What is shingles?

Shingles is a viral infection that causes a painful, blistering rash. It is caused by the varicella-zoster virus, which is the same virus that causes chickenpox. You can only get shingles if you have had chickenpox in the past.

The shingles rash develops into painful blisters that may also be itchy, usually on one side of the body, either on the face, chest, back, abdomen or pelvis. They can take several weeks to settle.

In 1 in 10 people, the pain and tingling of shingles can last for months or even years. This is called post-herpetic neuralgia.

What are the symptoms of shingles?

The initial symptoms of shingles include:

• pain
• a burning, tingling or itching sensation
• a stabbing sensation
• sensitivity to touch
• numbness in the affected area of the body
• sensitivity to light
• fever and/or headache
• fatigue

Two to 3 days after these symptoms appear, a painful rash will appear on the sensitive area of skin, usually on one side of the body in the area of one skin nerve (called a dermatome).

At first this rash consists of painful red bumps that quickly develop into fluid-filled blisters, which will eventually have a crusty surface. The rash can last for 10 to 15 days.

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What causes shingles?

Anyone who has had chickenpox in the past can develop shingles. The chickenpox virus stays in the nerve cells near the spine but is not active. Shingles occurs when the virus becomes active again.

Shingles can occur at any age, but it usually affects people over 40. About 1 in 3 people who have not been immunised against chicken pox or shingles will develop shingles at some stage during their lifetime. Shingles often occurs with no known trigger. It is more likely to occur if you:

• are aged 60 or older
• are experiencing physical and emotional stress
• have HIV and AIDS
• have had an organ transplant
• have recently had a bone marrow transplant
• have a condition which requires treatment that affects the immune system, such as chemotherapy for cancer

Usually, people only get shingles once in their lives. But sometimes, especially if you have a weakened immune system, you might get repeated infections. You cannot catch shingles from someone who has the condition. If you have not had chickenpox, you can catch chickenpox by coming into direct contact with fluid on the blisters of someone who has shingles.

When should I see my doctor?

See your doctor as soon as possible if you are experiencing any symptoms of shingles. Starting treatment with antiviral medicines within 3 days of the rash appearing should reduce the severity of symptoms and the risk of further complications, including post-herpetic neuralgia.

See your doctor straight away if you have symptoms of shingles and are experiencing the following:

• confusion
• memory loss
• severe headache
• symptoms that affect your eye area
• a temperature of 38°C or higher

You should also see your doctor if you are pregnant, or have a weakened immune system due to medicine that suppresses the immune system, or a condition that weakens your immune system.

How is shingles diagnosed?

Your doctor will ask about the symptoms and do an examination. They can test some of the fluid from the blisters to confirm it is shingles.

How is shingles treated?

There is no cure for shingles, but antiviral medicine may relieve the symptoms and help prevent complications. See your doctor for a prescription of antiviral medicines as soon as possible after symptoms develop. Treatment should be started within 3 days of the shingles rash appearing.

If you are pregnant, talk to your doctor about whether antivirals are right for you.

Over-the counter medicines, such as paracetamol and non-steroidal anti-inflammatories, can be used for pain relief. If over-the-counter medicines are not controlling your pain, your doctor may prescribe other medicines.

There are several things you can do to help manage the condition. They include the following.

• Try to keep the rash dry and clean.
• Cover the rash if possible to avoid spreading the virus to others. Use a non-stick dressing. Do not use antibiotic creams or sticking plasters on the blisters since they may slow down the healing process.
• Try not to scratch the rash. Scratching may cause infection and scarring of the blisters.
• After a bath or shower, gently pat yourself dry with a clean towel. Do not rub or use the towel to scratch yourself and do not share towels.
• Wear loose cotton clothes around the parts of the body that are affected.
• Cool compresses, baths or ice packs may help with the discomfort. Do not apply ice packs directly to the skin. Wrap the ice pack in a light towel and place it gently over the dressing. Wash the towel in hot water after use.
• If the blisters are open, applying creams or gels is not recommended because they might increase the risk of a secondary bacterial infection.
• Avoid contact with people who may be more at risk, such as pregnant women who are not immune to chickenpox, people who have a weak immune system and babies less than one month old.
• Do not share towels, play contact sports, or go swimming. Wash your hands often.

Can shingles be prevented?

There are 2 vaccines available to reduce the likelihood of developing shingles, Zostavax and Shingrix. If you are over 50, you can talk to your doctor about whether you need it. It is recommended for everyone over 60 and is given free of charge in Australia to people aged 70 to 79.

Vaccination will not guarantee that you will not get shingles, but it will reduce your chance of developing the condition. The vaccine used to protect against shingles is not the same as the vaccine used to protect against chickenpox. Read more about the chickenpox vaccine here.

Shingles vaccine

Vaccination is your best protection against shingles. This table explains how the vaccine is given, who should get it, and whether it is on the National Immunisation Program Schedule.

Some diseases can be prevented with different vaccines, so talk to your doctor about which one is appropriate for you. Zostavax should not be used in people who are immunocompromised.

Complications of shingles

In many people, shingles gets better without any complications. However, in others, several complications can occur. These include:

• ongoing pain from post-herpetic neuralgia. This is less common in younger people
• shingles occurring in the eye area could result in temporary or permanent vision loss. If you do have shingles in your eye, your doctor may refer you to an eye specialist for treatment
• the shingles rash could become infected and antibiotics may be needed