Shingles 101: Your questions answered

Shingles is caused by varicella zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays inactive in their body. The virus can reactivate later, causing shingles. 

The first time a person is exposed to and infected by VZV, they will develop chickenpox. After the infection resolves, the virus remains inactive in a bundle of nerve cells and can reactivate later in life to cause shingles. 

Almost all American adults over age 40 have been exposed to the chickenpox virus and are at risk for developing shingles. Shingles typically occurs in adults older than 50 years of age, and the risk further increases with age. People with weakened immune systems also have an increased risk of experiencing shingles and its complications, such as postherpetic neuralgia (PHN) and hospitalization. There are an estimated 1 million cases of shingles diagnosed yearly in the U.S. About 1 in 3 Americans will develop shingles during their lifetime. 

Most people have only one episode of herpes zoster in their lifetime. However, second and even third episodes are possible. Receiving the shingles vaccine can reduce a person's risk of developing shingles. 

In the early stages of shingles, a person may experience an itchy, tingly or painful sensation several days before the rash appears. Some people also complain of headache, sensitivity to light, body aches and general lack of well-being prior to the formation of the rash. Rash is the most common feature of shingles. The rash is usually painful, itchy or tingly.

People most commonly have shingles blisters or a localized rash appearing on one side of the trunk and shoulder area. People may also experience shingles on the back, scalp, face or neck. Other areas shingles may appear include the arms, hands or legs, and some people may even develop shingles in the eyes. In rare cases, it's possible to have shingles without a rash. The rash develops in new clusters every three to five days before drying and crusting over, typically in seven to 10 days, and fully clears up within four weeks. 

PHN pain can last months or even years after the shingles infection has cleared up. 

Shingles itself is not contagious. However, the varicella zoster virus that causes shingles is contagious, and if you have active shingles, you can spread the virus to another person, causing someone who has never had chickenpox or the chickenpox vaccine to develop chickenpox. A person with chickenpox is very contagious. 

People with active shingles can infect others who have never been exposed to the virus or received the chickenpox vaccine with chickenpox. 

Individuals are considered contagious until their blisters are dry and crusted over, which takes two to four weeks. Help reduce the spread of shingles by not touching the rash and keeping it covered. During the contagious period, avoid contact with pregnant women who aren't protected against chickenpox, premature infants and people with weakened immune systems.

Patients always want to know how to get rid of shingles. Shingles treatment is usually started once a person is diagnosed, ideally within 72 hours of the start of the rash. Antiviral medications for shingles, such as acyclovir, famciclovir or valacyclovir, are often prescribed for one week or longer, if needed.

Shingles medications to help control pain, such as anti-inflammatories, steroids or opioids, may be used as needed. Home remedies for shingles are not typically advised, but over-the-counter pain relievers acetaminophen or ibuprofen may be recommended.

Shingles vaccination is the best protection against shingles and the lingering pain. There is currently one vaccine available for protection against shingles: Shingrix.

A shingles vaccine is recommended by the Centers for Disease Control and Prevention (CDC) for all adults age 50 and older, and for individuals age 19 and older who are or will be immunodeficient or immunosuppressed because of underlying disease or therapy.

Two doses of Shingrix given two to six months apart is more than 90% effective in preventing shingles and postherpetic neuralgia.

The shingles vaccine is recommended for individuals age 50 and older with a healthy immune system, even if the person has received Zostavax for shingles in the past or has had a prior episode of herpes zoster. Individuals age 19 and older who are currently or will be immunodeficient or immunosuppressed because of underlying disease or therapy should also receive the shingles vaccine.

Clinically reviewed and updated March 2022.