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Shingles

Edited by Dr Claudia Pastides, 17th February 2020


Jump to: The symptoms of shingles | Is shingles contagious? | How shingles is treated | Shingles in pregnancy | Recurrence of shingles | Conditions that can be confused with shingles | Ophthalmic shingles | Complications of shingles | Frequently asked questions about shingles | References


What is shingles?

Shingles is a viral infection. What makes shingles a unique infection is that the virus which causes it has been fast asleep in the body for many years before the shingles rash comes up.

The virus that causes shingles is the very same virus that will have caused chickenpox, except it decided to hang around somewhere in the body, doing nothing, just sitting in the spinal cord, only to awaken again at some point in the future.

We don’t always know what causes the varicella zoster virus to wake up and cause shingles, but a common reason is if a person’s immune system is lowered, for example by stress or a period of illness.


Read on to discover the symptoms and treatment of shingles - and speak with a doctor today if you believe you may be suffering from this condition. Shingles is best treated within 3 days of the rash first appearing, so don’t delay speaking to a doctor.

The symptoms of shingles

Due to the virus settling in one part of the spinal cord, the painful blistery red rash that appears with shingles usually happens on one side of the body and along a defined strip of skin. This strip of skin is the one supplied by the nerve coming from the spinal cord where the virus has been asleep.

Before the rash appears, some people feel generally unwell and get a tingly or burning sensation over the skin.

Once the rash has gone, some can have long term nerve pain in the area where the rash was. This is called postherpetic neuralgia.

Is shingles contagious?

If someone has shingles, they can’t pass shingles on to someone else. However, because shingles is caused by the chickenpox virus, they CAN pass on chickenpox to someone that has never had chickenpox before.

If a person has shingles, they are contagious whilst they have the rash up until the blisters of the rash all crust over. This can take between 2 and 4 weeks.

As a result, people with shingles should try and stay away from anyone who might be at risk of catching chickenpox and at risk of becoming very unwell with it, for example:

  • Women who are pregnant and have never had chickenpox. (Women who are pregnant and have had chickenpox before will be immune to the virus and are not at risk.)
  • People with a weakened immune system, such as HIV/AIDS
  • Very young babies, less than a month old


How shingles is treated

Shingles is often treated with antiviral medication if you are:

  • Over the age of 50
  • Have shingles on a part of your body other than chest or back
  • Have a moderate or severe rash and/or pain

Antiviral medication can reduce the length of time someone has the rash and reduce the chances of long lasting nerve pain (postherpetic neuralgia) once the rash has gone.

Commonly prescribed antiviral medication includes aciclovir, famciclovir, and valaciclovir.

The painful rash can be soothed by applying a cool compress a few times a day or taking painkillers. You can also take painkillers such as paracetamol, ibuprofen or codeine, but check with your pharmacist or a doctor first which ones would be best for you.

If you’ve got severe pain, your doctor might prescribe medication that is specific for nerve pain, such as amitriptyline, duloxetine, gabapentin or pregabalin.,

It is also a good idea to wear loose fitting clothing over the rash to keep it covered, as this will prevent the virus from being spread to others.

A shingles vaccine is available and it reduces the chances of a person having shingles or severe shingles by about 90%. Some people might still get shingles despite having the vaccine, but it will be milder.


Shingles in pregnancy

If you develop shingles in pregnancy, you should let your doctor or midwife know. Usually shingles in pregnancy is mild and doesn’t cause problems for your unborn baby. You may need to be treated with antiviral medication, but this needs to be discussed with a specialist.


Recurrence of shingles

Shingles rarely happens more than once, but it is possible. Some people are more at risk of recurrence and this includes1:

  • Those aged over 50
  • Females
  • Having blood cancer, autoimmune disease, dyslipidemia (such as high cholesterol) or hypertension
  • Having shingles related pain that lasted longer than 30 days


Conditions that can be confused with shingles

Psoriasis can cause a burning sensation in the skin, as can shingles, however the appearance of the rash is usually very different from that of shingles. Psoriasis is typically a red and thick scaly skin rash, affecting the knees, elbows or scalp. There are variations of psoriasis however that look blistery, so if you have a new rash - it is best to run it past a doctor.


Ringworm is a fungal skin infection that looks like round red circles on the skin. It tends to look quite different from shingles, which is made up of little blisters, but early ringworm can bear some resemblance to shingles.


Hives can look like little red spots, or like large red patches. They can sting or burn too but hives happen as a result of an allergic reaction and often settle down quickly within hours or days.

Chickenpox and shingles are caused by the same virus and so the rash looks similar too. Shingles however occurs in people who have had chickenpox before and also affects one well defined area of the body, typically on one side, as opposed to chickenpox which usually affects the skin of the whole body.

If you’re unsure whether your rash is shingles or something else, speak to a doctor.


Ophthalmic shingles

Shingles can sometimes affect one of the nerves that supplies the eye, called the ophthalmic nerve. This can cause long lasting pain and permanent damage to the eye, so it needs urgent assessment and treatment.

