Shingles

What is shingles?

Shingles is a painful, blistering skin condition triggered when the chickenpox virus, which has been lying dormant in your nerves, wakes up again years later. It usually shows up as a band of blisters on just one side of your body.

What are the symptoms of shingles?

Shingles often starts a few days before any rash appears, with:

• tingling, burning or pain in one area of skin
• a headache or a general feeling of being unwell
• sometimes a mild fever or chills.

The rash itself usually follows on your chest or abdomen, though it can appear anywhere, including your face, eyes or genitals. It shows up as blotches on one side of your body only – a rash on both sides at once is unlikely to be shingles.

These blotches turn into itchy, fluid-filled blisters, with new ones appearing for up to a week, before they turn yellowish, flatten, dry out and scab over, usually within 7 to 10 days. On brown or black skin, the redness can be harder to spot than the raised texture of the rash itself.

The pain can range from a mild, constant ache to something severe, with occasional sharp, stabbing sensations, and the skin in the area is usually tender to touch.

The rash itself generally needs around a month to fully heal, and the skin can stay sore for some time even after it's gone. Rarely, shingles causes this kind of pain with no rash at all.

What causes shingles and who is at risk?

The virus behind shingles is varicella-zoster, which is what gives people chickenpox in the first place. Once you've had chickenpox, that virus doesn't leave your body – it lies inactive in your nerve cells, sometimes for decades, and can reactivate later in life, particularly once your immune system naturally weakens with age.

You can only get shingles if you've had chickenpox before. Things that make it more likely to appear include:

• being over 50, with risk continuing to rise as you get older
• having a weakened immune system, for example due to HIV, certain cancers, an organ transplant, or medicines such as steroids or chemotherapy
• periods of high stress, illness, or other conditions such as diabetes, chronic kidney disease or lung disease.

You can't catch shingles from someone else, and having shingles doesn't spread shingles to others.

However, if you haven't had chickenpox or the chickenpox vaccine, you can catch chickenpox through direct contact with fluid from someone's shingles blisters. This risk is low once the rash is covered, and there's no risk at all before blisters appear or once they've scabbed over.

A second or even third episode of shingles can happen, though this is uncommon unless your immune system is significantly weakened.

Are there different types of shingles?

Most cases follow the same pattern: a single stripe of rash confined to one side of the torso. A few variations are worth knowing about, though:

• shingles affecting the eye or the area around it, which needs urgent medical attention because of the risk to your sight
• Ramsay Hunt syndrome, a rarer form where shingles affects the nerve serving your face and ear, which can cause facial weakness and hearing problems
• a more widespread rash, which can happen in people with significantly weakened immunity
• very rarely, the pain of shingles without any rash appearing at all.

How is shingles diagnosed?

Shingles is usually diagnosed from its appearance alone, alongside a discussion of your symptoms and medical history. A band of blisters that follows the path of a single nerve, on only one side of your body, is a strong clue in itself.

If there's any doubt, for example if the rash looks unusual, a small sample of fluid from a blister can be sent to a lab to confirm the virus.

How is shingles treated?

There's no cure for shingles, and no surgical treatment applies, since it's a viral infection rather than a structural problem, but medication can shorten the illness and ease symptoms.

A mild rash may need no treatment at all. Antiviral tablets are usually offered where your immunity is already lowered, where the discomfort or the rash itself is more than mild, or where blisters have spread past your torso. These work best when started within about 3 days of the rash first appearing, so it's worth getting help quickly rather than waiting to see if it settles.

Other medicines that can help include:

• paracetamol or other over-the-counter painkillers
• steroid tablets or medicines aimed specifically at nerve pain, for more severe discomfort
• steroid treatment if the rash affects your eyes or face.

You can also help yourself at home while you recover:

• keep the affected skin clean and covered with something loose and non-sticky
• try a cool, damp compress or calamine lotion to soothe itching
• avoid rough fabrics against the rash, and make sure any dressing doesn't stick as it's removed
• avoid antibiotic cream on the rash, as this can slow healing
• avoid close contact with anyone who hasn't had chickenpox, particularly pregnant women, babies under a month old, and people with weakened immunity, until your blisters have fully scabbed over
• stay off work or school while the rash is still oozing and can't be covered.

Most people feel better within 2 to 4 weeks. Even after the rash clears, the skin underneath can stay tender or painful for a while longer.

When should I see a doctor?

If you're 18 or over, speak to a pharmacist as soon as you notice symptoms of shingles, ideally within 3 days of the rash appearing, so treatment can work as effectively as possible.

Beyond that, get same-day GP advice, or contact an out-of-hours or equivalent urgent care service, if you have shingles symptoms and:

• you're pregnant, or breastfeeding with the rash on your breast
• the rash is on or near your eye or nose, or you notice any change in your vision
• your immune system is significantly compromised
• you're 17 or younger.

Get emergency medical help if you develop a severe headache, sensitivity to light, a stiff neck, confusion, facial or muscle weakness, or if any of these appear alongside the rash, since these can be signs of a rarer but serious complication.