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Shingles

Shingles is the term used to describe a particular rash caused by the chickenpox virus. In chickenpox the rash is widespread, but in shingles it is an infection of the nerves that are connected to an area of skin. All our skin is connected to nerves and so any part of the body surface can be affected by shingles. Everyone who has had chickenpox carries the virus that causes shingles, but only about one person in four will develop shingles at some stage in their life.

What causes shingles?

Chickenpox and shingles are caused by herpes zoster. Shingles is caused by the reactivation of the chickenpox virus particles which have been lying dormant, often for many years, in a nerve cell. The reactivated virus spreads along the nerve to the skin.

The virus that causes both chickenpox and shingles is in the same family of viruses as the ones that cause cold sores and genital herpes. The same anti viral medicines are used to treat all of these conditions.

Who is at risk of getting shingles?

Most adults have antibodies to varicella zoster virus (90% in the UK), although not all people will recall having had chickenpox. The risk of getting shingles increases with age and is particularly common in people over 60. Men and women are equally at risk.

Most people who develop shingles have normal immunity and no other serious disease, but in some people it is triggered by another illness.

Is shingles contagious?

Unlike chickenpox, shingles is not very contagious. People who have had chickenpox cannot catch it. The risk to people who have not had chickenpox and who are in close contact with the shingles sufferer is low.

However, it is wise for someone with shingles to avoid close contact with young children and babies until all the crusts have dried. By this time the risk to others will be negligible.

What are the symptoms?

Shingles is usually preceded by a day or two of discomfort or pain in the skin attached to the affected nerve. This pain may be associated with feeling unwell. A flat, patchy red rash is the first sign of shingles.

Small fluid-filled blisters then appear and collapse, leaving small ulcers which later dry and form crusts. The crusts fall off and the rash finally heals after about two or three weeks. Some people also have headaches and a fever for the first few days.

Because shingles is caused by an inflamed nerve, most people will get some discomfort, which occasionally can be quite severe. The pain will often change its character from ‘electric’ or tingling sensations to aches, sharp pain and then an itchy feeling as the rash heals. A few fortunate patients have no pain at all.

I have heard the pain can last for years - Will this happen to me? Long-term pain is the most serious concern with shingles, though it is rare in people under 50 . About 50% of those over 60 will have pain one month after shingles, 25% after three months and occasionally quite severe pain is reported five or more years after the rash goes away. This long term pain is more common in people over 70.

Will the rash leave a scar?

Scarring is usually mild, consisting of a patchy white mark. About half the cases of shingles will leave a scar. This is also more common in elderly people. Hard or raised scarring is much less common.

How is shingles treated?

Anti viral drugs are available on prescription. The drugs work best when given as son as possible after the rash develops and must be started within 72 hours of the rash appearing. This medication may shorten the duration of the rash and the other symptoms such as headache and fever.

In people younger than 50, shingles is usually not so severe and has fewer after-effects, so anti viral treatment is optional. Pain is less likely and may be less severe in people who take medications. The pain may interrupt your sleep, and it can also interfere with day-to-day activities, so you may need pain killers or sleeping tablets. Shingles near the eye may need to be treated with anti viral to protect the eye. Because of the increased risk of pain, most people over 50 with shingles will be offered anti viral drugs.

In very rare situations, when a person with shingles is in close contact with someone who has poor immunity or is at particular risk (for example, people with leukaemia, high dose steroid users, pregnant women, HIV positive people) the person at risk should be offered immunisation.

Is a vaccine against shingles available?

A vaccine to prevent chickenpox is available in the United States, but not yet available for general use in the UK. In those who have had chickenpox the vaccine would not be expected to prevent shingles as the dormant particles are hidden away in nerve cells.

For more information about the vaccination please visit http://shinglesaware.co.uk/patients/information-for-patients.xhtml

What else can I do?

Make sure you have some strong painkillers as the pain can get worse after the rash appears. Paracetamol and aspirin are useful for fever and you may need sleeping tablets for a few nights. You should stay at home until all sores have crusted and rash is dry.

You can rub moisturiser into the skin once crusts have fallen off (but not before) as this may help prevent scarring. Some people find using Vitamin E cream and keeping the affected area out of the sun are useful.

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