Shingles is a painful rash that develops on one side of the face or body. The rash forms blisters that typically scab over in 7 to 10 days and clear up within 2 to 4 weeks. Most commonly, the rash occurs in a single stripe around either the left or the right side of the body. In other cases, the rash occurs on one side of the face. In rare cases (usually among people with weakened immune systems), the rash may be more widespread and look similar to a chickenpox rash.
Shingles is very common. Fifty percent of all Americans will have had shingles by the time they are 80. While shingles occurs in people of all ages, it is most common in 60- to 80-year-olds. In fact, one out of every three people 60 years or older will get shingles.
What Causes Shingles?
Shingles is caused by a reactivation of the chickenpox virus. It is distinctive because it affects only one side of the body. The early signs of shingles usually develop in three stages: severe pain or tingling, possibly itchy rash, and blisters that look like chickenpox.
The virus that causes shingles is a herpes virus, (Another name for shingles is herpes zoster.) Once you are infected with this kind of virus, it remains in your body for life. It stays inactive until a period when your immunity is down.
Shingles and Pain
The most common complication of shingles is pain — a condition called post-herpetic neuralgia (PHN). People with PHN have severe pain in the areas where they had the shingles rash, even after the rash clears up. In most patients, the pain usually clears up in a few weeks or months, but some people can have pain from PHN for years. Persistent pain from shingles is a common symptom in people over 60. In fact, one out of six people older than 60 years who get shingles will have severe pain.
As people get older, they are more likely to develop long-term pain as a complication of shingles and the pain is likely to be more severe.
Shingles may also lead to other serious complications.
- Outbreaks that start on the face or eyes can cause vision or hearing problems. Even permanent blindness can result if the cornea of the eye is affected.
- Bacterial infection of the open sores can lead to scarring.
- In a very small number of cases, bacteria can cause more serious conditions, including toxic shock syndrome and necrotizing fasciitis, a severe infection that destroys the soft tissue under the skin.
- The burning waves of pain, loss of sleep, and interference with even basic life activities can cause serious depression.
- In patients with immune deficiency, the rash can be much more extensive than usual and the illness can be complicated by pneumonia. These cases are more serious, but they are rarely fatal.
- Very rarely, shingles can also lead to pneumonia, brain inflammation (encephalitis), or death.
Shingles Usually Does Not Return
People who develop shingles usually have only one episode in their lifetime. However, a person can have a second or even a third episode.
The Shingles Vaccine
Adults 60 years old or older should talk to their healthcare professional about getting a one-time dose of the shingles vaccine. The vaccine can reduce your risk of shingles and the long-term pain it can cause. If you have already had shingles or you have a chronic medical condition, you can receive the shingles vaccine. (See more about the shingles vaccine in the chapter “Prevention.”)
Is Shingles Contagious?
Shingles cannot be passed from one person to another. However, the virus that causes shingles, the varicella zoster virus, can be spread from a person with active shingles to another person who has never had chickenpox. In such cases, the person exposed to the virus might develop chickenpox, but they would not develop shingles.
The virus is spread through direct contact with fluid from the rash blisters caused by shingles. A person with active shingles can spread the virus when the rash is in the blister phase. A person is not infectious before the blisters appear. Once the rash has developed crusts, the person is no longer contagious.
Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.
If You Have Shingles
If you have shingles,
- keep the rash covered
- avoid touching or scratching the rash
- wash your hands often to prevent the spread of varicella zoster virus.
Until your rash has developed crusts, avoid contact with
- pregnant women who have never had chickenpox or the chickenpox vaccine
- premature or low birth weight infants
- people with weakened immune systems, such as people receiving immunosuppressive medications or undergoing chemotherapy, organ transplant recipients, and people with human immunodeficiency virus (HIV) infection.
If you have not had chickenpox and you come into contact with someone who has shingles, ask your healthcare provider whether you should get a chickenpox vaccination.