All about shingles: causes, symptoms and vaccination

Shingles is an infection of a nerve and the surrounding skin, which results in an extremely painful, itchy rash on one side of your body.

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What causes shingles?

Also known as herpes zoster, shingles is caused by the varicella-zoster virus – the same virus that causes chickenpox.

If you've had chickenpox, the varicella-zoster virus can continue to lie dormant in the nervous system for years afterwards. It may then become active again much later on – multiplying and moving along the nerve fibres until it breaks out on the skin. Around 20 per cent of people who have had chickenpox will have a shingles attack later in life.

Shingles can happen when your immune system is lowered, which might happen because of certain medication including chemotherapy and corticosteroids, HIV and lupus. Age-related natural decline in your immune system response can also increase the chances of varicella-zoster virus being triggered and causing shingles. Research indicates that stress and illness can also cause shingles, with some countries reporting an increase in shingles during the Covid-19 pandemic.

What are the symptoms of shingles?

The most predominant symptom is pain, which may be accompanied by a burning or tingling sensation on the skin. You may also have a headache, high temperature and generally feel very weak.

The shingles rash tends to follow one or two days after the pain first appears. It typically affects just one side of the body – and is most commonly seen on the chest or stomach, although it can appear anywhere.

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Symptoms of a shingles rash

Shingles is far from pleasant, as you'd imagine. It starts off as groups of red spots, but these quickly turn into fluid-filled blisters. Some of these blisters will burst, while others fill up with blood or pus. Eventually, they'll turn yellow, dry out and scab over. The scabs drop off within around three weeks.

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How is shingles treated?

Shingles itself can't be cured – but there's plenty you can do to relieve the symptoms.

Keep the rash as dry and clean as possible, wear loose-fitting clothing and use non-stick dressings. Try applying calamine lotion to soothe and cool the skin, but not too much at once as it might become difficult to remove. A cold compress may also help – but never use it for more than 20 minutes, to avoid aggravating the blisters. Don't apply antibiotic creams as this can slow down healing.

Over-the-counter painkillers, such as paracetamol or ibuprofen, will help ease the aches and soreness. Your GP may also prescribe a course of antiviral tablets, but these are most effective if taken within 72 hours of the rash first appearing. They can reduce the severity and length of the shingles episode, as well as prevent further complications.

NHS advice is to call 111 as soon as you suspect you have shingles.

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How long does shingles last?

Most shingles attacks clear up within two to four weeks. However, the intense nerve pain and itching may sometimes persist long after the rash has gone. This condition is known as post-herpetic neuralgia, and affects older people in particular. It's normally treated with prescription painkillers. Most people will make a full recovery within a year.

Will shingles recur?

It's possible to get shingles more than once – but incredibly rare to get it more than twice.

Is shingles contagious?

Shingles is not contagious, but you can catch chickenpox from a person with shingles if you haven't had it before – so do take care, particularly when you're around someone with open blisters. Never share towels, flannels or cloths.

If you have shingles avoid contact with people who might be at risk of catching chicken pox, such as pregnant women, babies under one month old and people with weakened immune systems (such as cancer patients).

Aside from having had chickenpox, what are the main risk factors for shingles?

The virus is most likely to become reactivated as a result of a weakened immune system –for example, due to HIV, leukaemia or cancer treatment. Physical and emotional stress can also weaken your immunity.

Lastly, immunity naturally decreases with age, which is why shingles most commonly affects the over-70s.

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Is there a shingles vaccine?

Yes, the shingles vaccine first became available in the UK in 2013. It's given as a jab in the arm, and is available free to people in their 70s on the NHS, or privately to those over 50. For 70-79 year olds your GP or practice nurse should offer you the vaccine when you attend the surgery for other reasons, but contact them to arrange an appointment if you are concerned you might miss out. The vaccine is not available on the NHS to people 80 and over because it has been found to be less effective in this age group.

You can have the shingles vaccine at any time of year and may need one dose or two depending on the brand. The most commonly used vaccine is Zostavax, a live vaccine given in one dose. For those with a compromised immune system Shingrix, a non-live vaccine given as two doses, two months apart, is available.

The shingles vaccine reduces your risk of getting shingles, and if you do get shingles the symptoms will be milder and the illness shorter.

The shingles vaccine is available to people who have already had shingles before but you will need to discuss with your doctor what timing would be best following recovery.

Read more about shingles vaccines on the NHS website.

Visit the Shingles Support Society for more information on shingles.

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