Shingles explained: symptoms, treatment and the vaccine

What shingles is and how it starts

Shingles (herpes zoster) is caused by the varicella-zoster virus — the same virus behind chickenpox. Once you have had chickenpox, the virus lies dormant in nerve tissue and can reactivate years later, often when the immune system is weakened by age, illness or stress. When it reactivates, it travels along a nerve to the skin. The first sign is often a tingling, burning or painful patch of skin on one side of the body, followed a few days later by a rash of small blisters in a band or strip. Because it follows a single nerve, the rash almost always stays on one side and does not cross the midline.

Recognising the symptoms

Early shingles can be confusing because the pain often comes before the rash, and can be mistaken for other problems. Typical features are pain, tingling or itching in one area, followed by a red rash that becomes fluid-filled blisters, then crusts over within a week or two. It commonly affects the chest or tummy but can appear anywhere, including the face. People may feel generally unwell with a headache or mild fever. Shingles affecting the eye, or the tip of the nose, needs urgent medical attention because it can threaten sight. The rash is usually painful rather than merely itchy, which helps tell it apart from chickenpox.

How shingles is treated

Treatment aims to ease pain, help the rash heal and reduce the risk of complications. Antiviral medicines can shorten an attack and are most useful when started within the first few days, so early contact with a GP or NHS 111 matters, particularly for older people, those with weak immune systems, or shingles near the eye. Pain relief ranges from simple painkillers to medicines specifically used for nerve pain when needed. Keeping the rash clean and dry, wearing loose clothing and using cool compresses can soothe discomfort. Most people recover within a few weeks, though the pain can outlast the rash.

Complications and who is at risk

The most common lasting complication is post-herpetic neuralgia — nerve pain that continues for months or occasionally years after the rash has healed. It becomes more likely with increasing age. Shingles affecting the eye can damage sight and needs urgent specialist care. Rarely, it can affect hearing and balance or, in people with very weak immune systems, spread more widely. Shingles is not passed from person to person as shingles, but the fluid in the blisters can give chickenpox to someone who has never had it or been vaccinated, so people with active blisters should avoid close contact with newborns, pregnant women who have not had chickenpox, and those with weakened immunity.

Preventing shingles with vaccination

The most effective way to reduce the risk of shingles and its complications is vaccination. In the UK the NHS offers a shingles vaccine to older adults within an eligible age range and to people of any adult age who have a severely weakened immune system, following national guidance that is periodically updated. The vaccine substantially lowers the chance of getting shingles and, if it does occur, tends to make it milder and less likely to cause long-lasting nerve pain. If you are unsure whether you are eligible, your GP practice or pharmacist can check. Vaccination is worthwhile even if you have had shingles before.