Shingles is an infection of a nerve and the area of skin around it. It is caused by the herpes varicella-zoster virus, which also causes chickenpox.
Most people have chickenpox in childhood, but after the illness has gone, the virus remains dormant (inactive) in the nervous system. The immune system (the body’s natural defence system) keeps the virus in check, but later in life it can be reactivated and cause shingles.
Shingles usually affects a specific area on either the left or right side of the body. The main symptoms are:
See Shingles - symptoms for more information.
It is estimated that about 3 people in every 1,000 have shingles in the UK every year.
Shingles can occur at any age, but is most common in people who are over 50 years of age. Among people who are over 80 years of age, about 11 people in every 1,000 have shingles each year. Shingles is much less common in children.
It is unknown exactly why the shingles virus is reactivated at a later stage in life, but it may be due to having lowered immunity (protection). This may be the result of:
In most cases, the painful rash of shingles lasts 7 to 10 days and takes 2 to 4 weeks to fully heal. A number of different medicines can be used to treat the pain.
Complications can occur after you have had shingles, such as postherpetic neuralgia (see Shingles - complications). This is where severe nerve pain lasts for more than three months after the rash has gone.
It is estimated that postherpetic neuralgia affects at least 1 in 10 people with shingles. It is more common in older people, and affects around one-third of people who are over 80 and who have shingles.
An episode of shingles usually lasts two to four weeks. The first sign of the condition is a tingling sensation in the affected area, followed by pain and then a rash.
Any part of your body can be affected by the rash and pain of shingles, although the chest and abdomen (tummy) are most commonly affected. You may also:
Shingles may cause some early (prodromal) symptoms that last for one to four days before the rash first appears. These early symptoms can include:
Not everyone will experience these prodromal symptoms. In particular, a high temperature is uncommon.
Along with the early symptoms above, people with shingles experience a localised ‘band’ of pain in the affected area.
The pain caused by shingles can be a constant, dull or burning sensation and its intensity can vary from mild to severe. You may have sharp stabbing pains from time to time and the affected area of skin will usually be tender.
The pain is less common in young, healthy people and is rare in children. The pain can last for more than a week before the rash begins.
The shingles rash usually follows several days after the start of the pain. The rash appears on one side of your body and develops on the area of skin that is related to the affected nerve.
Initially, the shingles rash appears as red blotches on your skin, before quickly developing into itchy blisters that are similar in appearance to chickenpox. New blisters may appear for up to a week, but about three days after appearing they become yellowish in colour, flatten and dry out.
Finally, scabs form where the blisters were, which may leave some slight scarring. It usually takes two to four weeks for the rash to completely heal.
The symptoms of shingles are often mild. However, see your GP as soon as possible if you have the symptoms of shingles. Early treatment may help reduce the severity of your symptoms and your risk of developing complications.
Seek immediate medical treatment if you have any of the following symptoms:
See your GP if you develop the symptoms of shingles and you are pregnant or you have a weakened immune system (the body’s natural defence system).
Shingles is caused by the reactivation of the varicella-zoster virus, which is the virus that causes chickenpox (a highly infectious condition that most people have during childhood).
Chickenpox causes an itchy rash that blisters and then crusts over.
After you have had chickenpox, the varicella-zoster virus lies dormant (inactive) inside your body. It can later be reactivated and cause shingles.
It is not known exactly how the varicella-zoster virus is reactivated, but it may be linked to having lowered immunity (protection).
Your immunity to illness and infection can become lowered if there is a problem with your immune system (the body’s natural defence system). This can happen as a result of:
Your GP can diagnose shingles from your symptoms and the appearance of your rash. Testing is not usually necessary.
If your GP feels that you are at risk of developing complications or if they are unsure about your diagnosis, they may refer you to a specialist. Who you are referred to will depend on your circumstances, but it could be:
If you have a weakened immune system (the body’s natural defence system), you may need to be referred to a specialist so that your condition can be closely monitored. This is because you are at greater risk of developing complications. A referral is not always necessary, but will depend on your circumstances.
You may have a weakened immune system if you:
You will also be referred to a specialist if:
Children may be referred if their rash is extensive (covers most of their body) or if they are particularly unwell.
If your GP suspects that your eyes are being affected by shingles (ophthalmic shingles, see Shingles - symptoms), you may be referred to an ophthalmologist (a doctor who specialises in treating eye conditions).
Signs that your eyes may be affected include:
If you have eye problems that are caused by shingles, it is very important to see an ophthalmologist. This is because you are at risk of losing some of your vision if ophthalmic shingles is not treated.
It is not possible to catch shingles from someone else with the condition. The shingles virus is reactivated from a previous infection with the varicella-zoster virus (the virus that causes chickenpox) and is not transmitted by person-to-person contact.
However, it is possible for someone who has never had chickenpox to catch chickenpox from someone with shingles. In the UK, chickenpox is so common during childhood that 9 out of 10 adults have had it, so will not be affected.
The blisters (vesicles) that develop as a result of shingles contain virus particles. The virus can be spread through direct contact with the open blisters. If you have not had chickenpox before (usually as a young child), you can catch it from direct contact with:
If you have shingles, you are contagious until the last blister has scabbed over. This will usually occur five to seven days after your symptoms started.
Spreading the virus
If you have the shingles rash:
This will help prevent the virus being passed on to someone who has not had chickenpox.
If you have shingles, avoid:
Once your blisters have dried out and scabbed over, you are no longer contagious and you will not need to avoid anyone.
There is no cure for shingles, but treatment can help ease your symptoms.
