Shingles: symptoms, treatment and vaccination

NHS inform describes shingles as an infection of a nerve and the skin around it, caused by the varicella-zoster virus. After chickenpox, the virus stays in the body. NICE Clinical Knowledge Summaries describe shingles as reactivation of this latent virus in nerve cells, producing a rash in the area of skin served by one nerve.

The NHS says the virus can become active again if the immune system is weakened, for example through stress, certain conditions or treatments such as chemotherapy. NICE adds that both the frequency and the severity of shingles rise with age.

NICE also lists other risk factors: immune suppression from long-term steroids, HIV, lymph-system cancers or chemotherapy, certain conditions such as rheumatoid arthritis and asthma, psychological factors and female sex.

The NHS says first signs can be a tingling or painful area of skin, a headache or feeling generally unwell, with a rash usually appearing a few days later. In rare cases there is pain without a rash. NHS inform adds burning, numbness or itching and a high temperature as early features.

The rash appears as blotches on one side of the body only, then becomes itchy blisters that ooze fluid. A few days later they dry and scab. NHS inform says new blisters can appear for up to a week, and scabs may leave slight scarring. The NHS notes redness can be harder to see on brown and black skin.

A rash on both left and right sides of the body is unlikely to be shingles. The chest and tummy are most common, but it can appear anywhere, including face, eyes and genitals.

The NHS says to ask for an urgent GP appointment or call NHS 111 if you have shingles symptoms and you are pregnant, you are breastfeeding with a rash on the breasts, the rash is on your eye or nose, your vision has changed, you have a severely weakened immune system, or you are 17 or younger.

These groups may need antiviral medicine quickly, ideally within 3 days of the rash appearing. NICE adds that hospital admission or immediate specialist advice may be appropriate for people who are severely immunocompromised, systemically unwell, have eye involvement or have a severe or widespread rash.

Eye involvement matters because the NHS lists eye problems that can lead to sight loss among the complications.

NICE says shingles is usually diagnosed on clinical grounds, from the story of abnormal skin sensation followed by a one-sided blistering rash in a nerve territory. Clinicians also consider herpes simplex and contact dermatitis. The rash can look atypical in older people and in those with weakened immunity.

A mild rash may need no treatment, according to the NHS. Antiviral tablets may be offered if you have a weakened immune system, moderate or severe pain or rash, or a rash beyond the chest, tummy and back, ideally started within 3 days. Pain relief can include paracetamol, steroid tablets or medicines for nerve pain. Adults can ask a pharmacist, who can give the same antivirals as a GP.

NICE suggests specialist advice if new blisters keep forming after 7 days of antivirals, healing is delayed, shingles recurs or pain is poorly controlled.

The NHS suggests paracetamol for pain, keeping the rash clean and dry, loose-fitting clothing and a cool compress several times a day. Dressings or plasters should not be allowed to stick, and rough fibres should be avoided. NHS inform also suggests calamine lotion for itch.

Staying away from some people matters. The NHS says to try to avoid pregnant women who have not had chickenpox, people with a weakened immune system and babies under 1 month old. Stay off work or school if the rash is still weeping and cannot be covered, or until it has dried out.

Most people recover without problems. The NHS lists possible complications as post-herpetic neuralgia, a secondary skin infection, scarring or colour change, muscle weakness, eye problems and Ramsay Hunt syndrome, where the facial nerve is affected.

The NHS says post-herpetic neuralgia is long-lasting nerve pain in the area of the rash, and usually improves gradually over months to over a year. It is more likely when shingles was severe or widespread, and is more common in older people and those with diabetes or weakened immunity. NICE defines it as pain persisting beyond 90 days.

A GP may prescribe nerve-pain medicines, lidocaine plasters or, for difficult pain, refer to a pain clinic or neurologist, according to the NHS.

The NHS vaccination page says it is available for people turning 65 on or after 1 September 2023, for everyone aged 70 to 79, and for adults 18 and over with a severely weakened immune system. Eligible people are offered 2 doses, 6 to 12 months apart, or 8 weeks to 6 months apart for the immunocompromised group.

It helps reduce your chance of getting shingles and of serious problems if you do. You can get shingles more than once, so the NHS says to be vaccinated even after an episode. Most side effects, such as a sore arm, headache or tiredness, settle within 2 or 3 days.

Eligibility rules have changed in recent years, so check the current position with your GP surgery.

Most shingles care is through a pharmacist, GP or NHS 111, because the key factor is starting antivirals early rather than seeing a specialist. Ongoing nerve pain can be referred to an NHS pain service.

Private GP and dermatology appointments can give faster access to assessment, but the treatments are the same ones described by the NHS, and the 3-day window applies in either setting.