Introduction

Shingles, also known as herpes zoster,is an infection of a nerve and the skin around it. It's caused by the varicella-zoster virus, which also causes chickenpox.

It's estimated around one in every four people will have at least one episode of shingles during their life.

This topic covers:

Shingles

When to seek medical advice

Causes of shingles

Is shingles contagious?

Treating shingles

Complications of shingles

The shingles vaccine

Ophthalmic shingles

Symptoms of shingles

The main symptom of shinglesis pain, followed by a rash that develops into itchy blisters ,similar in appearance to chickenpox .

New blisters may appear for up to a week, but a few days after appearing they become yellowish in colour, flatten and dry out.

Scabs then form where the blisters were, which may leave some slight scarring and loss of skin pigment.

The pain may bea constant, dull or burning sensation, and its intensity can vary from mild to severe.

You may have sharp stabbing pains from time to time, and the affected area of skin will usually be tender.

In some cases shingles may cause some early symptoms that develop a few days before the painful rash first appears.

These early symptoms can include:

• a headache
• burning, tingling, numbness or itchiness of the skin in the affected area
• a feeling of being generally unwell
• a high temperature (fever)

An episode of shingles typically lasts around two to four weeks. It usuallyaffects a specific area on justone side of the body.

Itdoesn't cross over the midline of the body, an imaginary line running from between your eyes down past the belly button.

Any part of your body can be affected, including your face and eyes, butthe chest and tummy (abdomen) are the most common areas.

When to seek medical advice

Shingles isn't usually serious, but see your GP as soon as possible if you recognise the symptoms.They'll usually be able to diagnose shingles based on your symptoms and the appearance of the rash.

Early treatment may help reduce the severity of your symptoms and the risk of developing complications.

Referral to hospital

It's uncommon for someone with shingles to be referred to hospital, but your GP may consider seeking specialist advice if:

• they suspecta complication of shingles , such as meningitis or encephalitis
• shingles is affecting one of your eyesthere's a riskyou coulddevelop permanent vision problems if the condition isn't treated quickly
• a diagnosis isn't certain
• you have an unusually persistent case of shingles that's not responding to treatment
• you've been diagnosed with the condition twice
• you're pregnant
• you have a weakened immune system particularly in severe cases or cases affecting children

Causes of shingles

Most people have chickenpox in childhood, but after the illness has gone the varicella-zoster virus remains inactive (dormant) in the nervous system.

The immune system keeps the virus in check, but it can be reactivatedlater in life and cause shingles.

It's possible to have shingles more than once, but it's very rare to get it more than twice.

It's not known exactly why the shingles virus is reactivated at a later stage in life, but most cases are thought to be caused byhaving loweredprotection against infections and diseases (immunity).

This may be the result of:

• old age as you age, your immunity may decrease; shingles most commonly occurs in people over the age of 70
• physical and emotionalstress the chemicals released by your body when you're stressed can prevent your immune system working properly
• HIV and AIDS people with HIV are much more likely to get shingles than the rest of the population because their immune system is weak
• recently having a bone marrow transplant the conditioning you require before the transplant weakens your immune system
• recently having an organ transplant you may need to take medication to suppress your immune system soyour body accepts the donated organ
• chemotherapy chemotherapy medication, often used to treat cancer , can temporarily weaken your immune system

However, young people who are otherwise healthy can also sometimes develop shingles.

Is shingles contagious?

It's not possible to catch shingles from someone with the condition or from someone with chickenpox.

However, you can catch chickenpox from someone with shingles if you haven't hadchickenpox before.

The blisters of shingles contain live virus. If a person who has never had chickenpox makesdirect contact with an open blister or something with the fluid on it,they can contract the virus and develop chickenpox.

Preventing the spread of the virus

If you have shingles, you're contagious until the last blister has dried and scabbed over.

To help prevent the virus being passed on,avoid sharing towels or flannels, swimming or playing contact sports.You should also avoid work or school ifyour rash is oozing fluid (weeping) and can't be covered.

Chickenpox can be particularly dangerous for certain groups of people. If you have shingles, avoid:

• women who are pregnant and haven't had chickenpox before as they could catch it from youthis may harm their unborn baby
• people who have a weak immune system such as someone with HIV or AIDS
• babies less than one month oldunless it's your own baby, in which case your baby should haveproteins that fight infection (antibodies) to protect them from the virus

Treating shingles

Although there'sno cure for shingles, treatment is available to relieve the symptoms until the condition resolves. Most cases of shingles last around two to four weeks.

Treatment for shingles can include:

• covering the rash with clothing or a non-stick (non-adherent) dressing to reduce the risk of other people becoming infected with chickenpoxit's very difficult to pass the virus on to someone else if the rash is covered
• painkilling medication such as paracetamol , ibuprofen or codeine
• antiviral medication to stop the virus multiplyingalthough not everyone will need this

This is where severe nerve pain lasts for several months or more after the rash has gone.

Complications like this are usuallyin elderly people who have had the condition and those with a weakened immune system.

If you still develop shingles after having this vaccine, it may be milder and last for a shorter time than usual.

This vaccine is now routinely offered on the NHS as a single injection to peopleaged70 and 78.Check with your GP if you're eligible to receive it.

Read about:

Shingles vaccination

Who can have the shingles vaccine

Ophthalmic shingles

Some cases of shingles can affect one of the eyes and are known as ophthalmic shingles.

This occurs when the virus is reactivated in part of the trigeminal nerve,a nerve that controls sensation and movement in your face.

Symptoms can include:

• a rash over your forehead, nose and around your eye
• conjunctivitis inflammation of your eye that causes it to become red and watery, with a sticky coating on your eyelashes
• a red eye
• problems with your vision