Understanding Shingles: What You Need to Know
Shingles (or Herpes Zoster) is a painful rash caused by a virus. It is the same virus that causes chickenpox. The chickenpox virus is also known as “varicella zoster”. Anyone who’s had chickenpox can develop shingles later in life- as the virus stays in your body following the chickenpox infection and can become active again later on. The shingles rash appears as a stripe of blisters on one side of the body- usually the chest, back, buttocks or face. These blisters tend to feel itchy or burning. The way the rash appears is different to chickenpox, where the blisters start on the face, chest or back but then spread across the whole body.
Who Gets Shingles?
Shingles is most common in people over 50 and people with weakened immune systems. Risk factors that can increase your chance of shingles include:
- Aging, as the immune system weakens over time.
- Conditions that affect your immune system, like HIV/AIDS or cancer.
- Stress, which can impact immune health.
- Women going through Perimenopause or Menopause, as hormonal changes can affect immunity
- Serious physical injury
- Long-term use of steroids or other treatments that weaken the immune system.
- Didn’t get the chickenpox vaccine as a kid or an adult, or in the case of eligible adults, those who did not get the Shingles vaccine.
Many people who get shingles don’t actually have any above medical issues though!
Symptoms to Watch For
The rash starts as a patch or cluster of small bumps on your skin. People often feel the shingles rash before seeing it, as they get a strange burning sensation (like a friction burn), itch or tingling. This is because the virus is spreading along a nerve. The bumps show up differently, depending on your skin tone- on lighter skin, the bumps look red, and on dark skin, they can appear pink, brown, grey or purple.
These bumps turn into fluid-filled blisters, which also vary in colour, depending on your skin tone. The blisters tend to dry out and crust over within a 7 to 10 days. Shingles can cause a lot of pain and discomfort, and sometimes the pain continues even after the rash has cleared up.
Most often, the shingles rash forms a band or strip that wraps around one side of the torso (following the course of a nerve), or occasionally on a buttock. It can also appear around one eye, or on one side of the neck or face. If the shingles rash appears on your face or around your eye, you should see a doctor very urgently (the same day). The virus could damage your eyesight or the nerves in your ear.
Other symptoms of shingles include:
- Fever
- Headaches
- Fatigue
- Sensitivity to light
- Enlarged lymph nodes
- Stabbing or shooting pain
- Chills
- Upset stomach
If you’ve ever had chickenpox, these early signs could be a sign you are about to develop shingles.
Complications of Shingles
- One of the more severe effects of shingles is postherpetic neuralgia, where the pain continues in the affected nerve, even after the rash has healed. This can persist for months or years and can severely impact quality of life.
- A secondary skin infection can develop, when the blisters rupture- this can require antibiotics to clear it.
- Permanent scarring may occur, and
- In severe cases, if the eye area is affected, vision loss can occur
Shingles around the eye
- Blistering rash on the eyelid
- Blurred vision and sensitivity to light
- Conjunctivitis – redness and discharge affecting the “whites” of your eyes
- Keratitis -inflammation of of the surface of the cornea
- Iritis- pain and inflammation inside the eye
- Optic neuritis- inflammation of the optic nerve
- Cataracts
- Glaucoma (increased pressure in the eye)
- Permanent loss of vision
- Double vision
- Dry eyes
- Secondary bacterial infection
- Scarring of the cornea
The stages of Shingles
Is Shingles Contagious?
Yes, before the blisters crust over, they can release the chicken pox virus. The virus can infect people who are not immune to chicken pox, or who have weakened immune systems. That’s why people who are in the “eruptive” stage of the rash should avoid being in close contact with newborns, pregnant women, or people with weakened immune systems.
If you have shingles, you can also take the following steps to avoid spreading the virus to others:
- Avoid touching or scratching the rash
- Keep the rash covered, if possible
- Wash your hands frequently and thoroughly
If you’ve never had chickenpox or the chickenpox vaccine, you should avoid anyone who has active shingles. If you do catch the virus from, you won’t get a case of shingles initially- you’ll get chickenpox. But getting chickenpox in the first place places you at risk of shingles later on in life.
What about Shingles in pregnancy?
Shingles is rare in pregnancy. If it does occur, there is no clear evidence that it causes any pregnancy complications or harm to the developing foetus. If you are pregnant and think you have shingles- don’t delay- speak to your doctor as soon as possible, as antiviral medications can be prescribed. However, chickenpox is different- it is important to note that a pregnant woman who is not immune to chickenpox should avoid exposure to anyone who has shingles, to avoid catching chickenpox from them, as it can be very harmful to a developing foetus.
Can you breastfeed if you have Shingles?
If you get shingles while you’re breastfeeding, you’ll need to try to keep your baby away from the rash. As far as we know, the shingles virus does not pass into breast milk. However babies can get chickenpox from contact with shingles blisters. If you have a rash on or around the nipple/ breast areas you should pump and discard the breast milk from that side. It’s safe to breastfeed once the blisters have crusted over. Antiviral medications may be considered if a woman is breastfeeding, but this should be decided in consultation with your doctor.
Treatment Options
The goal of treatment is to reduce the severity and shorten the duration of pain. This includes:
- Antiviral medications, which are most effective when started early (within the first 3 days of the onset of the rash)
- Treatment for nerve pain, including anticonvulsant medications, numbing lotions/gels, prescription painkillers such as opioids, tricyclic antidepressants like Amitryptiline, Over the counter painkillers may not help shingles pain very nuch, as it is nerve pain.
- Less commonly, nerve block injections or steroid injections can be used, which can help relieve severe pain
- Over-the-counter or home remedies may help to relieve itch and discomfort- such as calamine lotion, cold compresses and oatmeal baths.
Can you get Shingles twice?
Most people who get shingles only get it once. But it can come back, typically if someone has a weakened immune system.
Prevention of Shingles
The shingles vaccine is your best defense against shingles. In Australia, vaccination is recommended for adults over 50 and anyone aged 18 years old who has a significantly weakened immune system. It’s very effective in preventing shingles and its complications, including postherpetic neuralgia. Certain groups of people are recommended to get the shingles vaccine in Australia.
Do I need the Shingles vaccine if I already had Shingles?
Unfortunately a bout of shingles does not protect you from a future bout- so the shingles vaccine is still recommended as a way to prevent the infection.
Looking for More Information?
- HealthDirect Australia offers detailed guides on shingles management and prevention. Check out their resources here including this handy infographic.
- The Australian Department of Health provides information on the Shingles vaccine here
