Shingles (herpes zoster)
Shingles is the chickenpox virus waking up. It stayed behind in the nerve roots after that childhood illness and gave no sign of itself for years.
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Medicines commonly prescribed for Shingles (herpes zoster)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 1 gActive substance: paracetamolManufacturer: Neuraxpharm Spain S.L.Prescription requiredDosage form: TABLET, 500 mgActive substance: paracetamolManufacturer: NeogenPrescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 100 mg/mlActive substance: paracetamolManufacturer: Industria Quimica Y Farmaceutica Vir S.A.Prescription required
Shingles is the chickenpox virus waking up. It stayed behind in the nerve roots after that childhood illness and gave no sign of itself for years. It travels out along a single nerve, which is why the rash forms a band down one side of the body, and why pain often arrives a few days ahead of it. One thing is worth knowing before anything else: antiviral medicines only work at the very start, and deciding to wait and see whether it clears on its own is the most expensive mistake here. Shingles is counted in days, not weeks.
Why the clock starts with the first blister
Antivirals do not kill the virus; they stop it multiplying. While new blisters keep appearing there is something to stop. Once they have dried out, the medicine has nothing left to act on. That gives treatment a window of roughly three days from the first blisters appearing, and the earlier within that window it starts, the better it works.
Starting early buys three things at once: the rash heals faster, the acute pain is milder and shorter, and the risk of pain lingering for months after the skin has healed goes down. None of these can be recovered later.
So the rule is simple. If grouped blisters appear on reddened skin on one side of the body, and the day before that patch was burning or aching, see a doctor the same day or the next — not once it becomes obvious what it is. Working out what you have is the doctor's job, and being wrong in the direction of one extra appointment costs nothing.
Treatment is sometimes still given after three days: if fresh blisters keep coming, if the face or eye is affected, or if the immune system is weakened. But that is making the best of things, not an equal substitute.
What it looks and feels like
The illness almost never starts with the skin. One to four days before the rash, an odd sensation appears in one limited area: burning, tingling, itching, a dragging or shooting pain. The skin there can become so sensitive that the touch of clothing hurts. In those days many people look for the cause in the wrong place — they think of a trapped nerve between the ribs, a pulled muscle, a bad tooth, kidney pain, and if the patch is on the left side of the chest, of the heart.
Then the rash arrives, and it is recognisable:
- red patches on which small blisters with clear fluid grow over a day or two; later they turn cloudy, break open and crust over;
- a position strictly on one side: the rash follows the path of a nerve as a band and does not cross the midline of the body. Matching spots on the left and the right are almost certainly not shingles;
- most often the band falls on the chest or the lower back; less often on the face, neck, an arm, a leg or the buttock;
- pain in that area carries on after the rash appears, and can be severe;
- some people also feel generally unwell, with a headache and a slight temperature.
The crusts usually fall off within two to four weeks. Rarely the virus causes pain along the nerve with no rash at all; the diagnosis is then made from the whole picture, and it is a difficult one.
Two situations counted in hours
There are two cases where an ordinary appointment is not enough.
A rash on the face, around the eye or on the tip of the nose. Blisters on the tip or the side of the nose are a well-known sign that the nerve branch which also supplies the eye is involved. Even if the eye itself is not yet troubling you, an eye specialist needs to look at it within hours. Shingles in the eye inflames the cornea and the inner layers, and without treatment it can leave lasting loss of sight. Warning signs from the eye: redness, pain in the eye, discomfort in bright light, blurring or worsening vision, swollen eyelids.
A rash in or around the ear together with weakness of the facial muscles. This is Ramsay Hunt syndrome, in which the virus affects the facial nerve. Half the face stops obeying — the eye will not close, the corner of the mouth droops — and earache, ringing or hearing loss, dizziness and sometimes a change in taste are added to it. Here too every hour counts: the earlier treatment begins, the better the chance the face recovers fully.
When to be seen the same day
Besides the two cases above, do not leave it until tomorrow if:
- the immune system is weakened — chemotherapy, treatment after a transplant, medicines that suppress immunity, HIV infection;
- the rash does not stay within one band but is scattered over the body;
- the pain is severe and ordinary painkillers do not touch it;
- the skin around the rash has become hot, bright red and swollen, pus is coming from the sores and a temperature has started — that is an added bacterial infection;
- shingles appears in someone who is pregnant, or in a baby.
Call an ambulance (112, the single European emergency number) if, alongside the illness, there is a severe headache with vomiting, confusion, a fit, a stiff neck, or sudden weakness in an arm or a leg. These complications are rare, but they need hospital care.
