Shingles
Also known as Herpes zoster
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is shingles?
Shingles is caused by reactivation of the varicella zoster virus that remains dormant in nerve roots after chickenpox. It produces a painful blistering rash in a band on one side of the body. Antiviral treatment started within 72 hours reduces severity and the risk of lasting nerve pain, and vaccination substantially reduces both.
Causes
- Reactivation of latent varicella zoster virus
- Decline in cell mediated immunity with age
- Immunosuppressive illness or medicines
- Physical or emotional stress in some cases
Symptoms
- Burning, tingling or pain in a band on one side
- Rash appearing days after the pain begins
- Fluid filled blisters that crust over
- Rash respecting the midline in a single dermatome
- Fever and headache
- Persistent nerve pain after the rash heals
- Eye involvement if the ophthalmic nerve is affected
Risk factors
- Age over 50
- Weakened immune system
- Cancer treatment or immunosuppressive therapy
- HIV infection
- Physical trauma
- Long term corticosteroid use
Diagnosis
- Clinical diagnosis from the dermatomal rash
- PCR of blister fluid in uncertain cases
- Urgent ophthalmology review if the eye or nose tip is involved
- Consideration of Ramsay Hunt syndrome with facial weakness
Treatment
- Antiviral therapy such as aciclovir within 72 hours of rash onset
- Adequate analgesia, including neuropathic agents
- Keeping the rash clean and covered
- Shingles vaccination for prevention in older adults
- Early specialist referral for eye involvement
- Treatment of postherpetic neuralgia with amitriptyline or gabapentin
Self care
- Start antivirals within 72 hours of the rash appearing
- Keep the rash clean, dry and covered
- Wear loose cotton clothing
- Use cool compresses for comfort
- Take pain relief regularly rather than waiting
- Avoid contact with pregnant women, newborns and immunosuppressed people until crusted
- Do not use topical antibiotic creams on the rash
When to see a doctor
Book an appointment if:
- Any suspected shingles, ideally within 72 hours
- Rash on the face, especially near the eye or nose tip
- Pain persisting after the rash heals
- Rash not crusting after ten days
- Shingles while immunosuppressed
- Recurrent episodes
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Shingles vaccination for older adults, which is highly effective
- Vaccination also reduces postherpetic neuralgia risk
- Maintain general health and manage stress
- Chickenpox vaccination in childhood prevents later shingles
- Discuss vaccination before planned immunosuppression
Outlook
The rash usually crusts within seven to ten days and heals over two to four weeks. Pain typically settles with it, but postherpetic neuralgia persists in a proportion, particularly over 60, and can last months. Early antiviral treatment and vaccination both substantially reduce that risk. Eye involvement needs specialist care to protect vision.
Common questions
Can shingles be caught from someone?
You cannot catch shingles itself, but someone who has never had chickenpox or the vaccine can catch chickenpox from contact with the blister fluid. Covering the rash prevents this.
What is postherpetic neuralgia?
Nerve pain that persists after the rash heals, sometimes for months or years. It becomes more likely with age, and early antiviral treatment and vaccination both reduce the risk.
Why is shingles near the eye urgent?
Herpes zoster ophthalmicus can cause corneal damage, uveitis and permanent vision loss. A rash on the forehead or the tip of the nose warrants same day ophthalmology assessment.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.