Shingles: Causes, Symptoms, Complications and Prevention

Everything you need to know about shingles: symptoms, complications, treatments, and prevention strategies for all age groups.

By Medha deb

Created on Oct 3, 2025

Everything you need to know about shingles: symptoms, complications, treatments, and prevention strategies for all age groups.

Shingles: Causes, Symptoms, Complications, Treatment, and Prevention

Shingles, also known as herpes zoster, is a common viral infection characterized by a painful skin rash and blisters. It is caused by the reactivation of the varicella-zoster virus, the same virus responsible for chickenpox. While shingles can affect anyone who has had chickenpox, its likelihood increases with age and weakened immunity.

What is Shingles?

Shingles is a viral infection resulting from the reawakening of the varicella-zoster virus, which remains dormant in nerve tissues after a person has had chickenpox. Years or even decades after the initial infection, the virus can reactivate and travel along nerve pathways to the skin, typically presenting as a painful, blistering rash. This condition almost always affects only one side of the body or face, often following the path of a single nerve.

Only people who have had chickenpox can develop shingles.
The main symptom is a distinctive, localized rash usually accompanied by pain or burning sensations.
Shingles is not the same as chickenpox but is caused by the same virus.

Who Can Get Shingles?

Anyone who has ever had chickenpox is at risk for shingles. After recovering from chickenpox, the virus stays dormant in the body but can reactivate later in life. The risk increases with age and certain medical conditions or treatments that suppress the immune system.

Most common in adults over age 50
People with weakened immune systems are at higher risk (including those with HIV, cancer, or undergoing chemotherapy or organ transplant)
Long-term steroid use or immunosuppressive medications increase the risk
About 1 in 3 people in the U.S. will develop shingles during their lifetime

Symptoms of Shingles

The first symptoms of shingles often precede the appearance of a rash and may include general viral symptoms. The classic presentation involves a combination of localized pain and a characteristic rash.

Early Symptoms (before rash):

Stabbing, burning, or shooting pain
Tingling, itching, or numbness in a localized area
Enlarged lymph nodes near the affected area
Fever and chills
Headache
General fatigue or malaise
Sensitivity to light
Upset stomach

Shingles Rash:

Begins as a cluster of small blisters (vesicles) on a red or darker skin background—may look different depending on skin tone
Usually appears on one side of the body or face, and in a band-like distribution following a nerve pathway (dermatome)
The blisters fill with fluid, break open, then crust over and heal in 2-4 weeks
The area may remain painful even after the rash resolves

Common Locations:

Chest and back (most common)
Face (including the eyes or mouth)—this requires urgent medical attention due to risk of complications
Lower back, buttocks, or legs

Special Forms & Complications of Shingles

Shingles Involving the Face or Eye

Rash appearing near the eye or on the forehead can lead to vision loss
Symptoms include pain, redness, swelling of the eyelid, blurred vision, sensitivity to light, and eye discharge
Complications can include glaucoma, cataracts, permanent vision damage, and secondary infections
Seek immediate medical care if shingles affects the eye or area around the eye

Shingles on Other Parts of the Body

The trunk and chest are the most common spots
Can also occur on the buttocks, arms, or legs

Shingles Pain and Postherpetic Neuralgia (PHN)

The most significant complication of shingles is postherpetic neuralgia (PHN), a chronic pain syndrome affecting the skin and nerves after the rash has resolved. This can persist for months or even years and is caused by nerve damage from the infection.

PHN affects up to 10-18% of shingles patients, most commonly older adults
Pain is often burning, stabbing, or throbbing, and may be severe
Complicates daily activities and significantly affects quality of life

Stages of Shingles

Shingles typically follows three main stages:

Pre-eruptive stage: Vague symptoms 1-5 days before the rash including pain, tingling, and flu-like symptoms (fatigue, headache, sensitivity)
Eruptive stage: Appearance of the painful rash and blisters, which break and crust over within 7-10 days; symptoms may include fever and continued malaise. Patient is most contagious during this stage, until blisters crust.
Chronic stage: In some, the pain continues (PHN) for weeks, months, or longer even after the rash has healed.

Causes and Risk Factors

Shingles is caused by reactivation of the varicella-zoster virus, a member of the herpesvirus family. After chickenpox, the virus survives in nerve tissues near the spine and brain (in the dorsal root or cranial nerve ganglia). It can reactivate, often decades later, especially if immunity weakens.