Easing things while treatment works
Skin care is simple, and its point is to avoid hindering healing and to keep infection out.
- Keep the rash clean and dry, and wash it with cool water without rubbing.
- Do not burst or scratch the blisters: a scar is easily left underneath, and bacteria get in through the broken skin.
- A cool compress — a damp cloth or a bag of ice wrapped in a towel — for a few minutes several times a day noticeably takes the burning off.
- Wear loose clothes in soft fabric; if the rash rubs against clothing, cover it with a dry non-stick dressing.
- Do not seal weeping blisters with plasters, and do not apply creams or ointments on your own initiative, steroid ones least of all.
Pain is dealt with in steps. The usual starting point is paracetamol or an anti-inflammatory painkiller. If that is not enough, the doctor adds medicines that act specifically on nerve pain; these are built up gradually and do not work on the first day. For very severe pain, stronger medicines are prescribed, but that is the doctor's decision. Putting up with the pain here is not only hard but harmful: poorly controlled pain in the acute phase is one of the reasons it later stays for a long time.
The pain that stays after the skin heals
The commonest complication is post-herpetic neuralgia: the rash has healed and the pain in the same area has not. It can burn, come in shooting bursts, or show itself as an unbearable sensitivity in which even the touch of clothing hurts. It happens because the virus damaged the nerve, and the nerve carries on sending pain signals with nothing to prompt them.
This is worth saying plainly: such pain sometimes lasts for months, and in some people for more than a year. The risk is higher in older people, with an extensive rash, and where the pain in the acute phase was severe. That is precisely why doctors press so hard for early treatment — it lowers that risk, though it does not remove it.
Post-herpetic neuralgia can be treated, and not with ordinary painkillers: medicines that act on nerve pain are used, along with preparations applied to the skin and, in difficult cases, help from a pain specialist. There is no need to wait for it to pass by itself; the sooner it is tackled, the easier it is to bring under control.
Can you pass shingles on?
Precision matters here, because the confusion frightens people for nothing.
You cannot catch shingles: it does not pass from person to person. It is your own virus, waking up. But the fluid in the blisters contains live virus, and someone who has never had chickenpox and is not vaccinated against it can fall ill after direct contact with that fluid — with chickenpox, not with shingles.
A person is considered infectious from the moment the blisters appear until every one of them has crusted over. Before the rash, and once the crusts have formed, nothing is passed on. While the rash is weeping it is enough to cover it with clothing or a dressing, and that allows normal family life without isolating.
Particular care is needed around those for whom chickenpox is dangerous:
- anyone pregnant who has not had chickenpox and is not vaccinated — chickenpox in pregnancy is a threat both to the woman and to the baby;
- newborn babies;
- people with a weakened immune system.
If contact has already happened, someone in these groups should speak to a doctor without waiting for symptoms: in the first days after contact there are measures that reduce the risk. Stay away from work and from nursery or school while the rash is weeping and cannot be covered.
The vaccine, and getting shingles twice
Having had shingles does not protect you for life: it can come back, although for most people it happens only once. The trigger is usually anything that lowers immunity for a while — a serious illness, an operation, medicines that suppress the immune system, a stretch of heavy stress — and above all age, because protection against this virus weakens naturally over the years.
A shingles vaccine exists, and it noticeably lowers both the chance of getting shingles and the risk of post-herpetic neuralgia; and if the illness does start, it runs milder. It is worth discussing for older adults and for people with a weakened immune system, including those who have already had shingles once.
The age at which it is offered, the number of doses and the interval between them differ from country to country. Check your own national immunisation schedule and ask your doctor, rather than carrying over a schedule from someone else's health system.
Online consultation
With shingles an online appointment mainly buys time, and here time is the treatment. The rash shows up well in a photograph, and in conversation a doctor can judge whether it looks like shingles, which day of it you are on, and whether there is reason to start antiviral treatment straight away.
Have several sharp photographs of the rash ready, taken in good light: one wide enough to show how the band runs, and one close up. Know the exact dates: when the first odd sensation in the skin began, and when the first blisters came out. Say which medicines you take regularly, whether you have any condition that weakens immunity, and whether you live with someone pregnant, a baby, or a person having chemotherapy.
At the end of it the doctor will either prescribe treatment and explain how to look after the skin, or — if the rash is on the face, next to the eye or in the ear, if the facial nerve is involved, or if the picture does not fit the usual one — arrange a same-day face-to-face appointment with the right specialist. Later on, if pain persists after the skin has healed, an online appointment is a convenient way to choose and fine-tune treatment for post-herpetic neuralgia.
This material is for information only and does not replace medical advice.
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