Learn more about shingles: 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.
Symptoms of shingles
Learn more about shingles: treatment
Treatment for shingles can help ease your symptoms until the condition improves. In many cases shingles gets better within around two to four weeks.
However, it's still important to see your GP as soon as possible if you recognise the symptoms of shingles.
Early treatment may help reduce the severity of the condition and the risk of potential complications.
Self-care for shingles
If you develop the shingles rash, there are a number of things you can do to help relieve your symptoms, such as:
- keeping the rash as clean and dry as possible – this reduces the risk of the rash becoming infected with bacteria
- wearing loose-fitting clothing – this may help you feel more comfortable
- not using rub-on (topical) antibiotics or adhesive dressings such as plasters – this can slow down the healing process
- using a dressing that won't stick to the rash (non-adherent) if you need to cover the blisters – this avoids passing the virus to anyone else
Calamine lotion has a soothing, cooling effect on the skin and can be used to relieve the itching.
If you have any weeping blisters, you can use a cool compress – a cloth or flannel cooled with tap water – several times a day to help soothe the skin and keep blisters clean.
It's important to only use the compress for around 20 minutes at a time and stop using them once the blisters stop oozing.
Don't share any cloths, towels or flannels if you have the shingles rash.
Staying off work or school
You only need to stay away from work or keep your child off school while:
- the rash is oozing fluid (weeping) and can't be covered
- you or your child are feeling unwell
If the rash is only on your body and can be covered by clothing, there's little risk of passing the infection on to others.
As well as painkilling medication, some people with shingles may also be prescribed a course of antiviral tablets lasting seven days.
Commonly prescribed antiviral medicines include aciclovir, valaciclovir and famciclovir.
These medications can't kill the shingles virus, but can help stop it multiplying. This may:
- reduce the severity of your shingles
- reduce how long your shingles lasts
- prevent complications of shingles, such as postherpetic neuralgia (although the evidence for this is uncertain)
Antiviral medicines are most effective when taken within 72 hours of your rash appearing, although they may be started up to a week after your rash appears if you're at risk of severe shingles or complications.
Side effects of antiviral medication are very uncommon, but can include:
Who may be prescribed antiviral medication?
If you're over 50 years of age and have symptoms of shingles, you'll usually be prescribed an antiviral medication.
You may also be prescribed antiviral medication if you have:
- shingles that affects one of your eyes
- a weakened immune system
- moderate to severe pain
- a moderate to severe rash
Pregnancy and antiviral medication
If you're pregnant and have shingles, it's likely your GP will discuss your case with a specialist to decide whether the benefits of antiviral medication significantly outweigh any possible risks. Shingles won't harm your unborn baby.
If you're under 50 years of age, you're at less risk of developing complications from shingles.
You may not need antiviral medication, unless the pain can't be controlled by over-the-counter painkillers.
Antiviral medication is good at controlling pain in the first week or two of the rash.
Children and antiviral medication
Antiviral medication isn't usually necessary for otherwise healthy children because they tend to only experience mild symptoms of shingles and have a small risk of developing complications.
However, if your child has a weakened immune system, they may need to be admitted to hospital to receive antiviral medication directly into a vein (intravenously).
To ease the pain caused by shingles, your GP may recommend painkilling medication.
Some of the main medications used to relieve pain associated with shingles are described below.
The most commonly used painkiller is paracetamol, which is available without a prescription.
Always read the manufacturer's instructions to make sure the medicine is suitable and you're taking the correct dose.
Non-steroidal anti-inflammatory drugs (NSAIDs)
However, NSAIDs may not be suitable if you:
- have stomach, liver or kidney problems, such as a stomach ulcer, or had them in the past
- have asthma
- are pregnant or breastfeeding
Ask your GP or pharmacist if you're unsure about whether you should take NSAIDs.
For more severe pain, your GP may prescribe an opioid, such as codeine. This is a stronger type of painkiller sometimes prescribed alongside paracetamol.
Occasionally, your GP may consider seeking specialist advice before prescribing an even stronger opioid, such as morphine.