Risk increases with aging (highest in those over 50)
Suppressed immune function (due to illness, HIV/AIDS, cancer, chemotherapy, radiation, or medications like steroids, methotrexate, or azathioprine)
Physical or emotional stress
Serious injury to the skin or nervous system
History of chickenpox (most adults born before widespread vaccination had it)

Is Shingles Contagious?

Shingles itself is not directly contagious between people; you cannot catch shingles from another person with the infection. However, the active shingles virus in fluid from the rash can cause chickenpox in individuals who have never had chickenpox or the vaccine.

Individuals exposed to open shingles blisters can develop chickenpox, not shingles
People with shingles should avoid contact with pregnant women who never had chickenpox or the vaccine, infants, and immunocompromised individuals until the rash has crusted

How is Shingles Diagnosed?

The diagnosis of shingles is primarily based on the patient’s history and the physical appearance of the rash. Health care providers typically recognize shingles by:

The distribution of the rash (usually on one side, along a dermatome)
The characteristic blisters and accompanying nerve pain

In rare situations where the diagnosis is unclear, laboratory tests can be used:

Polymerase chain reaction (PCR) testing
Viral culture of blister fluid
Direct fluorescent antibody testing

Treatment for Shingles

While there is no cure for shingles, early medical treatment can shorten the duration of the infection, reduce the intensity and duration of pain, and lower the risk of complications.

Antiviral Medications

Should be started ideally within 72 hours of developing the rash
Medications include acyclovir, valacyclovir, and famciclovir
Effectively reduce severity, speed healing, and decrease the risk of PHN

Pain Management

Analgesics: Acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and sometimes opioids for severe pain
Topical agents: Calamine lotion, cool compresses, or numbing creams
Medications for nerve pain: Gabapentin, pregabalin, tricyclic antidepressants

Additional Supportive Care

Antihistamines for itching
Rest, hydration, and good skin care
Antibiotics only if secondary bacterial infection develops

Shingles Vaccine & Prevention

Vaccination is the most effective way to prevent shingles and its complications. There are currently two shingles vaccines:

Vaccine Name	Description	Recommended Groups	Efficacy
Shingrix (Recombinant zoster vaccine)	Approved in 2017; not a live vaccine	Adults 50+ and immunocompromised adults	More than 90% effective against shingles and PHN
Zostavax (Live zoster vaccine)	Approved in 2006; live, weakened virus	Adults 60+ (no longer used as first choice in U.S.)	About 51% effective in older adults

Shingrix is now the preferred vaccine in the U.S.; it requires two doses, 2-6 months apart
Safe for most adults, including those with weakened immune systems
If you received Zostavax, you may still benefit from Shingrix
Prevents both shingles and postherpetic neuralgia in most cases

When to See a Doctor

If you develop a painful rash, especially in a band or on one side of the body
If the rash or pain involves your face, eyes, or genitals
If you have weakened immunity and develop a rash
If you are pregnant and develop a rash
If pain persists after the rash resolves

Complications of Shingles

Although most people recover fully, shingles can cause several complications among certain individuals:

Postherpetic neuralgia (PHN): persistent nerve pain after the rash heals
Vision loss (from shingles involving the eye)
Neurological problems (hearing problems, facial paralysis, balance issues)
Skin infections (from bacteria entering the open blisters)
Scarring

Frequently Asked Questions (FAQs)

Q: Can you get shingles more than once?

A: Yes, although most people only experience it once, shingles can recur, especially in those with weakened immunity.

Q: Who should get the shingles vaccine?

A: The CDC recommends the Shingrix vaccine for all adults age 50 and older as well as certain immunocompromised individuals aged 19 and older, regardless of prior shingles episodes or Zostavax vaccination.

Q: Is shingles contagious?

A: You cannot catch shingles from someone else, but exposure to shingles blisters can cause chickenpox in someone who never had chickenpox or was not vaccinated.

Q: What if my rash doesn’t heal or keeps getting worse?

A: Seek prompt medical attention—worsening or non-healing rashes could signal secondary infection or other complications.

Q: Are the vaccines safe?

A: The available shingles vaccines have been shown in clinical trials to be safe and effective, with the most common side effects being mild, such as soreness, redness, or swelling at the injection site, and some temporary muscle pain or fatigue.

Shingles and Daily Life

Shingles can have a major impact on quality of life during the active phase and potentially afterward if complications occur. Many people require time off work or school while symptoms are severe. Prompt diagnosis, treatment, and supportive care can greatly reduce the duration and severity of symptoms. Vaccination remains the best preventive strategy.

If you suspect you have shingles, contact your health care provider promptly for evaluation and management.

References

Author

medha deb

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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