Shingles: symptoms, treatment within 3 days and the NHS vaccine

Shingles is an infection of a nerve and the skin around it, caused by the varicella-zoster virus, which also causes chickenpox, according to NHS inform. After chickenpox the virus stays in the body and can become active again later, particularly if the immune system is weakened by stress, certain conditions or treatments such as chemotherapy. The NHS says you are more likely to get shingles, and it is more likely to cause serious problems, as you get older or if you have a severely weakened immune system.

It is possible to have shingles more than once, although NHS inform says it is very rare to get it more than twice. The NHS vaccine page stresses that it is important to be vaccinated even if you have had shingles before.

The first signs can be a tingling or painful feeling in an area of skin, a headache or feeling generally unwell. NHS inform adds burning, numbness or itching in an area of skin, and a high temperature. A rash usually appears a few days later, though in rare cases shingles causes pain without a rash. It appears as blotches on one side of the body only, usually on the chest and tummy but possibly anywhere including the face, eyes and genitals. A rash on both left and right sides is unlikely to be shingles.

The blotches turn into itchy blisters that ooze fluid and, a few days later, dry out and scab. New blisters can appear for up to a week. The pain may be a constant dull or burning sensation, from mild to severe, with sharp stabbing pains from time to time, and the skin stays tender. The rash can be red but harder to see on brown and black skin. A rash in and around the eye can make it sore and red and may affect sight or hearing and make it hard to move one side of the face.

• Tingling, burning or pain in a patch of skin before any rash.

• A one-sided band or cluster of blotches that become blisters.

• Headache, feeling unwell or a raised temperature.

• Skin that stays painful until after the rash has gone.

The NHS says to try to see a pharmacist within 3 days of the rash appearing if you are 18 or older. If you need medicine it can help to speed recovery and avoid longer-lasting problems, and a pharmacist can give the same antiviral medicines as a GP. A mild rash may not need treatment. Antiviral tablets may be offered if you have a weakened immune system, your pain or rash is moderate or severe, or the rash affects areas other than the chest, tummy and back. You usually need to start within 3 days of the rash first appearing. Treatment can also include painkillers, steroid tablets or medicines for nerve pain.

At home, the NHS suggests paracetamol for pain, keeping the rash clean and dry, wearing loose-fitting clothing and using a cool compress (ice or frozen vegetables wrapped in a towel, or a wet cloth) a few times a day. Do not let dressings or plasters stick to the rash and avoid rough fibres. NHS inform adds calamine lotion for itching. There is no cure for shingles, but early treatment may reduce severity and the risk of complications.

You cannot spread shingles to others, but because it is caused by the chickenpox virus people could catch chickenpox from you if they have not had chickenpox before or have not had the vaccine. The NHS advises trying to avoid anyone who is pregnant and has not had chickenpox before, people with a weakened immune system such as someone having chemotherapy, and babies less than 1 month old.

You can only spread the infection while the rash oozes fluid. The NHS says to stay off work or school if the rash is still weeping and cannot be covered, or until it has dried out. NHS inform says you are contagious until the last blister has dried and scabbed over. You can cover the rash with loose clothing or a non-sticky dressing.

Most people recover without problems, but the NHS lists post-herpetic neuralgia (pain lasting several months after the rash has gone), infection of the rash needing antibiotics, scarring or colour changes, muscle weakness, eye problems that can lead to sight loss, and Ramsay Hunt syndrome, a rare condition in which shingles affects the facial nerve causing weakness on one side of the face and sometimes hearing problems. The NHS says you can reduce the risk of complications by getting treatment as soon as possible after symptoms start.

If nerve pain persists after the rash heals, tell your GP, because medicines for nerve pain and specialist pain services can help. The NHS says the skin can stay painful for weeks after the rash has gone but usually gets better over time.

The NHS says the vaccine is available to people who turn 65 on or after 1 September 2023, to everyone aged 70 to 79, and to people aged 18 and over with a severely weakened immune system. Those turning 65 or aged 70 to 79 are offered 2 doses, given between 6 and 12 months apart, and stay eligible until their 80th birthday (second dose up to the 81st). People with a severely weakened immune system have 2 doses between 8 weeks and 6 months apart. If you turned 65 before 1 September 2023, you become eligible when you turn 70.

The vaccine helps reduce your chance of getting shingles and of serious problems if you do get it, and if you get shingles after vaccination the symptoms can be much milder. You can only not have it if you have had a serious allergic reaction to a previous dose or an ingredient, and if you have a high temperature or feel too unwell, wait until better. Your GP surgery usually contacts you, and you should call if you think you are eligible and have not been contacted.

Most shingles care starts with a pharmacist or GP, and urgent assessment applies for eye involvement, pregnancy or immune suppression. Eye symptoms may need an ophthalmology review. For ongoing nerve pain, GPs can prescribe nerve pain medicines and refer to a pain clinic.

Private GPs and pharmacies can assess rashes quickly, which can be useful given the 3-day treatment window. If you are not eligible for the NHS vaccine, you can ask a private provider about vaccination, noting that eligibility and availability differ, and that the NHS offers the vaccine free to those who meet the criteria.