Shingles: Symptoms, Urgent Warning Signs, and Who Is at Higher Risk

Shingles is an infection that causes a painful rash [1]. It happens when the varicella-zoster virus (VZV), the virus that causes chickenpox, reactivates in the body of someone who has already had chickenpox [2]. The rash usually appears on one side of the body or face [3][4]. If you think you have shingles, get advice as soon as possible: in the UK from a pharmacist or NHS 111 [1], and in the US from your doctor [4].

What Causes Shingles

After you recover from chickenpox, usually as a child, the virus continues to live in some of your nerve cells. For many adults, it stays inactive and never leads to shingles [4]. Shingles occurs when the virus reactivates later in life, often when the immune system is weakened [5]. This can be because of stress, certain conditions or treatments [1].

First Signs Before the Rash

The first signs of shingles can be a tingling or painful feeling in an area of skin, and a headache or feeling generally unwell [1]. The first sign is often burning or tingling pain, sometimes with numbness or itching on one side of the body [4], and pain, itching, tingling or numbness usually occurs before the rash [5]. People can also have a fever before the rash appears [3].

The timing varies: a rash will usually appear a few days later [1], pain, itching or tingling in the area where the rash will develop can happen several days before the rash appears [3], a red rash will appear somewhere between one and five days after the tingling or burning feeling starts [4], and these early signs can happen days or even weeks before the rash [5].

In rare cases, shingles can cause pain without a rash [1].

What the Shingles Rash Looks Like

Shingles usually develops in a small area on just one side of the body or face, because the reactivated virus travels in a specific nerve [4]. The rash most commonly appears in a single stripe around the left or right side of the body [3]. It usually shows up on the chest and tummy, but it can appear anywhere on the body, including the face, eyes and genitals [1].

The rash starts as blotches on the skin on one side of the body only, and a rash on both the left and right of the body is unlikely to be shingles [1]. The blotches become itchy blisters that ooze fluid, and a few days later the blisters dry out and scab [1]. The rash can be red, but this can be harder to see on brown and black skin [1].

How much it hurts can vary a lot. The pain can be intense and is often described as burning, throbbing or stabbing [5]. For some people, the symptoms are mild and they might just have some itching. For others, shingles can cause intense pain that can be felt from the gentlest touch or breeze [4].

Other Symptoms

Along with the rash, shingles can also cause fever, headaches, chills and an upset stomach [3][4]. Some people may also experience fatigue [5].

Sometimes the rash is more widespread on the body and looks similar to a chickenpox rash. This is very rare and usually occurs in people with weakened immune systems [3].

When to Get Urgent Help

If the Rash Is on Your Face or Near Your Eye

A rash in and around the eye can make it sore and red. It can affect your sight or hearing and make it hard to move one side of your face [1]. Shingles on the face can affect the eye and cause vision loss [3].

• The World Health Organization (WHO) notes that the rash can also appear on the face, sometimes near the eye: "If it occurs near the eye, it is a medical emergency. Contact your health-care provider right away." [5]
• In the US, NIA advises: "If you notice blisters on your face, see your doctor right away because this could be an urgent problem. Blisters near or in the eye can cause lasting eye damage and blindness." [4]

In the UK

The NHS advises: "Ask for an urgent GP appointment or get help from NHS 111 if:" "You have symptoms of shingles and:" [1]

• you're pregnant
• you're breastfeeding and the shingles rash is on your breasts
• the rash is on your eye or nose
• you have changes to your vision
• you have a severely weakened immune system, for example, from chemotherapy
• you're 17 years old or younger

"You might need medicine to help speed up your recovery and avoid longer-lasting problems." "This works best if you start taking it within 3 days of the shingles rash appearing." "You can call 111 or get help from 111 online." [1]

Who Is More Likely to Get Shingles

Anyone who has had chickenpox can develop shingles [5]. You're more likely to get shingles, and more likely to have serious problems from it, as you get older or if you have a severely weakened immune system [6].

• Age: shingles is much more common in adults over the age of 50 [5]. About half of all shingles cases are in adults age 60 or older, and the chance of getting shingles becomes much greater by age 70 [4].
• A weakened immune system: the risk of shingles and serious complications also increases with medical conditions that keep the immune system from working properly, such as certain cancers like leukemia and lymphoma, and HIV infection [2].
• Other conditions: diabetes, chronic kidney disease and lung disease may increase the risk [5].
• Stress: periods of high stress may temporarily weaken the immune system, potentially triggering a shingles outbreak [5]. Even stress or a cold can weaken your immune system for a short time [4].

Possible Complications

Most people recover from shingles without any problems [1]. The most common complication is long-term nerve pain called postherpetic neuralgia, or PHN [3].

PHN occurs where the shingles rash was, even after the rash clears up, and it can last for months or years after the rash goes away. It is extremely painful and can interfere with daily life, and the risk of PHN increases with age [3]. The pain can contribute to depression, anxiety, sleeplessness and weight loss. While there is no cure, PHN can be treated, and for most people it will lessen over time [4].