If you develop the shingles rash:
Calamine lotion has a soothing, cooling effect on the skin and can be used to relieve the itching. An antihistamine (a medicine that is often used to treat allergies) may also be useful for preventing itching at night. Before you use an antihistamine, read the manufacturer’s instructions or ask your pharmacist for advice.
To ease the pain caused by shingles, your GP may prescribe a painkilling medicine (analgesic). Several different painkilling medicines may be used, including:
These are described in more detail below. For children, your GP will seek further advice, for example from a paediatrician (a specialist in the care of children and babies) if paracetamol and NSAIDs are not effective at relieving the pain.
The most commonly used painkiller is paracetamol, which is available over-the-counter (OTC) without a prescription. Always read the manufacturer’s instructions to make sure that the medicine is suitable for you and that you are taking the correct dose.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are an alternative type of painkilling medicine, which are also available OTC. However, NSAIDs may not be suitable for you if you:
Ask your GP or pharmacist if you are unsure about whether you should take NSAIDs.
For more severe pain in adults, your GP may prescribe a weak opioid, such as codeine. This is a stronger type of painkiller which is likely to be prescribed with paracetamol. An even stronger opioid, such as morphine, is unlikely to be prescribed by your GP unless they seek specialist advice first.
If you have severe pain as a result of shingles, you may be prescribed an antidepressant medicine.
Antidepressants are commonly used to treat depression, but they can also be useful in managing the pain caused by shingles. Antidepressants may be particularly useful if you have experienced severe or prolonged pain.
The antidepressants that are used to treat shingles pain are known as tricyclic antidepressants. Tricyclic antidepressants affect the levels of certain chemicals in your body. The most commonly prescribed tricyclic antidepressants are:
Side effects of tricyclic antidepressants may include:
If you have shingles, you will usually be prescribed a much lower dose of tricyclic antidepressants than if you were being treated for depression. This will usually be as a tablet to take at night. Your dose may be increased until your pain settles down. It may take several weeks before you start to feel the antidepressants working, although this is not always the case.
As with antidepressants, anticonvulsants are most commonly associated with treating another condition. Anticonvulsants are often used to control seizures (fits) caused by epilepsy.
However, anticonvulsants can also help manage nerve pain. They work by stabilising electrical nerve activity within your brain. Gabapentin is the most commonly prescribed anticonvulsant for shingles pain.
Side effects of gabapentin may include:
As with antidepressants, you will have to take gabapentin for several weeks before you notice it working. If your pain does not improve, your dose may be gradually increased until your symptoms are effectively managed.
As well as painkilling medication, some people with shingles may also be prescribed an antiviral medicine.
This type of medicine cannot kill the shingles virus, but it can help stop it multiplying. Antiviral medicine may:
Antiviral medicines are most effective when they are taken within 72 hours (three days) of your rash appearing. However, they may be started up to a week after your rash appears if you are at risk of severe shingles or developing complications.
Commonly prescribed antiviral medicines include:
You will usually have to take this type of medicine for seven days.
If you are over 50 years of age and you have the symptoms of shingles, it is likely that you will be prescribed an antiviral medication. You may also be prescribed antiviral medication if you have:
If you are pregnant and you have shingles, it is likely that your GP will discuss your case with a specialist to decide whether the benefits of antiviral medication significantly outweigh any possible risks.
Shingles will not harm your unborn baby. If you are under 50 years of age, you are at less risk of developing complications from shingles. If this is the case, you may not need antiviral medication.
Antiviral medication is not usually necessary for children because children:
If your child is otherwise healthy, antiviral medicines are not likely to be of significant benefit, so they may not be prescribed.
A number of possible complications can occur as a result of shingles. They are more likely to occur if you have a weakened immune system (the body’s natural defence system) or if you are elderly.
Possible complications include:
Ophthalmic shingles is where shingles affects part of the trigeminal nerve (the nerve that controls sensation and movement in your face). This can cause complications that affect your eye, including:
Ophthalmic shingles may cause vision loss if it is not treated.
Ramsay Hunt syndrome is a complication that can occur if shingles affects certain nerves in your head. In America, Ramsay Hunt syndrome is estimated to affect 5 people in every 100,000 every year and it may affect a similar number of people in the UK.
Ramsay Hunt syndrome can cause:
Ramsay Hunt syndrome is usually treated with following medications:
The earlier treatment is started, the better the outcome. Around three-quarters of people who are given antiviral medication within 72 hours (three days) of the start of their symptoms usually make a complete recovery. If treatment is delayed, half of those treated will recover completely.
You may be more likely to have some permanent facial palsy (paralysis) if:
Around 1 in 20 people with Ramsay Hunt syndrome may experience some degree of permanent hearing loss.
Postherpetic neuralgia is the most common complication of shingles. Estimates vary, but postherpetic neuralgia is thought to affect one or two people in every 10 who have shingles. The condition becomes more common with age, and affects one-third of people over 80.
Postherpetic neuralgia can cause severe nerve pain (neuralgia) that persists after the rash and any other symptoms of shingles have gone. If you have pain for more than three months after your shingles rash has gone, you may have postherpetic neuralgia.
Types of pain that can be experienced by people with postherpetic neuralgia include:
Postherpetic neuralgia may be treated with a number of different painkilling medicines.
Peripheral motor neuropathy is a complication that affects one or two people in every 20 who have shingles. It is more common in elderly people.
Neuropathy means nerve damage. In this case, it is damage to a peripheral motor nerve (a nerve that controls movement). Peripheral motor neuropathy usually affects a single limb, such as an arm or leg, causing paralysis in that limb. It is usually possible to make a full recovery.
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