Shingles: symptoms, causes, treatment

Think of a bad dream you had when you were a kid. Your memory of that dream is tucked away somewhere in your brain. It's possible that—now or later in your life—that bad dream could come back to haunt your sleep again. 

Shingles is kind of like that bad dream. It's caused by a virus that can live in your body for many years and can eventually re-flare and make you sick.

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Shingles is the common name for a viral syndrome called herpes zoster. The varicella-zoster virus causes it. That’s the same viral infection that causes chickenpox (Nair, 2021).

If you’ve had chickenpox, the varicella-zoster virus can live quietly inside your nervous system or spinal cord. After years or decades of inactivity, that virus can reactivate and cause shingles (CDC-a, 2019).

The main symptom of shingles is a painful skin rash. That shingles rash usually consists of one or more clusters of fluid-filled blisters, which often rupture and leak.

These blisters emerge over three to five days. They usually show up on one side of the body or face, although they can also be widespread (Nair, 2021).  

The most common presentation of the shingles rash is a strip or band of blisters—called a dermatome—that appears around one of your sides and near your waistline, like a belt (NINDS, 2019). This also explains the term "shingles,” which comes from the Latin word "cingulum," which means belt. 

Before these blistery rashes appear, you may feel burning pain, itching, or tingling on the parts of the skin where the rashes will develop. Once the blisters appear, they tend to rupture and scab over within 7–10 days. They usually clear up after two to four weeks (CDC-b, 2019). If new lesions are still showing up more than a week after their initial appearance, that may be a sign that your immune system isn’t working right (Dworkin, 2007).

Some other symptoms of shingles include (Nair, 2021) (CDC-b, 2019):

• Severe pain

• Fever

• Fatigue

• Headache

• Chills

• Upset stomach

• Itchy skin

Once the blistering rash and other symptoms have gone away, shingles usually doesn't come back again. Fewer than 1% of shingles patients have a second episode (Harbecke, 2020).

Very common. According to the Centers for Disease Control and Prevention (CDC), roughly one out of every three Americans will get shingles at some point (Harpaz, 2008).

Anyone who has ever had chickenpox is at risk for shingles. And if you were born before 1980, there’s a 99% chance that you had chickenpox—even if you don’t remember having it (CDC-c, 2019).

Since the late 1990s and early 2000s, many Americans have received the chickenpox vaccine, which also protects against shingles (Gruver, 2020).

If you’ve ever had chickenpox, you’re at risk.

Apart from your history of chickenpox, shingles is much more common among older adults—those aged 65 and older—than among younger people. Estimates vary, but some researchers have pegged the risk for shingles at between one and three cases per 1,000 people for healthy adults under age 65. Meanwhile, that risk roughly triples among those older than 65 (Nair, 2021).

People who have a weak immune system are also at greater risk for shingles. This includes people who have HIV, those who have received an organ transplant, and those undergoing chemotherapy (NINDS, 2019).

Why does the long-dormant zoster virus suddenly flare? Experts aren’t 100% sure. But most now believe that a weakened immune system—either due to old age, illness, or one of the other factors mentioned above, such as an organ transplant—allows the virus to reactivate.

Once the virus reactivates, it starts to replicate (make copies of itself) inside of nerve cells. Some of these copies make their way down the nerves to the skin, where they tend to cause inflammation, blistering, pain, and other symptoms (Nair, 2021). 

There are several possible complications from shingles. 

Postherpetic neuralgia

For some people, shingles can turn into a chronic (long-term) pain condition. That condition is called postherpetic neuralgia, and it's the most common complication linked to shingles. By some estimates, 10–15% of people with herpes zoster will develop postherpetic neuralgia. Individuals older than 60 years of age account for 50 percent of these cases (Drolet, 2010). The older you are, the greater your risk.

For people with postherpetic neuralgia, the pain usually lingers around the site of the shingles rash. That pain tends to be cutting or burning, and it continues for three months or longer after the initial outbreak (Gruver, 2020).

Bacterial infection

About 2% of people with shingles develop a bacterial infection of the blisters, which can delay healing. Bacterial infections are more common among people with weak immune systems. Antibiotics are the go-to treatment (Albrecht, 2021).  

Brain inflammation (encephalitis)

This brain inflammation usually starts as delirium (confusion) a few days after the first blisters appear. But this delirium can also set in before the blisters or soon after they have healed.