Other complications can include [1]:

• scarring or changes in skin colour after the rash has healed
• muscle weakness
• eye problems, which can lead to sight loss
• Ramsay Hunt syndrome, a rare condition where shingles affects your facial nerve, causing weakness on one side of your face and sometimes hearing problems

The shingles rash can also become infected with bacteria [3].

Very rarely, shingles can lead to an infection of the lungs (pneumonia), hearing problems, inflammation of the brain (encephalitis) or death [3]. In rare cases, it can also lead to stroke [5].

People with weakened immune systems are more likely to have complications from shingles, and more likely to have a severe, long-lasting rash [3]. Getting treatment as soon as possible after your symptoms start can reduce the risk of complications [1].

Is Shingles Contagious?

You cannot get shingles from someone who has shingles [2]. But the virus can spread to someone who has never had chickenpox or the chickenpox vaccine, and they would get chickenpox, not shingles [1][5][7].

People who never had chickenpox or didn't get chickenpox vaccine can get the virus through direct contact with the fluid from shingles rash blisters [2][5], and by breathing in virus particles that come from the blisters [2]. People with shingles cannot spread the virus before the blisters appear or after the rash scabs over [2], and once the blisters crust over, the risk of spreading the virus is very low [5]. In the UK, you can only spread the infection to other people while the rash oozes fluid, and you should stay off work or school if the rash is still oozing fluid (weeping) and cannot be covered, or until the rash has dried out [1].

You can cover the rash with loose clothing or a non-sticky dressing [1]. To protect others, avoid touching or scratching the rash, and wash your hands often for at least 20 seconds [2].

Avoid contact with the following people [1][2][5]:

• anyone who is pregnant and has not had chickenpox [1][2][5] or chickenpox vaccine [2][5]
• people with a weakened immune system [1][2][5], like someone having chemotherapy [1]
• babies less than 1 month old [1], newborns [5], and premature or low birth weight infants [2]

In the US, keep away from them until your rash scabs over [2].

Getting Seen and Treatment

In the UK, the NHS advises seeing a pharmacist if you have symptoms of shingles and you're 18 years old or older, and trying to see one within 3 days of the rash appearing [1]. Treatment depends on how severe your symptoms are and whether you're at risk of complications, and if you have a mild rash you may not need any treatment [1].

In the US, NIA says it's important to see your doctor no later than three days after the rash starts. The doctor will confirm whether you have shingles and can make a treatment plan, and most cases can be diagnosed from a visual examination [4]. The CDC advises contacting your doctor as soon as possible to talk about treatment if you think you have shingles [2].

Easing Symptoms at Home

These things can help with the symptoms [1]:

• keep the rash clean and dry to reduce the risk of infection
• wear loose-fitting clothing
• use a cool compress (a bag of ice cubes or frozen vegetables wrapped in a towel, or a wet cloth) a few times a day
• do not let dressings or plasters stick to the rash
• do not wear clothes with rough fibres that can irritate your skin

Other tips that might help you feel better [4]:

• Apply a cool washcloth to your blisters to ease the pain and help dry the blisters.
• Keep the area clean and try not to scratch the blisters so they don't become infected or leave a scar.
• Get plenty of rest and eat well-balanced meals.
• Avoid stress as much as possible. It can make the pain worse.

How Long Shingles Lasts

The NHS, CDC and NIA each give a different length of time:

• The NHS: it can take up to 4 weeks for the rash to heal, and your skin can be painful for weeks after the rash has gone, but it usually gets better over time [1].
• The CDC: the blisters typically scab over in 7 to 10 days and clear up within 2 to 4 weeks [3].
• NIA: most cases of shingles last three to five weeks [4].

Shingles in Pregnancy and in Children

If you're pregnant and get shingles, it's mostly mild and there's usually no risk to you or your baby [1]. In the UK, a GP should arrange for a specialist to advise on whether you need treatment [1]. Children can have shingles, but it is not common [2].

The Shingles Vaccine

Vaccination is the best way to protect yourself from shingles [2], and a safe and effective vaccine is available to prevent shingles and its complications [5]. The vaccine helps reduce your risk of getting shingles, and if you get shingles after being vaccinated, the symptoms can be much milder [1]. You can get shingles more than once, so it's important to get vaccinated even if you've had shingles before [1].

• In the UK, the NHS says: "Ask your GP or care team if you're not sure if you're eligible for the shingles vaccine." [6]
• In the US, NIA advises talking with your doctor before getting the vaccine if you are unsure whether it is right for you or have other health concerns [4].

Conclusion

Most people recover from shingles without any problems, and getting treatment as soon as possible after your symptoms start can reduce the risk of complications. While the rash heals, keep it covered and stay away from people who could catch chickenpox from you, and ask your GP or doctor whether the shingles vaccine is right for you.

Medical Disclaimer

This article is for general information and does not replace advice from a qualified health professional. If you think you need urgent medical care, get emergency help straight away.