Shingles
Symptoms, Causes & Treatment
Understanding shingles: how to recognise it, why prompt antiviral treatment matters, and how to prevent post-herpetic neuralgia.
What Is Shingles?
Shingles (herpes zoster) is a painful, blistering skin rash caused by the reactivation of the varicella-zoster virus (VZV) -- the same virus that causes chickenpox. After a person recovers from chickenpox (usually in childhood), the virus remains dormant in the nerve ganglia. Years or decades later, it can reactivate, travelling along the nerve to the skin and causing the characteristic rash of shingles.
Shingles affects approximately 1 in 4 people during their lifetime. It is most common in people over 50, with the risk increasing significantly with age. Immunosuppression (HIV, chemotherapy, organ transplant, long-term corticosteroid use) is also a major risk factor.
The hallmark of shingles is a painful, unilateral (one-sided) rash that follows the distribution of a single dermatome (the area of skin supplied by one nerve). The rash typically appears as a band or strip on one side of the torso, though it can affect any dermatome, including the face.
Shingles is not directly contagious, but a person with active shingles blisters can transmit VZV to someone who has never had chickenpox, causing them to develop chickenpox (not shingles).
What Are the Symptoms of Shingles?
Shingles has a characteristic prodrome followed by the classic dermatomal rash. Recognising early symptoms allows prompt antiviral treatment.
Prodrome: burning, itching, or tingling pain along a dermatomal band (1–4 days before rash) · Painful, blistering rash in a strip on one side of body · Rash typically on trunk, face, or around eye · Headache and fever · Post-herpetic neuralgia: persistent pain after rash heals
Shingles affecting the eye (herpes zoster ophthalmicus) — same-day ophthalmology referral · Ramsay Hunt syndrome (ear pain, facial palsy, vesicles in ear) · Shingles in immunocompromised patients · Widespread shingles (disseminated zoster) · Signs of bacterial superinfection of shingles blisters
Seek urgent assessment immediately if shingles affects the eye area (herpes zoster ophthalmicus) or if you develop confusion, photophobia, or neck stiffness. Eye shingles can cause permanent vision loss without prompt treatment.
What Causes Shingles?
Shingles is caused by reactivation of varicella-zoster virus (VZV) from latency in the dorsal root ganglion, triggered by declining cellular immunity.
Herpes zoster virus reactivates from latency in the dorsal root ganglion after primary varicella infection. Risk of reactivation increases with age and immunosuppression. Vaccination significantly reduces risk.
Post-herpetic neuralgia (PHN) occurs in 10–15% of shingles patients — rising to 50% in those over 70. It causes debilitating burning or stabbing pain that persists for months to years after the rash heals.
Herpes zoster ophthalmicus (HZO) occurs when the V1 branch of the trigeminal nerve is affected. It causes vesicles on the forehead, eyelid, and tip of nose, and risks sight-threatening corneal involvement.
Psoriasis is an immune-mediated chronic inflammatory skin disease. T-cell activation drives rapid keratinocyte proliferation (3–5 days instead of 28–30), producing the characteristic thickened plaques.
Common eczema triggers include wool, synthetic fabrics, dust mites, pet dander, pollen, mould, soaps, detergents, food allergens (in children), and emotional stress. Identifying and avoiding personal triggers reduces flare frequency.
Contact dermatitis occurs when skin comes into contact with an irritant (irritant contact dermatitis) or a specific allergen (allergic contact dermatitis via type IV delayed hypersensitivity). Common allergens: nickel, latex, fragrances, preservatives.
Key Risk Factors
How Is Shingles Diagnosed?
Shingles is diagnosed clinically on the characteristic dermatomal rash. In atypical cases, VZV PCR from vesicle fluid confirms diagnosis. Blood VZV IgM may support diagnosis in disseminated or ophthalmic cases.
How Is Shingles Treated?
Antivirals started within 72 hours of rash onset significantly reduce severity, duration, and risk of PHN. Pain management is an equally important part of treatment.
