Dear Alice,

What are shingles?

— CW

Dear CW,

Shingles, also known as herpes zoster, is a viral infection that affects approximately one-third of Americans. The virus typically causes an itchy or painful skin rash of small, fluid-filled blisters that develop on one side of the body or face. Eventually, the blisters dry out, form a crust, and sometimes leave behind scars. Interestingly, shingles is caused by a re-activation of the varicella-zoster virus in the body, the same virus that causes the chickenpox. Shingles itself isn't contagious, meaning that a person with shingles can't spread shingles to another individual. However, the varicella-zoster virus is contagious. If someone who’s never been vaccinated for or exposed to the virus has direct physical contact with open shingles sores or blisters, it can cause them to catch chickenpox. It’s highly recommended that anyone who suspects they may have shingles seek medical attention as soon as possible, as the condition can result in serious health issues if left untreated.

So, what’s the difference between shingles and chickenpox if they’re caused by the same virus? The biggest difference between the two conditions is the timing of the outbreak. Usually, most people in the United States get chickenpox during their childhood years. However, some of the varicella-zoster virus can remain dormant (or inactive) in the body for years, re-activating later on to cause a shingles outbreak during a time of weakened immunity. This is why shingles outbreaks are most common amongst individuals with chronic illnesses or compromised immune systems, people taking immunosuppressive drugs, and those over the age of 50. In fact, age is the most relevant risk factor, as the risk for developing shingles and having potential complications rises dramatically for people who are 50 years of age or older. While multiple outbreaks of shingles are fairly rare, the risk of recurrence is higher in immunocompromised individuals.

Knowing what to look out for can not only help folks seek treatment early, but it can also prevent transmission to others. Symptoms of shingles may include:

  • Red, itchy rash with fluid-filled blisters, often on one side of the abdomen or near an eye
  • Pain, tingling, burning, and itchiness at infected sites of the skin, sometimes one to five days before the appearance of a rash
  • Fever or chills
  • General achiness, fatigue, headache, and upset stomach

A shingles outbreak typically lasts about seven to ten days and then blisters begin to scab over. It may take an additional two to four weeks for the skin to clear completely — at this point, the person is usually no longer actively contagious. It’s worth noting that symptoms and the degree to which they’re experienced may vary between individuals. For example, some folks with shingles might experience pain without the rash or vice versa. If left untreated, however, shingles can lead to severe complications, including postherpetic neuralgia (PHN), a long-term nerve pain can last for months to years, as well as vision loss, hearing problems, and additional skin infections. Thus, if there’s a suspicion that shingles may be the culprit for a given set of symptoms, getting it checked out is wise, especially for those over the age of 60 and anyone experiencing symptoms that are affecting the eyes. Confirmation of a shingles diagnosis is only possible by assessing a person’s symptoms and ordering laboratory testing. Starting treatment as soon as possible is recommended for best results and may include pain relievers (analgesics) or medicated creams to reduce the pain or itching. Additionally, treatment may also include a prescription for an antiviral drug that can shorten the duration and severity of the outbreak, as well as mitigate potential complications.

While shingles is less contagious than chickenpox, there are steps individuals can take towards prevention. Frequent handwashing, covering a shingles rash, and avoiding the urge to scratch are ways to prevent spreading the virus to others during an active outbreak. At-home remedies that might help with discomfort include wet compresses, calamine lotion, and oatmeal baths. In addition, pain relievers, either over-the-counter or prescription, can also help relieve some of the pain caused by shingles (though avoiding aspirin is a critical recommendation for young children, as it can lead to Reye’s syndrome). Furthermore, there have been reports of airborne transmission — so it’s highly recommended that those with an active outbreak also avoid direct contact with newborn babies, pregnant people, and anyone with a weakened immune system.

Fortunately, there are also effective preventative strategies for avoiding a shingles infection all together. First, there’s the chickenpox vaccine, which most children receive as part of routine pediatric immunization in the US. Additionally, for individuals who are 50 years and older, the US Food and Drug Administration (FDA) has approved the use of a shingles vaccine. While this vaccine does not guarantee immunity, it can help to reduce the onset, duration, and severity of outbreaks if they do occur.

To learn more about the condition, the Centers for Disease Control and Prevention (CDC) has additional information. If you’re experiencing concerning symptoms or are interested in being vaccinated, it may be a good idea to talk with your health care provider for more advice.

Hope this information helps!

Last updated Dec 04, 2020
Originally published Jan 19, 1995

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