Herpes Zoster (Shingles): Symptoms, Causes & Treatment

Shingles, or herpes zoster, is a neuro-cutaneous disease resulting from reactivation of the varicella-zoster virus, the same virus that causes chickenpox. After recovering from chickenpox in childhood, the virus does not disappear completely but remains dormant and inactive in the nerve roots near the spinal cord for many years.

When the immune system weakens — with aging, severe stress, illness, or immune-suppressing medications — the virus may reactivate and travel along a specific nerve to the skin, causing pain and burning then a characteristic rash in the form of a stripe or band of painful blisters, usually limited to one side of the body and not crossing its midline, often on the chest, back, or face.

The most distinctive feature of shingles is the pain, which may precede the rash and persist after it, and in some patients — especially older adults — it may turn into chronic nerve pain known as postherpetic neuralgia. Starting an antiviral early within the first 72 hours of the rash is therefore very important to speed healing and reduce the severity of pain and complications. An effective vaccine is also available and recommended for older adults to prevent the disease and its complications.

• Pain, burning, and tingling in a specific area of skin that may precede the rash.
• A red rash turning into painful blisters in a band on one side.
• Itching and marked sensitivity to touch.
• Sometimes fever, headache, and fatigue.

• Reactivation of the dormant varicella-zoster virus after a previous chickenpox infection.
• Weakened immunity with aging.
• Severe stress, illness, or immune-suppressing medications.

• Age over 50.
• A weakened immune system and chronic illnesses.
• Immune-suppressing medications and chemotherapy.

• Clinical diagnosis from the characteristic rash and its one-sided distribution.
• Tests to confirm the virus when needed or in atypical cases.

Antivirals

• Starting an antiviral early within the first 72 hours speeds healing and reduces pain and complications.

Pain relief

• Pain relievers and nerve-pain treatments when needed.
• Cool compresses and keeping the rash clean to prevent bacterial infection.

This content is educational and does not replace medical advice; medications are prescription-only.

• Chronic postherpetic neuralgia.
• Eye involvement when the rash appears around it (requires an eye doctor).
• Bacterial infection of the rash.

• The shingles vaccine recommended for older adults.
• Supporting immunity and managing chronic diseases.
• Avoiding contact of the rash with non-immune people and pregnant women.