Shingles: Symptoms, Causes, & Treatment

Shingles is a viral infection caused by the varicella-zoster virus, the same virus that causes chickenpox. It often causes a painful rash with fluid-filled blisters, burning, tingling, or nerve pain that usually affects one side of the body.

Shingles can develop when the virus becomes active again years after a chickenpox infection, especially in older adults and people with weakened immune systems. Symptoms may begin with fever, headache, or sensitive skin before the rash appears.

Treatment for shingles typically includes antiviral medications such as acyclovir, famciclovir, or valacyclovir, which work best when started early. In some cases, shingles can lead to complications such as postherpetic neuralgia, vision problems, or bacterial skin infections.

Shingles symptoms

The main symptoms of shingles are:

• Red blisters on the skin that appear in bands and affect only one side of the body

• Fluid-filled blisters, which may burst and form sores or scabs

• Pain caused by inflammation of the nerves affected by the virus

• A burning or pins-and-needles sensation where the blisters appear

• Tingling and itching in the affected area;

• Redness and swelling of the skin;

• Small sores on the skin after the blisters dry out.

About 48 hours before the blisters appear, shingles may cause general discomfort, fever, headache, sensitivity to light, and skin that feels more sensitive or painful.

Shingles blisters are more common on the chest, back of the neck, lower back, or face, especially in the area of the trigeminal nerve. When the blisters burst, they release a clear fluid, which can increase the risk of a bacterial infection.

The blisters usually last around 10 days, but in some cases they can persist for up to 21 days. If you develop symptoms of shingles, it is important to see a primary care provider or dermatologist so the most appropriate treatment can be started as soon as possible.

Is shingles contagious?

Shingles itself cannot be caught from another person, as it only develops in people who have already had chickenpox.

However, according to the CDC, someone who has never had chickenpox or the chickenpox vaccine can get chickenpox after direct contact with fluid from shingles blisters.

Confirming a diagnosis

Shingles is diagnosed by a dermatologist or primary care provider based on symptoms, health history, history of chickenpox in childhood, chickenpox vaccination status, and an examination of the skin lesions.

The doctor may also order blood tests, such as a varicella-zoster virus IgM antibody test, which may be detected during an active viral infection.

This test can help rule out other conditions with similar symptoms, such as herpes simplex, impetigo, ecthyma, erysipelas, contact dermatitis, dermatitis herpetiformis, or insect bites.

Another test the doctor may order is an RT-PCR test using fluid from the blisters, corneal fluid, or blood, especially if the infection has affected the eye or has spread through the body.

Possible causes

Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. After a chickenpox infection, which usually happens in childhood, the virus remains inactive in the nervous system without causing symptoms.

However, the virus can reactivate when the immune system becomes weakened, causing shingles instead of chickenpox. This is because most people do not get chickenpox more than once in their lifetime.

Risk factors

Risk factors for shingles include:

• Age (more common after age 50)
• Emotional stress
• Long-term use of corticosteroids
• Use of immunosuppressive medications
• HIV infection
• Cancer
• Chemotherapy
• Radiation therapy
• Conditions that weaken the immune system

Although less common, shingles can occur in children and infants who have previously had chickenpox.

Treatment options

Treatment for shingles should be guided by a dermatologist or primary care provider. According to the CDC, antiviral medications such as acyclovir, famciclovir, and valacyclovir are commonly used to treat shingles and work best when started as soon as possible after the rash appears.

To help relieve symptoms, the doctor may recommend pain relievers, such as ibuprofen, or topical treatments for nerve pain, such as lidocaine patches. Once the rash has healed, capsaicin products may also be recommended to help manage lingering nerve pain.

In some cases of severe pain or postherpetic neuralgia, the doctor may prescribe anticonvulsants, such as gabapentin, or antidepressants, such as amitriptyline.

Home remedies

During treatment, some home measures can help ease discomfort and support recovery, but they do not replace the treatment prescribed by your doctor. Options include burdock tea or mulberry leaf tea.

To prepare the tea, add 1 tablespoon of chopped burdock or mulberry leaves to a saucepan with 1 cup of water. Boil for 3 to 5 minutes, then cover and let it cool until lukewarm.

Once lukewarm, strain the tea and gently apply it to the affected area with gauze, 1 to 2 times a day. Always use a clean piece of gauze for each application.

Read more about home remedies for shingles to help relieve discomfort.

Possible complications

Complications of shingles may include:

• Postherpetic neuralgia

• Inflammation of the cornea or vision loss

• Brain inflammation, or encephalitis

• Facial paralysis

• Hearing problems

• Balance issues

In addition, bacterial infections can develop in the areas with skin blisters, especially if they are not cared for or treated properly.