Shingles is a painful, itchy skin rash that usually appears on your chest, but can also affect your trunk, back, legs or face. It is caused by the varicella zoster virus, the same virus responsible for chickenpox. It is more common in the elderly and people with weakened immune systems. Treatment works best within 2 to 3 days of the rash appearing. Vaccination with the shingles vaccine can reduce your risk of shingles and the long-term pain it can cause.
- About 1 out of every 3 people will get shingles in their lifetime, with the risk rising to 1 in 2 for adults who live to 85 years old.
- Shingles is caused by the same virus (varicella zoster) that causes chickenpox.
- See your doctor straight away (within 48 hours) if you think you have shingles.
- Complications include long-term pain after the rash has healed, and possible eye or ear damage if the rash is on your face.
- Antiviral medication can reduce the risk of complications.
- There is a vaccine to help prevent shingles.
What causes shingles?
If you have been infected with the varicella zoster virus, you will most likely get chickenpox. Symptoms may be very mild or severe. When you recover from chickenpox, the virus stays in your body – it 'hides out' in your spinal nerve cells and can lie dormant (inactive) for many years.
You develop shingles when this dormant virus is reactivated. This can happen if your immunity is lowered, such as by cancer treatment, HIV or ageing or other illnesses, such as rheumatoid arthritis and type 2 diabetes or during times of stress.
Is shingles contagious?
You cannot catch shingles from someone with the condition or from someone with chickenpox. However, you can catch chickenpox from someone with shingles if you haven't had chickenpox before. The shingles blisters contain live virus. If a person who has never had chickenpox makes direct contact with an open blister or something with the fluid on it, they can contract the virus and develop chickenpox. A person with shingles is not infectious before the blisters appear or once the rash has developed crusts.
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, which 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 to 4 days before the rash appears.
|Stage 2|| A rash that lasts for about 7 to 10 days.
|Stage 3||Resolution, which takes about 2 to 4 weeks.
How is shingles diagnosed?
To diagnose shingles, your doctor will ask you about your symptoms and 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.
See your doctor as soon as you think you may have shingles. This should be within 48–72 hours of the rash first appearing, so you can be given antiviral medication to reduce the risk of complications. The earlier that antiviral medication is given, the more effective it is. If it is a holiday period, go to an afterhours clinic.
How is shingles treated?
The treatment for shingles helps to reduce the severity of the rash and its duration and to manage the pain. There are a few things that you can do to ease your symptoms. Antiviral medicines help to fight the virus and other medications can be used to manage the pain.
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.
- 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 on its effectiveness.
- Avoid direct contact with other people, particularly immuno-compromised people, infants aged under one year and pregnant women.
- It is possible to get shingles more than once.
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 and is usually continued for 7 to 10 days, but it 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).
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 is not effective, or for moderate-to-severe pain, stronger pain relievers such as codeine, tramadol, 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. The choice of pain relief will depend on the severity of the pain.
- Generally, for mild pain, your doctor may prescribe capsaicin cream, where a small amount of cream is rubbed onto the painful area of your skin 3 to 4 times a day. It is only applied on healed skin and not on blisters as it can cause a painful burning feeling.
- For moderate-to-severe pain, your doctor may prescribe pain relievers such as amitriptyline, nortriptyline or gabapentin. If this does not relieve your pain, then stronger pain relievers may be considered, but referral to a pain management specialist may also be needed.
Read more about post-herpetic neuralgia.
How is shingles prevented?
In 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 New Zealand, one dose of the shingles vaccine is funded for people aged 65 years, or for people aged between 66 and 80 years inclusive from 1 April 2018 and 31 December 2020.
- 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 group. You are at increased risk of shingles if you have a weakened immune system, rheumatoid arthritis, COPD, asthma and diabetes. Read more about shingles vaccine.
The following links provide more information on shingles.
- Zoster (herpes zoster/shingles) Immunisation Handbook, NZ, 2020
- The diagnosis and management of herpes zoster and its complications BPAC, NZ, 2014
Angela is a pharmacist in the Quality Use of Medicines Team at Waitematā District Health Board. She has experience in hospital pharmacy in New Zealand and in the UK, and was previously a medical writer for Elsevier in The Netherlands. Angela is interested in promoting the safe use of medicines, particularly high-risk medicines.