Shingles: Symptoms, Causes, and Treatment

Shingles, or herpes zoster, is a viral infection caused by the same virus that leads to chickenpox. It appears as a painful rash, usually on one side of the body. After chickenpox, the virus lies dormant in nerve tissue near the spinal cord and brain. Years later, it can reactivate as shingles. The risk rises with age, especially after 50. The CDC estimates that 1 in 3 people will develop shingles in their lifetime. While it cannot spread as shingles, the virus can cause chickenpox in someone who hasn’t had it before. Doctors can identify it by its distinctive rash pattern.

In plain words

Shingles is a painful rash caused by the same virus as chickenpox. After you have chickenpox, the virus stays in your body. Years later, it can wake up and cause shingles. The rash usually appears on one side of your body or face. It can cause burning, itching, or sharp pain. About 1 in 3 people will get shingles in their lifetime. It's more common in older adults. The shingles vaccine can help prevent it. You can't give shingles to someone else, but the rash can spread chickenpox to people who never had it.

What is Shingles: Symptoms, Causes, and Treatment?

Symptoms

Early symptoms

Burning or tingling sensation: A burning or tingling sensation in a specific area, usually on one side of the torso, face, or neck, often precedes the rash. (2) (7)
Pain: Pain is often the most prominent symptom, described as deep aching, itching, or stabbing, usually on one side of the body. (2) (7)
Redness and rash: A rash of red spots develops within a few days, turning into fluid-filled blisters. The rash follows nerve pathways, often appearing in a stripe. (2) (7)
Flu-like symptoms: Some people experience flu-like symptoms, including fever, headache, and fatigue, before the rash appears. (2) (7)

Serious or emergency symptoms

Rash near the eye: If the rash affects the eye (herpes zoster ophthalmicus), it can threaten vision and requires immediate medical attention. Seek emergency care right away. (2)
Facial paralysis: Ramsay Hunt syndrome, a severe form of shingles affecting facial nerves near the ear, can cause hearing problems or facial paralysis. Seek emergency care right away. (2)
Widespread blistering: Disseminated zoster, resembling chickenpox, can occur in people with weakened immune systems and requires urgent medical care. Seek emergency care right away. (2)
Severe headache or confusion: These symptoms could indicate viral spread to other organs and require immediate medical attention. Seek emergency care right away. (2)

Causes

Primary causes

Reactivation of varicella-zoster virus: Shingles is caused by the reactivation of the varicella-zoster virus (VZV), the same virus responsible for chickenpox. After chickenpox resolves, VZV remains dormant in nerve cells. (1) (7)
Weakened immune system: Reactivation often occurs when the immune system weakens due to age, stress, illness, or medications that suppress immunity. (1) (7)
Not contagious as shingles: Shingles itself is not contagious, but open blisters can pass VZV to others who are not immune, potentially causing chickenpox. (1) (7)

Risk factors

Age

The risk of shingles increases with age, especially after 50. About half of shingles cases occur in those over 60. (3)

Weakened immune system

People with weakened immune systems due to diseases like HIV or cancer, or medications such as chemotherapy or steroids, are at increased risk. (3)

Previous chickenpox infection

Having had chickenpox is a prerequisite for developing shingles, though most adults in the U.S. meet this criterion. (3)

Trauma or extreme stress

Trauma or extreme stress may play a role in triggering shingles in some cases. (3)

Diagnosis

Doctors typically diagnose shingles by the rash’s appearance — its stripe-like pattern on one side of the body is distinctive. They may also ask about pain or tingling before the rash emerged. In unclear cases, a swab of blister fluid can confirm VZV in a lab. MedlinePlus notes that tests are rarely needed unless the presentation is atypical, like in people with very weak immunity where the rash might spread more widely.

Treatment

Medication options

Antiviral medications

Antiviral drugs are most effective if started within 72 hours of the rash appearing. They won’t cure shingles but can speed healing, reduce pain severity, and lower the risk of complications. (5) (8)

Pain relievers

Over-the-counter pain relievers may help milder cases. Severe pain may require prescription pain relievers or numbing patches. (5) (8)

Antidepressants and anticonvulsants

For postherpetic neuralgia — persistent pain after the rash clears — doctors might prescribe antidepressants or anticonvulsants that affect nerve pain signals. (5) (8)

Lifestyle and self-care

Shingles vaccine: The CDC strongly recommends the shingles vaccine (Shingrix) for adults 50+, even if you’ve had shingles before. It’s over 90% effective at preventing shingles and postherpetic neuralgia. Two doses are needed, 2-6 months apart. (3)
Keep the rash clean and dry: Clean the rash area gently and keep it dry to prevent bacterial infections. Loose clothing can reduce irritation. (3)
Cool compresses: Applying cool compresses or calamine lotion may ease itching and discomfort. (3)
Avoid contact with high-risk individuals: Until scabs form, avoid contact with pregnant women, newborns, and those with weak immunity to prevent spreading the virus. (3)

Always discuss dosing and treatment changes with your own prescriber.

Possible complications

Postherpetic neuralgia: Postherpetic neuralgia (PHN) — lingering nerve pain after the rash clears — is the most common complication, affecting up to 18% of shingles patients. PHN risk rises with age. (6)
Bacterial skin infections: Scratching the rash can lead to bacterial skin infections, which may require antibiotics. (6)
Vision loss: If shingles affects the eye (herpes zoster ophthalmicus), it can lead to vision loss if not treated promptly. (6)
Neurological problems: Shingles affecting facial nerves can lead to neurological problems like balance issues or facial paralysis. (6)

When to see a doctor

Routine follow-up

Seek medical advice within 3 days of rash onset for best antiviral results. Early treatment can reduce the severity and duration of symptoms. (4) (8)
Those with weak immune systems should contact a doctor right away — they may need intravenous antivirals. (4) (8)

Seek emergency care

Seek immediate care if the rash is near an eye to prevent vision damage. (4) (8)
Call emergency services if you experience severe headache, confusion, or difficulty breathing, which could indicate viral spread to other organs. (4) (8)

Frequently asked questions

What is Shingles?

Shingles, or herpes zoster, is a viral infection caused by the reactivation of the chickenpox virus. It appears as a painful rash, usually on one side of the body. The risk rises with age, especially after 50. (1) (4)

What are the first signs of Shingles?

Early signs include tingling, burning, or numbness in a specific area, usually on one side of your torso, face, or neck. This is often followed by redness and a rash of small blisters within a few days. (2) (4)

What causes Shingles?

Shingles is caused by the reactivation of the varicella-zoster virus (VZV), the same virus responsible for chickenpox. Reactivation often occurs when the immune system weakens due to age, stress, illness, or medications that suppress immunity. (1) (7)

How is Shingles treated?

Treatment includes antiviral medications like acyclovir, valacyclovir, or famciclovir, which are most effective if started within 72 hours of the rash appearing. Pain relievers and lifestyle measures like cool compresses can also help. (5) (8)

Can Shingles be cured?

Shingles cannot be cured, but early antiviral treatment can speed healing, reduce pain severity, and lower the risk of complications like postherpetic neuralgia. (5) (8)

References

CDC — About Shingles source 1
CDC — Shingles Signs & Symptoms source 2
CDC — Shingles Vaccination source 3
NHS — Shingles source 4
NHS — Shingles - Treatment source 5
MedlinePlus — Shingles source 6
Mayo Clinic — Shingles - Symptoms and causes source 7
Mayo Clinic — Shingles - Diagnosis and treatment source 8