Shingles Explained

Herpes zoster, commonly known as shingles, occurs when a virus within the nerves becomes active again later in life and causes a rash. The virus, varicella-zoster, is the same one that causes chickenpox and is associated with the herpes virus. Once you get this virus it remains inactive in the nerve tissue for the rest of your life. Shingles ensue when the virus become active again.

It is unclear what causes the virus to reactivate but it is believed that the immune system’s reaction to the virus weakens after childhood chickenpox.

When the virus become active again in adulthood it travels through the nerves that may cause a burning or prickly sensation over the affected area. When the virus extends to the skin a few days later it causes a painful, blistering rash along the affected nerve.

Anybody that had chickenpox is at risk for developing shingles later in life, but not all of these individuals will experience a reactivation of the virus. It is most common in people over 50 and people with a compromised immune system. People undergoing treatment for cancer and individuals with HIV are more prone to shingles. Although this disease can occur at any age, the chances of getting shingles increases as you get older. Although it is uncommon in children, symptoms are usually mild when shingles surfaces in a young person.


The first symptom of shingles is usually a burning sensation, mild tingling or a shooting pain in a particular area of the skin.

The affected area is usually only on one side of the chest, stomach, face or a portion of the arm or leg. This area may be so sensitive that you may not be able to tolerate clothing touching the area. After about five days the skin will become red and slightly swollen and a blistery rash will cluster in patches or follow a line along an infected nerve.

The blisters may be itchy and painful and can grow to be as big as the palm of your hand. The blisters continue to form over two to seven days before eventually breaking and forming a crust before it begins to heal. You may also experience a low-grade fever and mild muscle aches.


It can be difficult to diagnose shingles before the rash appears. Once the blisters begin to form, your doctor will most likely diagnose shingles based on symptoms and the appearance of the skin. In rare instances when the doctor cannot conclude a diagnosis of shingles based on observation and symptoms, he or she may scrape tissue to collect cells from the affected skin and examine them to determine if they are consistent with the herpes zoster infection. If the rash forms across the bridge of your nose or near your eyes the doctor will most likely refer you to an ophthalmologist as well.

Expected Duration

Shingles usually takes 7-10 days to run its course, although blisters can take several weeks to completely disappear.

The appearance of your skin should return to normal within 4 weeks. Occasionally, dark spots remain on the skin where the original rash was. The duration of pain varies from patient to patient. Most people report a decrease in pain within 2-3 months and about 10% of people experience pain for many months. In rare instances, only about 2% of cases, the pain lasts longer than 1 year.


The one time vaccine Zostavax helps prevent shingles and decreases the risk of post-herpetic neuralgia, long term pain over the affected area, and is recommended for people over 60. It contains the same ingredients as the chickenpox vaccine in a dose 14 times stronger. The chickenpox vaccine that children receive is still too new to know if it will prevent shingles later in life.


If the condition is diagnosed with 72 hours after the appearance of the rash, your doctor may prescribe antiviral medication to help reduce the risk of developing chronic pain from shingles. The rash and blisters should be rinsed twice a day with cool water and you may be prescribed an antibiotic ointment to prevent infection in open blisters. Intense pain can be managed with prescription pain medication. For post-herpetic neuralgia, medications that alter the way pain signals are perceived in the body may be suggested to keep the pain in check.


Most people make a full recovery from an acute episode with no lasting pain. Once you have had shingles it is unusual for it to return. The chance of it returning increases from 2% to 20% in people with AIDS. Long term complications such as post-herpetic neuralgia may continue for months or years and the disease may cause mild to moderate discoloration, primarily darkening.

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