If you have a shingles rash on your nose (in particular at its tip, on the sides or at the root of your nose), speak to your doctor straight away as this can be a sign that the shingles might affect your eyes too.

If you have any changes to your vision or a red eye with your shingles, let your doctor know straight away.


Complications of shingles

The most common complication of shingles is postherpetic neuralgia. This is a persisting pain that continues for 90 days or more after the rash appears. It is rare in people under the age of 50.

Postherpetic neuralgia is more common as people get older 2:

  • 7.4% of people aged 50-59
  • 21.2% of people aged 60-69
  • 28.6% of people aged 70-79
  • 34.4% of people aged over 80

Other complications include:

  • Changes to the skin, such as scarring or colour changes
  • Infection of the rash with bacteria may occur, needing treatment with antibiotics. (Severe infections such as necrotizing fasciitis or sepsis are rare but life threatening.)
  • Ramsay Hunt Syndrome, when herpes infects the facial nerve, causing a rash in one ear, facial drooping and problems with hearing and balance
  • Motor neuropathy, which is when the infection affects a nerve that is responsible for making a muscle move

Rare complications that are more likely to occur in people that are immunocompromised:

  • Inflammation of the brain, meninges and nerves of the head and neck
  • Spread of the reactivated virus to the lungs, liver, bowel and brain

Frequently asked questions about shingles

1. Can I go to work with shingles?

If you have shingles, you can give chickenpox to people that haven’t had it before. If your rash is weepy and hasn’t crusted over, you are infectious. So unless your rash is in a place where it can be covered up, it is best to stay off work until your rash has completely crusted over. Ask a doctor for advice if you aren’t sure if it is ok for you to go to work.


2. How long will I have to be off work with shingles?

If your rash is in a place where it can be completely covered up and you feel well in yourself, you might be ok to go to work. Speak with your doctor first. If your rash is weepy, not crusted over and in a place that can’t be covered up - it is best to stay off work and away from public places until it is all crusted over.


3. Can you get shingles if you have had chickenpox?

You can only get shingles if you’ve had chickenpox. Shingles is caused by reactivation of the chickenpox virus which has been asleep inside your body since you caught chickenpox.


4. Can you fly with shingles?

Although shingles isn’t contagious, if you have shingles you can give someone chickenpox (if they haven’t had chickenpox before). If your shingles rash has crusted over and isn’t weepy, you are not infectious and can fly. However if your rash is weeping and hasn’t crusted over, you’ll need to ask the airline for advice as some airlines may not permit you to travel with shingles.


5. Can children get shingles?

Anyone who has had chickenpox before is at risk of shingles, including children. However shingles is rare in people under the age of 50.


6. Can stress cause shingles?

Yes, research has shown that stress may partially contribute to someone developing shingles. This could be because of the effects of stress on the immune system.


7. How long does the Shingrix vaccine last?

Shingrix is the new shingles vaccine. We know from studies that, for most people, Shingrix protects for at least 4 years, and it is likely to protect for even longer than that.


8. How can I get rid of shingles fast?

There is no quick way to get rid of shingles unfortunately. Antiviral medication can help reduce the length of time you have the rash and the severity too, but it needs to be started within 3 days of symptoms beginning. The best thing to do is to prevent shingles by having the vaccine.


9. How do you know if you have shingles?

Shingles typically looks like in the picture below. It is a red, blistery and sore or itchy rash that affects one distinct part of the body. The best way of knowing for sure if you have shingles is by speaking to a doctor.


10. How long is shingles contagious for?

Shingles is contagious from the moment the blistery rash appears until the last blister has fully crusted over. This can take between 2 and 4 weeks.


11. Is shingles serious?

No. Most of the time it isn’t. It tends to be a mild infection that is an uncomfortable nuisance in 9 out of 10 cases. However for some, it can leave long lasting nerve pain (called postherpetic neuralgia) or be very serious, for example:

  • If you get shingles in or around the eye, it can lead to loss of vision. So if someone gets a shingles-like rash around their eye or on their face, it is important that they see a doctor as soon as possible.
  • Rarely shingles can cause inflammation of the brain, hearing problems or weakness in the muscles of the face
  • Severe skin infections by bacteria can happen on top of the viral rash

If you think you might be suffering from shingles, contact a GP today to discuss it.


References

  1. Hope-Simpson, R.E. (1975) Postherpetic neuralgia. The Journal of the Royal College of General Practitioners 25(157), 571-575.
  2. Kim YJ, Lee CN, Lee MS, et al. Recurrence Rate of Herpes Zoster and Its Risk Factors: a Population-based Cohort Study. J Korean Med Sci. 2018;34(2):e1. Published 2018 Dec 20. doi:10.3346/jkms.2019.34.e1
  3. https://wa.kaiserpermanente.org/healthAndWellness/index.jhtml?item=%2Fcommon%2FhealthAndWellness%2Fadult%2FseniorHealth%2Fshingles.html