What is Shingles?

What is Shingles?

Shingles, also known as herpes zoster, is a viral infection that results in a painful rash on the face or body. In the early stages, shingles can feel like a burning, tingling, or painful sensation, eventually developing into a rash and can cause shooting pain. The rash can look like a band of red blisters that usually affects one side of the body and typically dry up and scab over within one to two weeks. Even though shingles are not life-threatening, if gone untreated, the virus that causes shingles can lead to other life-threatening conditions such as encephalitis, stroke, or meningitis.

Shingles is caused by the varicella-zoster virus, which is the same virus that leads to chickenpox. When someone has had chickenpox as a child, the virus remains in the body even after symptoms disappear. The virus can become active again in the form of shingles when the person who developed chickenpox reaches adulthood and more often affects older adults. While there is no cure, there are vaccines to lower the risk of shingles and treatments for its symptoms.

Are Shingles Contagious?

The virus that causes shingles is contagious and can spread from person to person by direct contact. It has also been known to spread, in rare cases, by airborne transmission. If the fluid from the blisters comes in contact with a person who has not had chickenpox or the chickenpox vaccine, the person will contract the virus that causes chickenpox and will be able to develop shingles later in life. If a person has already had chickenpox or the chickenpox vaccine, antibodies against the virus will already be present in the body.

Since the chickenpox virus can spread via direct contact, shingles in parents can cause chickenpox in their children. To reduce the risk of spreading the virus to others, people with shingles should keep their rash completely covered until the blisters scab over. The virus cannot spread before the blisters appear or after the blisters have scabbed over.

Stages of Shingles

Stages

Three stages are commonly associated with shingles:

  1. The pre-eruptive stage happens before the rash appears and is characterized by pain, or less commonly, itching at specific locations on the body along one or more nerves. This may also result in symptoms such as headaches, fatigue, light sensitivity, and sometimes fever. This stage can last from one to ten days but lasts about 48 hours for most people.
  2. The acute eruptive stage is characterized by more severe pain and the appearance of a rash that begins as a discoloration of the skin and progresses to cause fluid-filled blisters. The virus can easily be spread to others during this stage, so covering the blisters is strongly recommended until the blisters eventually dry up and scab over. This stage typically lasts one to two weeks, though full healing of the skin may take weeks longer. The rash and blisters cause permanent skin discoloration and scarring for some people.
  3. The chronic stage, is characterized by a recurring pain that persists more than four weeks after the blisters have healed. The pain can be very severe and debilitating, and it can last for weeks, months, or years. Symptoms at this stage can also include burning sensations, tingling sensations, numbness, and possibly nerve damage. It is especially common in elderly adults to experience recurring shingles pain.

Signs & Symptoms of Shingles

Symptoms

For most people, the most noticeable shingles symptoms include pain and a band of blisters that develops around one side of the body. For some people, it may affect one side of the face or neck, but the rash can appear anywhere on the body.

General signs and symptoms of shingles include:

  • Pain
  • Burning, itching, or tingling sensations on the skin
  • A red rash that appears shortly after the pain is first experienced
  • Fluid-filled blisters that break open and scab over
  • Headache
  • Fatigue
  • Fever
  • Light sensitivity, mostly in more severe neurological case

People experiencing signs and symptoms of shingles should immediately contact a doctor, especially if they are pregnant, over 50, have weakened immune systems, or experience symptoms near the eye or on the face. Early treatment  should start as soon as possible to reduce the risk of further complications.

What Do Shingles Look Like?

The shingles rash usually appears as a band of red, fluid-filled blisters. In most people, the rash stretches across one side of the torso or flank (upper abdomen or back and sides). In rare instances, the rash can appear on both sides. Another common place for the rash to appear is one side of the forehead or surrounding one eye. However, the rash can appear anywhere on the body.

What Causes Shingles?

Causes

Shingles are caused by the varicella-zoster virus, which is the same virus that leads to chickenpox. When someone has had chickenpox as a child, the virus remains in the body even after symptoms disappear. The virus can become active again in the form of shingles when the person reaches adulthood, and the condition more often affects older adults.

About one-third of Americans will develop shingles throughout their lifetime. According to the CDC, more than 99% of Americans born before 1980 have chickenpox, even if they do not remember having it because they were too young or it was a mild case and are therefore at risk of developing shingles.

Risk Factors for Shingles

Risk Factors

Anyone who has had chickenpox is at risk of getting shingles, but the risk increases with age. People with weakened immune systems due to illness or long-term stress also risk developing shingles. Our immune systems can keep the virus dormant, but if the immune system is weakened, the virus can become active again.

Risk factors for shingles include:

  • Age. The risk of shingles is significantly higher in adults over the age of 60.
  • HIV (Human immunodeficiency virus). This virus attacks and weakens the immune system.
  • Certain cancers. Some cancers such as leukemia or lymphoma can weaken the immune system.
  • Certain cancer treatments. Receiving certain cancer treatments such as chemotherapy or radiation treatment can temporarily weaken the immune system.
  • Immunosuppressant drugs. Medications that suppress the immune system include steroids, such as those used to treat psoriasis, or medication administered after an organ transplant.
  • Long-term stress. Long-term stress or trauma weakens the immune system because it lowers the body’s white blood cell count, which reduces the ability to fight off infection.
  • Recent childbirth. Having a baby can dramatically impact the immune system.

Shingles Prevention

Prevention

Vaccines are available for children and adults to reduce the risk of chickenpox and shingles. The CDC recommends that children, adolescents, and adults who have never had chickenpox receive the varicella (chickenpox) vaccine, which contains a weakened form of the virus so that the immune system starts producing antibodies that will protect against it. Two doses are recommended for optimal effectiveness, and most states require children to have two doses before beginning the school year.

Shingrix is a vaccine that is currently recommended by the CDC to help prevent shingles. There are no documented cases of transmission of the varicella-zoster virus from people who have received this shingles vaccine. It is recommended that adults over the age of 50 receive the vaccine in two doses, with two to six months between doses. Shingrix is also recommended for adults 18 years of age and older who have weakened immune systems.

For someone who currently has shingles, covering the blisters until they scab over will help prevent the spread of the virus to others.

Shingles vaccine side effects

Side effects may be experienced after receiving the shingles vaccine, but they will usually go away in two to three days. Possible side effects may include:

  • Soreness, redness, pain, or swelling at the injection site
  • Fatigue
  • Headache
  • Stomachache or nausea

These side effects are more common in younger people. Allergic reactions to the shingles vaccine are possible, but rare. You should wait to get the vaccine if you currently have shingles, are moderately or severely ill, have a fever, or are pregnant or breastfeeding.

Get Care

Trust NewYork-Presbyterian for Comprehensive Shingles Care

If you or a loved one are experiencing symptoms of shingles, contact a doctor immediately so that treatment can begin as soon as possible. NewYork-Presbyterian offers flexibility and care for your individual needs by scheduling same-day appointments for critical needs and early, late, or weekend appointments to best fit your schedule. NewYork-Presbyterian accepts most insurances and will refer you to our experienced and compassionate medical specialists as needed.

We utilize a patient portal, making connecting with your medical team and viewing medical records easier. Schedule an appointment or video visit with one of our healthcare professionals or at a medical group location and learn more about how we can diagnose shingles and the treatment options we offer.