Shingles
Created: 09.01.2025
Updated 13.10.2026
Approved by: Consultant Dermatologist, Dr James Denny
What is shingles?
Shingles, also known as herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox.
After recovering from chickenpox, the virus remains dormant within the body's nerve cells. Years or even decades later, it can reactivate and develop shingles. Approximately one in three people will experience shingles during their lifetime, with the condition becoming more common after the age of 50.
Shingles is not spread from person to person in the same way as chickenpox. However, someone with active shingles can transmit the varicella-zoster virus to a person who has never had chickenpox or the chickenpox vaccine, causing them to develop chickenpox rather than shingles.
The virus is spread through direct contact with fluid from the blisters until they have crusted over.
Who is at risk?
Anyone who has previously had chickenpox can develop shingles.
Common risk factors include:
- Increasing age, particularly over 50 years
- A weakened immune system
- Cancer treatment or immunosuppressive medication
- Chronic illness
- Significant physical or emotional stress
People with weakened immune systems are more likely to develop severe disease and complications.
What are the symptoms?
The symptoms of shingles often begin before the rash appears.
Early symptoms may include:
- A tingling or painful feeling on one side of the body
- Burning or itching skin
- Headache
- Sensitivity to light
- Feeling generally unwell
Within a few days, a characteristic shingles rash develops.
The rash usually:
- Appears on one side of the body or face
- Follows the path of a single nerve
- Develops into groups of fluid-filled blisters
- Crusts over within 7 to 10 days
- Heals over 2 to 4 weeks
Shingles affects the chest, back, abdomen, or face most commonly, although it can occur anywhere on the body.
Pain can range from mild discomfort to severe nerve pain.
How is shingles diagnosed?
A dermatologist or healthcare professional can usually diagnose shingles from its characteristic appearance and distribution.
Further investigations are rarely required. However, laboratory testing may occasionally be performed when the diagnosis is uncertain or when the rash appears unusual.
Early diagnosis is important because antiviral treatment is most effective when started promptly.
What are the treatments?
Treatment aims to reduce symptoms, shorten the duration of the illness, and lower the risk of complications.
Antiviral medicines
Antiviral medicines, including aciclovir, valaciclovir, and famciclovir, are the mainstay of treatment.
They are most effective when started within 72 hours of the rash developing and may:
- Reduce the severity of the infection
- Shorten recovery time
- Lower the risk of postherpetic neuralgia
Patients with facial involvement, eye symptoms, or weakened immune systems should seek urgent medical assessment, as treatment may still be beneficial beyond 72 hours.
Pain management
Pain relief depends on symptom severity and may include:
- Paracetamol or ibuprofen
- Prescription pain medication
- Medications for nerve pain, such as gabapentin or pregabalin
Topical preparations such as calamine lotion or lidocaine patches may help soothe irritated skin.
Self-care
Helpful measures include:
- Keeping the rash clean and dry
- Wearing loose-fitting clothing
- Avoiding scratching the blisters
- Resting and staying well hydrated
Until all blisters have crusted over, avoid close contact with:
- Pregnant women who are not immune to chickenpox
- Newborn babies
- Individuals with weakened immune systems
- People who have never had chickenpox or the chickenpox vaccine
What are the possible complications?
Most people recover fully, but serious complications can occur, particularly in older adults and those with weakened immune systems.
These include:
- Postherpetic neuralgia, where nerve pain persists after the rash has healed
- Eye involvement (herpes zoster ophthalmicus), which can threaten vision
- Secondary bacterial skin infection
- Rare neurological complications
Prompt treatment significantly reduces the likelihood of long-term complications.
Can shingles be prevented?
Vaccination is the most effective way to reduce the risk of shingles.
The Shingrix vaccine is recommended for older adults and certain people with weakened immune systems. It substantially lowers the risk of developing shingles and postherpetic neuralgia.
Maintaining overall health and managing underlying medical conditions may also help support immune function, although shingles cannot always be prevented.
What is the prognosis?
The outlook for shingles is generally excellent when diagnosed and treated early.
Most people recover within two to four weeks, although nerve pain may persist for several months in some individuals.
Early assessment by a dermatologist is particularly important for facial shingles, severe pain, recurrent episodes, or when the diagnosis is uncertain.
Frequently Asked Questions (FAQs)
Can you get shingles if you've never had chickenpox?
No. Shingles only develops in people who have previously been infected with the varicella-zoster virus. If you have never had chickenpox or the chickenpox vaccine, exposure to someone with shingles may cause chickenpox, not shingles.
What are the first signs of shingles?
The earliest symptoms are often a tingling, burning, or painful sensation on one side of the body, followed by the appearance of a blistering rash a few days later. Some people also experience headaches, fever, or sensitivity to light.
How quickly should shingles be treated?
Antiviral medicines work best when started within 72 hours of the shingles rash appearing. Prompt medical assessment is especially important if the rash affects the face or eyes, or if you have a weakened immune system.
Is shingles contagious?
Shingles itself cannot be passed from one person to another. However, the virus can spread through direct contact with blister fluid and cause chickenpox in someone who has never had chickenpox or been vaccinated against it.
When should I see a dermatologist for shingles?
You should seek specialist advice if the diagnosis is uncertain, the rash affects your face or eyes, symptoms are severe, pain persists after the rash heals, or you have a weakened immune system. Early treatment helps reduce the risk of long-term complications.
