Shingles | Mate huaketo hei

Also known as herpes zoster

Shingles (mate huaketo hei) is a painful blistering rash caused by the herpes zoster virus. It can be prevented by vaccination. Early treatment is important to reduce the risk of ongoing pain.

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Shingles (mate huaketo hei) tingles or hurts and then an itchy rash appears on one side of your body. The rash is in the skin of the infected nerve. It starts as red pimples that blister and then scab over to heal.  The liquid in the blisters is infectious!  Scabs are not. The rash is made up of small blisters that typically scab over after 7–10 days and the pain usually settles in 2–4 weeks.

It can be prevented by vaccination. Early treatment reduces the risk of ongoing pain – a common complication for 1 in 3–4 older people.  It can be prevented by vaccination – a childhood vaccine for chickenpox and a specific vaccine for shingles. It’s free for 65-year-olds.

On this page you can find the following information:

Key points about shingles

  1. Nearly everyone is infected with chickenpox , more than 97% by the age of 40.
  2. About 20–30% of people will get shingles in their lifetime. The annual risk increases from 1–2 per 1000 in those under 50 years of age, to about 5 per 1000 in the 50-55 age group. The risk rises to about 10 per 1000 (1%) of those age 70-80 with peaking of risk for people in their 80s. Overall, for those aged 50 years and over, the risk is about 11% per year at age 65 and rises with age.
  3. Women have a higher risk of getting shingles than men.
  4. The chickenpox virus (varicella zoster) hides in our nerve cells after recovery – defeated by our immune system. As we age our immune system weakens and it invades the infected nerve cell until it reaches the skin.
  5. See your doctor straight away if you think you have shingles and would like medicine to reduce the risk of ongoing pain.
  6. A common complication (in about 1 in 3 or 4 of those aged 50 and over) is long-term pain after the rash has healed. Other complications depend on the site of infection (possible eye or ear damage if the rash is on your face), or if the virus spreads to other places. 
  7. Early antiviral medicine can reduce the risk of complications. 
  8. Vaccination with shingles vaccine reduces your risk of getting shingles and the long-term pain it can cause.

What causes shingles?

If you have had chickenpox, you were infected with the varicella zoster virus. In the past, nearly every child would become infected by the time they were an adult, but now we have a vaccine. When you recover from chickenpox, the virus ‘hides out’ in nerve cells and stays dormant (inactive).

You develop shingles when this dormant virus reactivates. This can happen if your immunity is lowered by getting older, during times of stress or by having cancer treatment or other conditions, eg, HIV, rheumatoid arthritis or type 2 diabetes.

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Is shingles contagious?

Yes, but the infection spread is chickenpox, not shingles. You can catch chickenpox from somebody who has shingles if you are not already immune. Shingles is the late result of chickenpox infection.

The shingles blisters contain a live virus. If you have never had chickenpox and make direct contact with an open blister or something with the fluid on it, you can contract the virus and develop chickenpox. 

A person with shingles is only infectious when the blisters appear, and until the blisters have all developed crusts. It is possible to get shingles more than once.

What are the symptoms of shingles?

Once the virus has been reactivated, it multiplies, spreads and causes pain along the path of the nerve that is infected. This may be on your chest, back, legs or face but on one side of your body only. The infection usually has 3 stages.

Stages of the illness Description
Stage 1 Pain that usually occurs 1–4 days before the rash appears. 
  • The pain is usually the first symptom of shingles.
  • It can appear as a tingling, itching or burning sensation, with stabbing pain every now and again.
  • You may also feel unwell with symptoms such as tiredness, fever and headache.
 Stage 2  A rash that lasts for about 710 days.
  • This may start off as your skin looking red (which is often missed) and you may notice a rash of small blisters over the next 3–4 days.
  • Because the blisters tend to follow nerve paths they’re usually in a line or ‘belt’ which is often from your back around to your tummy, and almost always on just one side.
  • The rash also may appear on one side of your face, neck or scalp.
  • The rash is usually painful, or very sensitive to touch. 
  • About 12 days after the rash, blisters may form, which then turn yellow, dry out and crust over.
  • You are most infectious when your blisters burst. The virus can be spread by other people being in contact with the fluid from the blister.
 Stage 3 Recovery, which takes about 24 weeks.
  • Crusted lesions may be present for 24 weeks.
  • Healing may take longer with people who have weakened immune systems.
  • If the blisters have burst there may be scarring or changes in skin colour for some time after the rash has gone.

Sometimes pain can carry on for months to years after the rash has gone – 1 in 5 people experience it for more than a year. The pain is described as burning, sharp and jabbing, or deep and aching. This is called post-herpetic neuralgia (also called nerve pain). Read more about post-herpetic neuralgia below.

