The blisters (vesicles) that develop as a result of shingles contain virus particles. The virus can be spread through direct contact with the open blisters. If you have not had chickenpox before, you can catch it from direct contact with:
# the fluid from the blisters of someone who has shingles
# something that has the fluid on it, such as bed sheets or a towel
If you have shingles, you are contagious until the last blister has scabbed over. This will usually occur five to seven days after your symptoms started.
From before the time the rash erupts until after it’s healed, you’ll be itchy – in some cases, the rash can be extremely painful. The rash usually lasts about 7 to 10 days and completely disappears after one month. The pain can last for up to 3 months or longer in a very small percentage of people. While you will likely have only one bout of herpes zoster, some people may get it several times.
The rash itself is reddish, with many tiny, fluid-filled blisters. For a few days, the rash spreads, although its extent varies from one person to another. The rash commonly occurs on one side of the trunk of your body as a band of blisters that go from the middle of your back around one side of your chest to your breastbone. The blisters will break, dry out, and then crust over.
When the virus becomes active again, you may get symptoms such as rash, upset stomach, headache, fever, and chills. These symptoms are often preceded by warning signs (the prodrome) such as sensitivity, itchiness, numbness, or pain in the days before the rash appears. The rash produces painful, fluid-filled blisters, and you’ll feel tingling or burning sensations.
When the varicella-zoster virus enters its “quiet” phase after chickenpox, it remains dormant in certain nerves. The shingles rash will break out in the areas of the body connected to those nerve cells. As a result, only one section or one side of the body is often affected. Common sites for the rash include the chest, back, buttocks, neck, and sometimes the face and scalp.
The most common complication of shingles is postherpetic neuralgia. This occurs when the nerve pain associated with shingles persists beyond one month, even after the rash is gone. It is a result of irritation of the nerves of sensation by the virus. The pain can be severe and debilitating. Postherpetic neuralgia occurs primarily in people over the age of 50 and affects 10%-15% of people with shingles. There is evidence that treating shingles with antiviral agents can reduce the duration and occurrence of postherpetic neuralgia.
The pain of postherpetic neuralgia can be reduced by a number of medications. Tricyclic antidepressant medications (amitriptyline [Elavil] and others), as well as antiseizure medications (gabapentin [Neurontin], carbamazepine [Tegretol], pregabalin [Lyrica]), have been used to relieve the pain associated with postherpetic neuralgia. In 2012, the FDA approved the use of gabapentin enacarbil (Horizant), previously used for the management of restless legs syndrome, for the treatment of postherpetic neuralgia. Capsaicin cream (Zostrix), a derivative of hot chili peppers, can be used topically on the area after all the blisters have healed, to reduce the pain. Lidocaine pain patches (Lidoderm) applied directly to the skin can also be helpful in relieving nerve pains by numbing the nerves with local lidocaine anesthetic. These options should be discussed with your health care professional.
Chickenpox must be prevented in order to prevent shingles. A vaccine for chickenpox is now available and it is hoped that immunized individuals will be less likely to develop shingles in later life.
The risk of spreading shingles is low if the rash is covered. People with shingles should keep the rash covered, not touch or scratch the rash, and wash their hands often to prevent the spread of shingles. Once the rash has developed crusts, the person is no longer contagious.
Yes. A single dose of herpes zoster vaccine called Zostavax is recommended for adults 60 years of age and older whether or not they report a prior episode of shingles. Zostavax does not treat shingles or post-herpetic neuralgia (pain that persists after the rash resolves) once it develops.
Shingles is not usually dangerous to healthy individuals although it can cause great misery during an attack. Anyone with shingles on the upper half of their face, no matter how mild, should seek medical care at once because of the risk of damage to the eye. Very rarely, shingles can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death. For about one person in five, severe pain can continue even after the rash clears up. This pain is called post-herpetic neuralgia. As people get older, they are more likely to develop post-herpetic neuralgia, and it is more likely to be severe.