If you have severe pain as a result of shingles, you may be prescribed an antidepressant medicine.
These medications are commonly used to treat depression, but are also proven to be useful in relieving nerve pain.
The antidepressants most often used to treat shingles pain are known as tricyclic antidepressants (TCAs).
Examples of TCAs most commonly prescribed for people with shingles are amitriptyline, imipramine and nortriptyline.
Side effects of TCAs can include:
If you have shingles, you'll usually be prescribed a much lower dose of TCAs than if you were being treated for depression.
This will usually be a tablet to take at night. Your dose may be increased until your pain settles down.
It may take several weeks before you start to feel the antidepressants working, although this is not always the case.
Anticonvulsants are most commonly used to control fits (seizures) caused by epilepsy, but they're also useful in relieving nerve pain.
Gabapentin and pregabalin are the most commonly prescribed anticonvulsants for shingles pain.
Side effects of these medications can include:
- increased appetite
- weight gain
- feeling sick
As with antidepressants, you may need to take anticonvulsants for several weeks before you notice it working.
If your pain doesn't improve, your dose may be gradually increased until your symptoms are effectively managed.
Learn more about shingles: complications
Complications of shingles are more likely if you have a weakened immune system (the body's natural defence system) or are elderly.
Some of the main complications associated with shingles are described below.
Postherpetic neuralgia is the most common complication of shingles. It's not clear exactly how many people are affected, but some estimates suggest as many as one in five people over 50 could develop postherpetic neuralgia as the result of shingles.
Postherpetic neuralgia can cause severe nerve pain (neuralgia) and intense itching that persists after the rash and any other symptoms of shingles have gone.
Types of pain experienced by people with postherpetic neuralgia include:
- constant or intermittent burning, aching, throbbing, stabbing, or shooting pain
- allodynia – where you feel pain from something that should not be painful, such as changes in temperature or the wind
- hyperalgesia – where you are very sensitive to pain
Postherpetic neuralgia sometimes resolves after around three to six months, although it can last for years and some cases can be permanent. It can be treated with a number of different painkilling medicines.
Read about treating postherpetic neuralgia.
If one of your eyes is affected by shingles (ophthalmic shingles), there's a risk you could develop further problems in the affected eye, such as:
- sores (ulceration) and permanent scarring of the surface of your eye (cornea)
- inflammation of the eye and optic nerve, the nerve that transmits signals from the eye to the brain
- glaucoma – where pressure builds up inside the eye
If not treated promptly, there's a risk that ophthalmic shingles could cause a degree of permanent vision loss.
Ramsay Hunt syndrome
Ramsay Hunt syndrome is a complication that can occur if shingles affects certain nerves in your head.
In the US Ramsay Hunt syndrome is estimated to affect 5 in 100,000 people every year, and may affect a similar number of people in the UK.
Ramsay Hunt syndrome can cause:
- hearing loss
- the sensation that you or the environment around you is moving or spinning (vertigo)
- hearing sounds coming from inside your body, rather than an outside source (tinnitus)
- a rash around the ear
- loss of taste
- weakness (paralysis) of your face
Ramsay Hunt syndrome is usually treated with antiviral medication and corticosteroids.
The earlier treatment is started, the better the outcome. Around three-quarters of people given antiviral medication within 72 hours of the start of their symptoms usually make a complete recovery.
If treatment is delayed, only about half of those treated will recover completely.
Those who don't make a full recovery may be left with permanent problems, such as a degree of permanent facial paralysis or hearing loss.
A number of other possible problems can also sometimes develop as a result of shingles, including:
- the rash becoming infected with bacteria – see your GP if you develop a high temperature, as this could be a sign of a bacterial infection
- white patches (a loss of pigment) or scarring in the area of the rash
- inflammation of the lungs (pneumonia), liver (hepatitis), brain (encephalitis), spinal cord (transverse myelitis), or protective membranes that surround the brain and spinal cord (meningitis) – these complications are rare, however
Shingles is rarely life threatening, but complications like those mentioned above mean around 1 in every 1,000 cases in adults over the age of 70 is fatal.