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Shingles (herpes zoster) is a painful, blistering skin rash due to the varicella-zoster virus, the virus that causes chickenpox.

See also: Ramsay Hunt syndrome

Herpes zoster

After you get chickenpox, the virus remains inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes active again in these nerves years later.

The reason the virus suddenly become active again is not clear. Often only one attack occurs.

Shingles may develop in any age group, but you are more likely to develop the condition if:

• You are older than 60
• You had chickenpox before age 1
• Your immune system is weakened by medications or disease

If an adult or child has direct contact with the shingles rash on someone and has not had chickenpox as a child or a chickenpox vaccine, they can develop chickenpox, rather than shingles.

The first symptom is usually one-sided pain, tingling, or burning. The pain and burning may be severe and is usually present before any rash appears.

Red patches on the skin, followed by small blisters, form in most people.

• The blisters break, forming small ulcers that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks. Scarring is rare.
• The rash usually involves a narrow area from the spine around to the front of the belly area or chest.
• The rash may involve face, eyes, mouth, and ears.

Additional symptoms may include:

• Abdominal pain
• Chills
• Difficulty moving some of the muscles in the face
• Drooping eyelid (ptosis)
• Fever and chills
• General ill-feeling
• Genital lesions
• Headache
• Hearing loss
• Joint pain
• Loss of eye motion
• Swollen glands (lymph nodes)
• Taste problems
• Vision problems

You may also have have pain, muscle weakness, and a rash involving different parts of your face if shingles affects a nerve in your face. See: Ramsay Hunt syndrome

Your doctor can make the diagnosis by looking at your skin and asking questions about your medical history.

Tests are rarely needed, but may include taking a skin sample to see if the skin is infected with the virus that causes shingles.

Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus but cannot confirm that the rash is due to shingles.

Herpes zoster usually clears in 2 to 3 weeks and rarely recurs. If the virus affects the nerves that control movement (the motor nerves), you may have temporary or permanent weakness or paralysis.

Sometimes, the pain in the area where the shingles occurred may last from months to years. See: Postherpetic neuralgia

Sometimes, the pain in the area where the shingles occurred may last for months or years. This pain is called postherpetic neuralgia. It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe pain. It is more likely to occur in people over 60 years.

Other complications may include:

• Another attack of shingles
• Blindness (if shingles occured in the eye)
• Deafness
• Infection, including encephalitis or sepsis (blood infection) in persons with weakened immune systems
• Bacterial skin infections
• Ramsay Hunt syndrome if shingles affected the nerves in the face

Call your health care provider if you have symptoms of shingles, particularly if you have a weakened immune system or if your symptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you do not receive emergency medical care.

Avoid touching the rash and blisters of persons with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine.

The chickenpox vaccine may be recommended for teenagers or adults who have never had chickenpox. Medical evidence has shown that older adults who receive the vaccine are less likely to have complications from shingles. Adults older than 60 should receive the vaccine as part of routine medical care.

See: Chickenpox vaccine

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Kimberlin DW, Whitley RJ. Varicella-zoster vaccine for the prevention of herpes zoster. N Engl J Med. 2007;356(13):1338-1343.

American Academy of Pediatrics Committee on Infectious Diseases. Prevention of varicella: recommendations for use of varicella vaccines in children, including a recommendation for a routine 2-dose varicella immunization schedule. Pediatrics. 2007;120(1):221-231.

Urman CO, Gottlieb AB. New viral vaccines for dermatologic disease. J Am Acad Dermatol. 2008;58(3):361-370.

Tyring SK. Management of herpes zoster and postherpetic neuralgia. J Am Acad Dermatol. 2007;57:S136-S142.