It's more common among people with weakened immune systems, those who have had previous or widespread shingles outbreaks, and those who have blisters on their head or neck (Albrecht, 2021). 

Herpes zoster ophthalmicus (HZO)

This complication describes shingles that have infected cranial nerves related to the eyes and vision. Between 8% and 20% of people with shingles will develop HZO, which can cause permanent vision loss. 

This complication may begin with a headache, fever, and fatigue. You may also notice numbness or pain in or around your eye, on your forehead, or on the top of your head. Also, if you have blisters or rash on your nose, this is highly connected to HZO. Early treatment is critical, so don’t delay in seeing a medical professional (Albrecht, 2021). 

Other complications

Some other shingles complications are (Nair, 2021) (CDC-d, 2019):

• Scarring at the site of the blisters

• A bacterial infection of the blisters, which can delay healing. This complication affects about 2% of shingles cases.  

• Nerve problems or numbness

• Pneumonia

• Ear inflammation and hearing problems

In some cases, a health care professional can diagnose shingles based on its telltale blisters and other symptoms. But in other cases—especially among younger people or those with weak immune systems—these symptoms may not provide enough information for an accurate diagnosis.

If a medical professional can’t diagnose you based on your symptoms alone, several tests can identify whether you’re dealing with shingles. The primary test involves a swab of one of your lesions, followed by a lab analysis of the swab (CDC-e, 2019).

If you think you have shingles, you should see a medical professional immediately. Prompt treatment can reduce the chances that you’ll go on to develop postherpetic neuralgia, bacterial infections, or other complications (Nair, 2021).

The sooner you start treatment, the more effective these treatments tend to be (CDC-f, 2019). A doctor can also determine if you're dealing with shingles or if it's another type of skin condition such as herpes simplex (Nair, 2021).

The main treatment for shingles is a prescription antiviral medication. Antivirals stop the virus from multiplying. Ideally, you should start taking these drugs as soon as possible—ideally within 72 hours after your rash appears. The most commonly prescribed are acyclovir, valacyclovir (see Important Safety Information), and famciclovir (Albrecht, 2021). These drugs speed up the disappearance of blisters, reduce pain, and lower the risk of complications like postherpetic neuralgia (Nair, 2021). Again, the sooner you can start on these, the better. So don’t delay before seeing a medical professional (CDC-f, 2019).

If you experience pain, which is typical, prescription and non-prescription treatments can also be helpful. Non-prescription options include over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen. If your pain is severe, your doctor may prescribe a stronger pain medication (Albrecht, 2021).

Finally, wet compresses, calamine lotion, and colloidal oatmeal baths can help with itching or discomfort (CDC-f, 2019).

Not exactly.

If you have shingles, the varicella-zoster virus can spread to someone else (like a partner or child) who comes into direct contact with the fluid from your blisters. But if that happens, the person you infect would develop chickenpox, not shingles. That person could later develop shingles. The lesions are considered non-infectious after crusting (Albrecht, 2021).

You can’t spread the virus to someone who has already had it. Likewise, you are not at risk of “catching” shingles from someone else unless you have never had chickenpox and are not vaccinated against the varicella-zoster virus.

It’s also possible that someone could catch the varicella virus by inhaling aerosols released by the fluid in shingles blisters. By covering up your active shingles blisters, you help shut off all these transmission routes (CDC-a, 2019). 

The best way to cover your blisters is with a new, non-stick bandage. Be sure to wash your hands very well after bandaging (or touching) your blisters (AAD, n.d.). 

Again, if you’ve ever had chickenpox, you’re at risk for shingles. And because pretty much every person older than 50 has had chickenpox, the Centers for Disease Control and Prevention (CDC) now recommends that all healthy adults 50 and older get the shingles vaccine. No test for a prior varicella infection is required. 

This vaccine (Shingrix) involves two separate shots in your upper arm. A medical professional will give you these shots two-to-six months apart. The CDC recommends the shingles vaccine even if you’ve already had shingles. The vaccine is 90% effective at preventing new shingles outbreaks (CDC-g, 2018).

Shingles is often a manageable, one-time problem. But in some cases—especially if you don't get treated immediately or if your immune system is weakened—it can lead to serious and lasting complications. Speak with your healthcare provider

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

July 21, 2021

Written by

Health Guide Team

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.