Shingles, an infection most often associated with a painful rash, is caused by the varicella-zoster—or chickenpox—virus.1 Once a person has had chickenpox earlier in life, the virus may lie dormant in nerve cells for years.2 Then, for reasons not completely understood, the virus may reactivate as shingles, also referred to as herpes zoster,3 most commonly affecting people over age 50 or those with weakened immune systems.4
Like chickenpox, shingles causes itchy blisters that may start on the chest, back or face, spreading to the rest of the body.5 Unlike chickenpox, however, shingles rash is often accompanied by pain,6 which may continue for months or even years after the rash has cleared up.7
In its beginning stages, the shingles rash manifests itself as pink or red blotchy patches that usually appear on one side of the body, clustered along nerve pathways, and many people experience shooting pain in the rash areas.8
Causes of shingles
Though the link between the chickenpox virus and shingles is well established, the triggering mechanism of the more serious and painful disease isn’t as fully understood.
“While the exact cause of shingles is unknown, experts do know that the virus can remain inactive in nerve tissues near the spinal cord and brain for decades,” says Eric Grahling, MD, a pain management expert at Comprehensive Pain Management of Central Connecticut. “We believe that it may recur so many years later if a person has a lowered immunity due to infections that comes with age or has a weakened immune system due to medical treatments or a disease.”9
Is shingles contagious?
A person with a shingles rash that hasn’t yet scabbed over can infect another person who isn’t immune to chickenpox. This usually occurs via direct, physical contact with open shingles sores or blisters. Once the virus is passed on, the infected person will develop chickenpox, not shingles.10
Shingles symptoms and complications
The most common first symptom of shingles is pain, which may be intense. Depending on the pain’s location, it may be mistaken for a heart, lung or kidney problem. Plus, some people may experience the pain of shingles without ever developing its rash.11
If and when the rash does develop, it most commonly appears as a band of blisters wrapping around the right or left side of the upper body, though the rash may appear around 1 of the eyes or on 1 side of the face or neck.12
Individual symptoms of shingles may include:13
- Itching, tingling or burning
- Blisters that break open then crust over
- Sensitivity to light or touch
- Headache
- Fever and/or chills
- Fatigue
While most shingles symptoms are gone within 3 to 5 weeks, there are complications which may develop and persist:14
- Postherpetic neuralgia (PHN) is constant, chronic pain that lasts long after the shingles rash has healed. The pain may be the worst where blisters were present, and the skin in the area may be extremely sensitive to heat and cold.
- Bacterial infection of the skin may occur where the shingles rash was located. This complication may lead to additional tissue and scarring problems. If the infection is located on or near the eyes, the corneas may become infected, which may lead to blindness.
For older adults, shingles may cause other serious health complications, such as a higher risk of stroke, vision loss, dementia, PHN and death.15
Shingles prevention
A vaccine—like Shingrix, which the FDA approved in 2017—may help prevent shingles. Shingrix is recommended for people over age 50, as well as for people aged 19 and over with weakened immune systems.16
Though it doesn’t guarantee that someone won’t contract shingles, Shingrix may be likely to reduce the course and severity of the disease, offering protection against shingles for more than 5 years.17 Plus, getting vaccinated may reduce a person’s risk of PHN.18
Shingles treatments
Shingles may be treated with a variety of anti-viral drugs including Acyclovir, Valacyclovir and Famciclovir, which act to shorten the length and severity of shingles symptoms and help prevent nerve damage.19 These treatments are most effective when they’re administered as soon as possible after the shingles rash appears.20
Since there is no cure for shingles, treatment with antivirals is focused on relieving the pain associated with the disease, and other treatments may include:21
- Over-the-counter pain relievers
- Itch-relief creams or lotions
- Cool compresses on affected areas
- Steroids
- Antidepressants or anticonvulsants
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Sources:
1“Shingles,” Mayo Clinic, last accessed August 7, 2023,
2“Shingles: What You Should Know,” WebMD, last accessed August 7, 2023,
3“Shingles,” Mayo Clinic.
4“Shingles,” Johns Hopkins Medicine, last accessed August 7, 2023,
5“Shingles: What You Should Know.”
6“Shingles: What You Should Know.”
7“Shingles,” Johns Hopkins Medicine.
8“What Does Shingles Look Like?” Healthline, last accessed August 7, 2023,
9“What Actually Causes Shingles—and How You Can Prevent It,” Health.com, last accessed August 7, 2023,
10“Shingles,” Mayo Clinic.
11“Shingles,” Mayo Clinic.
12“Shingles,” Mayo Clinic.
13“Shingles,” Mayo Clinic.
14“Shingles,” Mayo Clinic.
15James Roland, “Why Is Shingles More Serious In Older Adults?” Healthline, last accessed August 28, 2023,
16“Shingles,” Mayo Clinic.
17“Shingles,” Mayo Clinic.
18“Shingles,” Mayo Clinic.
19“Shingles (Herpes Zoster),” Centers for Disease Control and Prevention, last accessed August 7, 2023,
20“Shingles (Herpes Zoster),” Centers for Disease Control and Prevention.
21“Shingles,” Johns Hopkins Medicine.
This information is provided for educational purposes only. It is not to be used for medical advice, diagnosis or treatment. Consult your healthcare provider if you have questions or concerns.
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