Other complications from shingles infection include glaucoma, vision loss, facial weakness and hearing loss. If you experience any of these, see your GP for advice. 

How is shingles diagnosed?

See your doctor as soon as you think you may have shingles. This should be within 3 days of the rash first appearing for antiviral medication to be most effective in reducing the risk of complications. The earlier that antiviral medication is given, the more effective it is – but it can be given up to 7 days after the rash appears. If it is a holiday period, go to an afterhours clinic. It is particularly important to seek medical advice if your rash is by your eyes or if you are immunosuppressed (your immune system doesn't work well).

To diagnose shingles, your doctor will ask you about your symptoms and will also do an examination. Some people may have pain with no rash or rash with no pain. In such cases, a blood test may be needed to confirm the diagnosis.

How is shingles treated?

The treatment for shingles helps to reduce the severity of the rash and how long it lasts. It also helps in managing the pain associated with shingles. Antiviral medicines help to fight the virus and other medications can be used to manage the pain. There are also a few things that you can do for yourself to ease your symptoms.

Self-care for shingles

  • Keep the affected area clean and dry. Simple absorbent dressings can be used to cover the rash; this will help to prevent passing it on. Sticky (adhesive) dressings should not be used as they can slow healing and cause irritation. Antiseptics should not be used due to a lack of evidence that they are effective. A damp cool cloth on the affected area may relieve itchiness and pain.
  • Wear loose clothing to reduce friction/rubbing of the blisters.
  • Do not scratch the blisters – scratching can spread the virus and cause scarring. Calamine lotion is sometimes used to relieve the itch, but there is limited information about how effective it is.
  • Avoid direct contact with other people, particularly immuno-compromised people (people whose immune systems don't work well), infants/pēpi aged under 1 year and pregnant women.

Antiviral medications

Your doctor may prescribe an antiviral medication, eg, valaciclovir or aciclovir, depending on your age, how long it has been since the rash started and how badly you are affected.

Antiviral medication can reduce the severity and the duration of pain associated with shingles. Antiviral treatment helps by slowing the multiplying virus. It’s best if it’s started within 3 days of the rash but may be started up to 7 days after the rash first appears.

Medications for pain

Pain from shingles can happen during the infection (called acute pain) or may continue for months to years afterward (called post-herpetic neuralgia).

Acute pain

The choice of pain relief will depend on the severity of the pain. For mild-to-moderate pain, paracetamol or a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, is best. If this doesn't work, or for moderate-to-severe pain, stronger pain relievers such as codeine, morphine, tricyclic antidepressants and gabapentin may be used. Read more about pain relief medications.

Post-herpetic neuralgia (ongoing pain)

About 1 in every 3 people who have had shingles go on to have pain that lasts for months or years after the rash has gone. This is a type of nerve pain or neuropathic pain. Read more about post-herpetic neuralgia.

How is shingles prevented?

The best protection against shingles is vaccination. Chickenpox vaccine should prevent you from getting the virus, and so decrease the risk of both chickenpox and shingles. In Aotearoa New Zealand, shingles vaccine (called Zostavax) is available for people over the age of 50. It reduces the risk of getting shingles and its complications – you may still get shingles, but the symptoms are usually less severe and post-herpetic neuralgia is less likely.

  • In Aotearoa New Zealand, the shingles vaccine is free for people aged 65. (A catch-up for older people ended on 31 December 2021).
  • Some people aged under 65 years who are at increased risk of shingles may also want to think about having the vaccination, although it is not funded for this age group.
  • You are at increased risk of shingles if you have a weakened immune system, rheumatoid arthritis, COPD, asthma and diabetes or are a household contact of an immunocompromised person. Read more about the shingles vaccine.

Learn more

The following links provide more information on shingles.

Shingles Ministry of Health, NZ
Shingles NIH Senior Health
Shingles (herpes zoster) DermNet NZ

References

  1. Zoster (herpes zoster/‌shingles) Immunisation Handbook, NZ, 2020
  2. The diagnosis and management of herpes zoster and its complications BPAC, NZ, 2014
  3. Vericella zoster virus (Oka strain) live attenuated vaccine NZ Formulary
  4. Post-herpetic neuralgia DermNet, NZ, 2014
  5. Post-herpetic neuralgia Cleveland Clinic, US, 2021
Credits: Health Navigator Editorial Team. Reviewed By: Dr Osman David Mansoor, Medical Officer of Health, Tairawhiti DHB. Last reviewed: 10 Feb 2022