Immunizations

Shingles (zoster)

Shingles is a painful rash caused by reactivation of the chickenpox virus. Early treatment can reduce complications. Learn about symptoms, risks, treatment and when to seek care.

Shingles occurs when the varicella zoster virus, which causes chickenpox, reactivates after lying dormant in your nerve cells. This leads to a painful, localized rash that requires prompt attention.

Common Symptoms

  • Early signs: Pain, burning, tingling, numbness, or increased sensitivity in a band or patch of skin on one side of the body. Some people may experience flu-like symptoms such as fever or headache before the rash appears.
  • Rash: Red, blistering, usually forming a single stripe on one side of the torso but can affect the face, neck, or eye area. Blisters form, break, crust over, and heal within two to four weeks.
  • Pain: Can range from mild to severe and may begin before the rash appears. Postherpetic neuralgia, lingering nerve pain, can persist for months after the rash heals.

Causes and Risk Factors
Shingles is caused by reactivation of the varicella zoster virus in nerve cells. Risk factors include:

  • Age over 50
  • Weakened immune system from medical conditions or treatments
  • Physical or emotional stress
  • Previous chickenpox infection

Diagnosis

  • Clinical: Most cases are diagnosed based on the typical rash and nerve pain.
  • Laboratory: Fluid from a blister can be tested if the diagnosis is uncertain. Blood tests are not useful for confirming active shingles.

Complications

  • Postherpetic neuralgia (persistent nerve pain)
  • Shingles near or in the eye, which can cause vision loss
  • Bacterial infection of the rash

When to Seek Care and Prevention
Seek care promptly if you notice a painful, blistering rash, especially on your face or near your eyes, or if your immune system is weakened. Antiviral medicines are most effective when started within 72 hours of rash onset and can reduce severity and complications.

Vaccination with the recombinant zoster vaccine is recommended for most adults 50 and older to lower the risk of shingles and postherpetic neuralgia. TidalHealth can help with questions about symptoms, pain, and prevention.

Is shingles contagious?
Shingles can spread the virus to someone who has never had chickenpox or the chickenpox vaccine. They would develop chickenpox, not shingles. The virus spreads through direct contact with fluid from shingles blisters. Covering the rash and practicing good hygiene reduces the risk.

How long does shingles last?
The rash and blisters usually last two to four weeks. Pain can begin before the rash and, in some people, persist for months as postherpetic neuralgia.

Can shingles come back?
Yes, though most people have only one episode. Recurrence risk is higher with a weakened immune system.

Will the shingles vaccine prevent it completely?
No vaccine is 100% effective, but the recombinant zoster vaccine (Shingrix) significantly lowers the risk of shingles and its complications. Two doses are recommended for most adults 50 and older.

When should I see a doctor?
See a provider as soon as you suspect shingles, ideally within 72 hours of rash onset. Seek urgent care if the rash is near your eye, if you have a weakened immune system, are pregnant, or develop signs of infection.

What treatments help with symptoms and pain?
Early antiviral medicines can shorten the illness and reduce complications. Pain may be managed with over-the-counter or prescription medications, topical treatments, or nerve pain medications. Your provider can create a personalized plan.

Can I work or go to public places with shingles?
Avoid close contact with people who have never had chickenpox, those with weakened immune systems, pregnant women, and newborns until the rash crusts over. Check with your provider or employer about work restrictions.

Is laboratory testing always needed?
No. Most cases are diagnosed clinically. Testing fluid from a blister may be done if the rash is unusual or if you are at higher risk for complications.

What are serious complications to watch for?
Seek care immediately for a rash near the eye, sudden vision changes, severe headache with stiff neck, high fever, confusion, or a rapidly spreading or infected-looking rash.

Can pregnant women get shingles or pass it to the baby?
Pregnant women who have never had chickenpox can develop it if exposed to someone with shingles. Shingles during pregnancy should be managed with an OB practitioner. Newborns and pregnant women exposed to the virus may need special care.