Herpes Zoster (Shingles)

Shingles is a painful rash caused by reactivation of the varicella-zoster virus, the same virus responsible for chickenpox, which remains dormant in nerve tissue after a childhood chickenpox infection and can reactivate later in life. It typically causes a band of blisters along the path of a single nerve, most often on one side of the body. It is more common with increasing age and in people with weakened immune systems.

It occurs when the dormant varicella-zoster virus, present in nerve tissue since a previous chickenpox infection, reactivates, often triggered by a weakened immune system related to ageing, stress, illness, or certain medical treatments. Anyone who has previously had chickenpox is potentially at risk of developing shingles later in life. It cannot be caught directly from someone with shingles as shingles, but someone without immunity could catch chickenpox from contact with a shingles rash.

Symptoms typically begin with pain, tingling, or burning in a specific area, often on one side of the body, followed within a few days by a band of painful, fluid-filled blisters in that same area. Some people also experience fatigue, headache, and mild fever. The rash usually resolves within two to four weeks, though pain can sometimes persist afterwards.

For most people, shingles causes a painful but self-limiting illness that resolves within a few weeks. It can be more serious if it affects the eye (needing urgent specialist assessment to protect vision) or occurs in people with significantly weakened immune systems. A notable complication is postherpetic neuralgia, persistent nerve pain in the affected area that can continue for months after the rash has healed, particularly in older adults.

Treatment includes antiviral medication, most effective if started within 72 hours of the rash appearing, to reduce severity and duration of the illness and lower the risk of complications like postherpetic neuralgia. Pain relief, including specific medications for nerve pain if needed, helps manage symptoms during and after the acute rash. Keeping the rash clean and covered helps prevent secondary bacterial infection and reduces the small risk of spreading the virus to others who have not had chickenpox.

Yes, a shingles vaccine is available and recommended for older adults in the UK, significantly reducing the risk of developing shingles and, if it does occur, reducing the severity and risk of complications such as postherpetic neuralgia. This vaccine differs from the childhood chickenpox vaccine and is specifically for preventing reactivation in those who have already had chickenpox. Ask your GP whether you are eligible for shingles vaccination based on your age and health.

Chickenpox is the initial infection with varicella-zoster virus, typically occurring in childhood, causing a widespread itchy rash across the whole body. Shingles is a reactivation of the same virus later in life, causing a more localised, painful rash typically confined to a band on one side of the body, following the path of a single affected nerve. Both are caused by the same virus but represent different stages of infection with quite different typical presentations and age groups affected.

See a doctor as soon as possible if you suspect shingles, ideally within the first 72 hours of the rash appearing, since antiviral treatment is most effective when started early. A private GP or dermatology assessment can typically be arranged within a day or two given the time-sensitive nature of treatment. Seek urgent care immediately if the rash is near the eye, given the risk of serious eye complications, or if you have a significantly weakened immune system.