the skin is very easily seen in this photograph.

      Herpes zoster (shingles) on the chest

      illustration

    A Closer Look

     

    Self Care

     

    Review Date: 12/4/2022

    Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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