Herpes Zoster (Shingles)

Medically reviewed by The Dermatologists and written by Dr. Alexander Börve

Last updated on Sept 10, 2024

Herpes zoster, also known as shingles, is a viral skin condition originating from the chickenpox virus – varicella zoster virus. Even after symptoms of chickenpox go away, the virus still remains in the body, causing the viral skin infection years after the chickenpox first presents.

Herpes Zoster (Shingles) causing painful, red, fluid-filled blisters on the upper torso. The clusters of blisters are a classic symptom of the reactivation of the varicella-zoster virus

You will only get herpes zoster only if you have had chickenpox before. Both men and women of all ages can get shingles, but It is most common in people over 50 years old. For most people, the pain will disappear within one to three months. Older people with shingles sometimes experience very persistent pain that can be difficult to treat. Individuals with a weakened immune system may get a more serious form of the disease and can sometimes require hospitalization. After contracting herpes zoster, the immune system will prevent future outbreaks. The virus spreads through direct contact.

Symptoms

Shingles is marked by painful, stinging blisters on one side of the body. The rash occurs almost always only on one side of the body and then in the same area of the affected area on the other side.

The first symptom of shingles is usually an intense pain in one area of the skin. They often also tingle, itch, and ache. The rash occurs in a stripe pattern, which distinguishes it from hives.

Red rash caused by Herpes Zoster (Shingles) on the right leg, showing a classic presentation of painful, inflamed skin distributed along a nerve pathway.

Typically shingles appear on the upper body, but it can occur anywhere on the body. Headache and fever are also other common symptoms. After one to three days, the rash in the affected areas will turn into blisters. In the beginning, the blisters are clear, but they gradually darken.

Shingles eventually heal by itself – the rash dries up within one to two weeks and then the scabs fall off after a week. The pain in the affected area usually disappears within a few months. However, for older people, there is a fairly high risk that the pain will remain for a very long time.

Red rash on the neck caused by Herpes Zoster (Shingles), featuring visible dark patches and open blisters, showing typical progression as the rash advances.

Shingles is rare in pregnant women. However, the disease is in a more severe from for pregnant women than in others. If a pregnant woman gets shingles and she has had chickenpox before, the fetus will already have antibodies against chickenpox.

If you have shingles, you should avoid contact with pregnant women who have not had chickenpox. This applies especially to women who are late in pregnancy, as there is a risk that the child has chickenpox when it is born, which can be a serious condition.

What can I do?

Sometimes you can get a bacterial infection of the skin after wounds of the blisters. To avoid infections, you should shower and keep the skin clean, and also cover the blisters with an airy dressing. Avoid scratching and tearing blisters.

A cool shower, calamine lotion and cold alsol solution can relieve itching, while prescription pain medications containing acetaminophen can relieve pain.

If the prescription drugs do not help, contact your healthcare provider to get appropriate treatment. You will be primarily treated the pain with painkillers or anti-inflammatory medications. In some cases, it may be necessary to use morphine preparations or nerve blocks.

Should I seek medical care?

It can be hard to determine if you have shingles without a diagnosis or medical examination. If you are older than 50 years or have a weakened immune system, you should promptly consult a physician if you suspect shingles. Regardless of age, you should contact your doctor if you have severe pain, rash on the face (near your eyes) or feel very sick.

The doctor will then decide if the virus infection should be treated with drugs, which is known as anti-viral treatment. For an effective treatment must start within 72 hours after the rash starts to appear. If you have a rash on the face, especially the eyelids or nose tip, make sure to have an ophthalmologist check the eye in an ophthalmic microscope to see if the cornea is damaged.

Shingles and Eye Involvement (Ocular Shingles)

Herpes zoster (shingles) can sometimes affect the face, including areas around the eye, and is known as herpes zoster ophthalmicus (HZO). This condition involves the reactivation of the varicella-zoster virus near the eye, leading to a rash on the forehead, eyelids, or scalp, and can potentially affect the eye itself.

Symptoms to Watch For:

If shingles involves the eye area, you may notice:

• Red, painful rash on the forehead, scalp, or around the eyes.
• Eye discomfort, redness, sensitivity to light, or blurred vision.
• Eyelid swelling or discharge.

Involvement of the eye can cause complications, such as keratitis (inflammation of the cornea) or other forms of eye inflammation that may lead to vision impairment. For this reason, it’s crucial to seek medical attention if the shingles rash appears near your eye.

Why Early Treatment is Crucial:

If shingles affects your face or eye, early treatment is key to preventing lasting damage. Antiviral medications, when started within 72 hours of rash onset, can significantly reduce the risk of severe eye complications and reduce pain duration. Treatment with oral antivirals is important to reduce the risk of corneal scarring and more serious eye conditions.

Seeing an Ophthalmologist:

If you notice a rash on your forehead, eyelid, or scalp, it’s important to see a dermatologist or general practitioner promptly. Additionally, an ophthalmologist (eye specialist) may need to examine your eye to ensure there is no damage to the deeper structures, such as the cornea or retina. This examination can prevent long-term vision problems or even blindness.

Treatment

The rash heals within 2-4 weeks, but nerve pain can remain for months. The rash pain can be reduced with topical creams. The shingles vaccine can prevent herpes zoster, and antiviral drugs can reduce symptoms if started within 72 hours after the rash appears.

Treatment with anti-virus lasts for a week and is taken in tablet form. Most people tolerate the medication without problems. However, despite the short duration of treatment, there can be a few side effects for some people. The most common side effects include headache, abdominal pain, vomiting and diarrhea. The treatment may also provide more serious symptoms such as confusion, hallucinations and affected alertness. The risk of these side effects increases with weaker kidney function, which is most common among older people. The risk of serious side effects may also increase if you do not drink enough fluids.

Prevention with Vaccination

The best way to prevent shingles and its complications is through the shingles vaccine (Shingrix). Shingrix is over 90% effective at preventing shingles and postherpetic neuralgia (PHN) in adults 50 years and older with healthy immune systems. By preventing shingles, the vaccine also reduces the risk of serious complications, such as PHN—a form of long-term nerve pain that can be debilitating.

The Shingrix vaccine is recommended for adults over 50 years and adults 19 years and older with weakened immune systems. It is administered in two doses, spaced 2 to 6 months apart, and provides strong protection against shingles and its complications. Although there is no specific claim that Shingrix prevents ocular shingles, reducing the risk of shingles overall can help prevent severe complications, including those that could affect the eye.

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