Shingles | Mate huaketo hei

Also known as herpes zoster

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

On this page you can find the following information:

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.

Image: DermNetNZ.org

Early treatment with antivirals 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.

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 that protects against chickenpox. 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.

Image: 123RF

What are the symptoms of shingles?

Shingles most commonly affects one side of the body, but it can occur on one side of the face. In rare cases (usually in people with weakened immune systems), the rash may be more widespread on the body and look similar to a chickenpox rash.

The infection usually has 3 stages.

Stages of shingles 
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. 

Who is at risk of getting shingles?

Shingles typically affects older people, but it can also occur in healthy younger persons and even in children. Those whose immune systems have been weakened by cancer, HIV infection, AIDS, or treatment with certain medicines are also at increased risk of getting shingles. 

  • Anyone who has had chickenpox is at risk of getting shingles later in life. About 1 in 3 people who have not been immunised against chickenpox or shingles will get shingles in their lifetime.
  • Shingles usually affects older people. The older you are if you get shingles, the higher your risk of getting serious disease. People who have a weakened immune system are also at risk of getting more severe disease, even if they are young.
  • Women have a higher risk of getting shingles than men.
  • Most people who develop shingles have only 1 episode during their lifetime. However, you can have shingles more than once. 

An attack of shingles during pregnancy will not harm the unborn baby. The mother is already carrying the varicella zoster virus before developing shingles and there is no increase in the risk of passing it on to the fetus if shingles develops. However, an attack of chickenpox during pregnancy can be serious and requires urgent medical attention.

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.

Shingles vaccine 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 New Zealand there are 2 brands of vaccines that protect against shingles – Shingrix and Zostavax. These vaccines differ in the way they work, their cost and how they are given. Read more about the differences between Shingrix and Zostavax. 

What are the complications of shingles?

The most common complication of shingles is long-term nerve pain called postherpetic neuralgia. Long term nerve pain occurs in the areas where the shingles rash was, even after the rash clears up. It can last for months or years after the rash goes away. The pain can be very severe and can interfere with daily life. Read more about pain after shingles.

Shingles on the face may lead to complications involving the eye, including blindness. Very rarely, it can also lead to pneumonia (lung infection), hearing problems, or brain inflammation (encephalitis).

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
  6. Who is at risk from shingles Australian Government, 2022
  7. Shingles Australian Government, 2022
Credits: Health Navigator Editorial Team. Reviewed By: Dr Osman David Mansoor, Medical Officer of Health, Tairawhiti DHB. Last reviewed: 10 Feb 2022