Supportive Measures
Calamine lotion soothes the rash. Keep the rash covered with a clean, non-stick dressing. Take paracetamol and ibuprofen for pain. Avoid contact with pregnant women, newborns, and immunocompromised individuals until the rash has crusted. Do not scratch blisters.
Recurrent Shingles & Post-Herpetic Neuralgia
Recurrent shingles is uncommon in immunocompetent individuals. More than two episodes warrants investigation for immunodeficiency. Post-herpetic neuralgia is treated with amitriptyline, gabapentin, pregabalin, or topical lidocaine/capsaicin patches. Specialist pain clinic referral for refractory PHN.
When Should You Seek Medical Advice for Shingles?
Shingles affecting the eye or ear · Shingles with confusion, neck stiffness, or photophobia suggesting meningitis · Shingles in an immunocompromised patient · Very widespread blistering (disseminated zoster).
You have a painful unilateral rash with blistering · Rash appears near or on the eye · You have severe pain without a rash yet (pre-eruptive shingles) · You are immunocompromised.
How Can You Prevent Shingles and Its Complications?
Shingles can be largely prevented through vaccination. These measures reduce the risk and impact of shingles.
Shingrix (recombinant zoster vaccine) is offered to all adults aged 70–79 on the NHS in the UK. It reduces shingles risk by 90% and post-herpetic neuralgia risk by 89%. Two doses given 2–6 months apart.
Start antiviral treatment (valaciclovir or aciclovir) within 72 hours of rash onset for maximum benefit. If started after 72 hours, treatment still reduces severity but the benefit is smaller.
Good shaving technique significantly reduces folliculitis. Use a single-blade or safety razor, shave in the direction of hair growth, and replace blades frequently. Consider electric shaving or laser hair removal for chronic pseudofolliculitis barbae.
Frequent, effective milk removal is the most important mastitis prevention. Feed or express every 2–3 hours; never skip feeds. Get breastfeeding support from a midwife, health visitor, or lactation consultant early — before problems develop.
Ensure your baby latches on deeply and correctly. A poor latch causes nipple trauma (cracks), which are an entry point for bacteria. Ask for a latch assessment if breastfeeding is painful.
Seek breastfeeding support immediately if you notice breast hardness, redness, or pain. Early identification and treatment of blocked ducts prevents progression to mastitis and abscess.
Speak to a Clinician About Shingles
Through The GP Service, a licensed clinician can assess shingles symptoms, prescribe antiviral treatment promptly, and manage post-herpetic neuralgia if it develops.
Expert clinical advice, when you need it.
Shingles FAQs
Shingles is caused by reactivation of the varicella-zoster virus (the same virus that causes chickenpox), which lies dormant in nerve tissue after the initial infection. It can reactivate decades later, particularly when immunity is reduced by age, stress, or illness.
Yes. The shingles vaccine (Shingrix) is highly effective at preventing shingles and post-herpetic neuralgia. In the UK it is offered on the NHS to adults aged 70–79. It is also available privately. Vaccination is recommended even if you have had shingles before.
The antiviral drugs aciclovir, valaciclovir, and famciclovir reduce the severity and duration of shingles if started within 72 hours of rash onset. Starting treatment as early as possible gives the best outcomes.
Post-herpetic neuralgia (PHN) is persistent nerve pain that continues after the shingles rash has resolved. It affects around 10–15% of shingles patients, particularly older adults. Early antiviral treatment significantly reduces the risk of PHN.
You cannot give shingles to another person. However, if someone has never had chickenpox or been vaccinated, close contact with an active shingles rash can transmit the varicella-zoster virus, potentially causing chickenpox.
Shingles affecting the eye (herpes zoster ophthalmicus) requires urgent ophthalmological assessment. It can cause serious complications including corneal scarring, uveitis, and permanent vision loss if not treated promptly.
Yes. Shingles can recur in some individuals, particularly those who are immunocompromised. The shingles vaccine reduces recurrence risk. More than two episodes of shingles warrants investigation for an underlying immunodeficiency.
Most shingles rashes resolve within 2–4 weeks. The rash goes through stages: pain and tingling, then blistering, then crusting and healing. Post-herpetic neuralgia can persist for months or years in a minority.