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Shingles, also known as herpes zoster, is a painful rash caused by a viral infection. Although shingles can appear anywhere on your body, it is most commonly seen as a single stripe of blisters that wraps around your torso on either the left or right side. The varicella-zoster virus causes shingles, the same virus that causes chickenpox. The virus remains inactive in nerve tissue near your spinal cord and brain after you've had chickenpox. The virus can reactivate as shingles years later. Shingles isn't life-threatening, but it may be excruciatingly painful. Vaccines can help to lower the risk of developing shingles. Early treatment can help minimize the duration of shingle infection and reduce the risk of complications.

Sign and symptoms

The initial symptom of shingles is usually pain. It can be excruciating in some cases. Depending on where the pain is felt, it can be mistaken for a symptom of heart, lung, or renal problems. Some people get shingles pain even without getting the rash. The shingles rash usually appears as a stripe of blisters that wraps across your torso on either the left or right side. The shingles rash sometimes appears around one eye, on one side of the neck, or the face. The rash doesn't generally seem red on various skin tones, and depending upon complexion, the rash can appear dull pink, dim brown, or purplish. The following are some of the signs and symptoms to look out for:

  • Pain and burning in the affected area
  • Fever, chills
  • Itching 
  • Tingling and numbness 
  • Red rash accompanied by pain
  • Fluid-filled blisters that form crusts later
  • Headaches
  • Shivering or consuming inclination in or under your skin 
  • have red patches 
  • Touch sensitivity 
  • Muscle weakness and fatigue 
  • Blurred vision and light sensitivity


The varicella-zoster virus causes shingles, the same virus that causes chickenpox. Shingles can develop in anyone who has had chickenpox. The virus penetrates your nerve system after recovering from chickenpox and remains dormant for years. It may eventually reactivate and move through nerve pathways to your skin, resulting in shingles. However, not everyone who gets chickenpox develops shingles. 

The cause of shingles is unclear. However, as you become older, your immunity to infections may deteriorate. Shingles is more common in the elderly and those with weakened immune systems.

Varicella-zoster belongs to the herpes virus family, which contains the viruses that cause cold sores and genital herpes. As a result, shingles is sometimes referred to as herpes zoster. However, the virus that causes chickenpox and shingles is different from the virus that causes cold sores or genital herpes, which is a sexually transmitted infection.

Risk factors

A weakened immune system may activate the shingle virus. After you've had chickenpox, you're bound to get shingles if you:

  • Are 50 or older
  • Have certain cancers, HIV, or another condition that lowers down your body's immunity
  • Undergoing cancer treatment: Radiation or chemotherapy can weaken your resistance to diseases, leading to shingles.
  • Take long term steroids or other medications that prevent organ transplant rejection


Shingles can lead to the following complications:

Neurological Issues: Shingles can cause an inflammation of the brain (encephalitis), facial paralysis, or hearing or balance issues, depending on which nerves are damaged.

Loss of vision: Ophthalmic shingles (shingles in or around the eyes) can cause painful eye infections and vision loss.

Postherpetic neuralgia: Shingle’s pain can last for weeks or months after the blisters have healed. Damaged nerve fibers transmit pain signals from your skin to your brain, resulting in postherpetic neuralgia.

Infections of the skin: Bacterial skin infections can occur if shingles blisters aren't treated properly.


Shingles is diagnosed by a history of pain on one side of the body, as well as the characteristic rash and blisters. A tissue scraping or culture of the blisters may be taken by your doctor. This includes utilizing a sterile swab to collect a specimen of tissue or liquid. Tests are then sent to a laboratory for examination to confirm the presence of the infection. Scraping for smears and cultures often results in negative results since viruses are difficult to recover from scrapes. A direct immunofluorescence assay can then be used since it is more sensitive than viral culture and can distinguish herpes simplex viral infections from varicella-zoster virus (VZV) infections.

Immunodeficiency should be investigated when the patient's presentation is atypical (e.g., severe disease or a rash that extends beyond one area).

Differential diagnosis


Although there is no cure for shingles, timely treatment with antiviral medications can promote healing and reduce the risk of complications. The following medications are among them:

  • Famciclovir
  • Acyclovir (Zovirax)
  • Valacyclovir (Valtrex)

Because shingles can cause severe pain, your doctor may also prescribe:

  • A topical capsaicin patch (Qutenza)
  • Anticonvulsants like gabapentin (Neurontin) and tricyclic antidepressants like amitriptyline
  • Medications containing narcotics, such as codeine
  • Corticosteroids and local anesthetics 

Oral corticosteroids are controversial in the treatment of patients with zoster infection. Oral corticosteroids have been found in certain studies to improve inflammatory features and hence lessen pain and cosmetically improve the rash in individuals with acute zoster infection as an adjuvant option in treating acute zoster infection.  However, studies have yielded conflicting results, and many people believe that any minor advantage is outweighed by the adverse effects of corticosteroids, particularly in the elderly. Caution is essential for senior patients because they are at a higher risk of significant adverse effects. Steroids should be avoided by those who have any of the following conditions:

Secondary bacterial infection may require topical antibiotic therapy. To avoid secondary bacterial infection, keep the rash clean and dry. Adhesive dressings should be avoided if at all possible. There is no need to avoid school or work if the rash can be covered or the lesions have crusted. However, if the rash is weeping and not on a covered part of the skin, the person should avoid going to school or work.


Shingles can be prevented with the use of a shingles vaccination. In the United States, people eligible for the Shingrix vaccine should receive it. 

 Shingrix was approved by the Food and Drug Administration (FDA) in the United States in 2017. Shingrix, according to studies, provides shingles protection for more than five years. Shingrix is a virus-based nonliving vaccination. It is given in two doses, with a two-to-six-month interval between them. Shingrix is approved and recommended for persons aged 50 and older, including those who have had shingles or who have previously taken the Zostavax vaccine. Although the Zostavax vaccination is no longer available in the United States, it may still be used in other countries.

Redness, pain, tenderness, swelling, and itching at the injection site, as well as headaches, are the most common side effects of either shingles vaccine. You can develop shingles even if you get the shingles vaccine. However, this vaccine is likely to shorten the course and severity of the disease, as well as lower your risk of developing postherpetic neuralgia.

The shingles vaccination is solely used as a preventative measure. It's not intended to help people already sick with the disease. You should always consult your healthcare provider to determine which option is best for you.