Launching September 2027

Shingles

Shingles At A Glance

  • Shingles is a painful rash caused by reactivation of the varicella-zoster virus, the same virus that causes chickenpox.
  • It commonly begins with pain, burning, tingling, itching, or unusual skin sensitivity followed by a blistering rash on one side of the body or face.
  • Risk increases with age and in people whose immune systems are weakened by illness or medication.
  • Shingles involving the eye, ear, face, or nervous system can cause serious complications and requires prompt medical attention.
  • Diagnosis is usually based on the characteristic pain and rash pattern, although testing may be used when the presentation is unusual.
  • Antiviral medication works best when started early and can shorten the illness and reduce the risk of complications.

Table of Contents

Table of Contents

What Is Shingles?

Shingles, also called herpes zoster, is a painful rash caused by the varicella-zoster virus—the same virus that causes chickenpox. After chickenpox, the virus stays inactive in nerve tissue and may reactivate years later as shingles.

Shingles usually causes pain, burning, tingling, itching, and a blistering rash on one side of the body or face. Most cases heal within two to four weeks, but serious eye, ear, brain, or widespread complications can occur. Early antiviral treatment can shorten illness and reduce complications.

Learn More

About Shingles – CDC
https://www.cdc.gov/shingles/about/index.html

Explains causes, symptoms, complications, contagiousness, protection of others, and vaccination.

Shingles – NIH MedlinePlus
https://medlineplus.gov/shingles.html

Offers patient-friendly information about symptoms, antiviral treatment, pain, home care, and prevention.

How Common Is Shingles?

About 1 in 3 people in the United States develops shingles during their lifetime. Risk rises with age and with conditions or medicines that weaken the immune system.

Anyone who has had chickenpox can develop shingles, including people who do not remember having it. Shingles can occur more than once.

Learn More

About Shingles – CDC
https://www.cdc.gov/shingles/about/index.html

Explains causes, symptoms, complications, contagiousness, protection of others, and vaccination.

What Symptoms Might You Notice?

Symptoms may begin several days before the rash and can include:

  • Pain, burning, tingling, itching, or unusual skin sensitivity
  • A stripe or patch of fluid-filled blisters, usually on one side
  • Rash on the trunk, face, scalp, neck, arm, or leg that usually does not cross the body’s midline
  • Headache, fever, chills, fatigue, or upset stomach
  • Pain from light touch, clothing, or a breeze
  • Eye redness, pain, light sensitivity, eyelid rash, or vision change
  • Ear pain, ear blisters, hearing change, dizziness, or one-sided facial weakness

Some people have nerve pain with little or no visible rash. A widespread rash, rash on both sides, or unusual lesions are more likely with immune suppression and require prompt care.

Learn More

Clinical Overview of Shingles – CDC
https://www.cdc.gov/shingles/hcp/clinical-overview/index.html

Provides clinical information about rash patterns, complications, diagnosis, and early treatment.

Ramsay Hunt Syndrome – NIH MedlinePlus
https://medlineplus.gov/ency/article/001647.htm

Explains shingles involving the ear and facial nerve, including facial weakness, hearing changes, and vertigo.

How Is Shingles Diagnosed?

A clinician usually diagnoses shingles from the pain pattern and the appearance and location of the rash. They ask when symptoms began, whether new blisters are appearing, vaccination history, immune conditions, medicines, pregnancy, and eye, ear, or neurologic symptoms.

Testing is useful when the rash is unusual, there are no visible blisters, the immune system is weakened, or another condition such as herpes simplex, contact dermatitis, impetigo, or an insect reaction is possible.

Learn More

Clinical Overview of Shingles – CDC
https://www.cdc.gov/shingles/hcp/clinical-overview/index.html

Provides clinical information about rash patterns, complications, diagnosis, and early treatment.

Chickenpox and Shingles Tests – NIH MedlinePlus
https://medlineplus.gov/lab-tests/chickenpox-and-shingles-tests/

Explains when lesion or other testing may be used and what results can mean.

Shingles infographic – click to enlarge

What Causes Shingles?

Shingles occurs when inactive varicella-zoster virus becomes active again in a sensory nerve. The exact trigger is not always known.

  • Older age
  • Cancer, HIV, transplant, or another immune condition
  • Chemotherapy, high-dose steroids, biologic medicines, or other immune-suppressing treatment
  • Major illness or physical stress
  • Less commonly, shingles can occur in healthy younger adults

Shingles is not caused by poor hygiene or by catching shingles from someone else. Exposure to shingles can cause chickenpox—not shingles—in someone who has never had chickenpox or the chickenpox vaccine.

Learn More

About Shingles – CDC
https://www.cdc.gov/shingles/about/index.html

Explains causes, symptoms, complications, contagiousness, protection of others, and vaccination.

What Can Make Shingles Worse?

Complications are more likely with:

  • Delaying antiviral treatment after the rash begins
  • Age 50 or older, especially older age
  • A weakened immune system
  • A severe rash or severe pain at the start
  • Rash on the face, nose, eye, ear, or scalp
  • Scratching, picking, or allowing blisters to become infected
  • Poorly controlled pain or inability to sleep, eat, or drink
  • Not seeking care for new weakness, confusion, vision, or hearing symptoms

Treatment works best when started within 72 hours of rash onset, but later treatment may still be appropriate if new blisters are appearing or complications are possible.

Learn More

Clinical Overview of Shingles – CDC
https://www.cdc.gov/shingles/hcp/clinical-overview/index.html

Provides clinical information about rash patterns, complications, diagnosis, and early treatment.

Prevention

CDC recommends two doses of recombinant zoster vaccine (Shingrix):

  • Adults Age 50 and Older: Two doses, usually 2–6 months apart, even after prior shingles or Zostavax.
  • Immunocompromised Adults Age 19 and Older: Two doses, usually 2–6 months apart; the second may be given 1–2 months after the first when faster protection is needed.
  • After Shingles: Vaccination is still recommended, but wait until the active illness and rash have resolved.
  • Pregnancy: There is no routine recommendation to give Shingrix during pregnancy; vaccination is generally delayed until afterward.
  • Missed Second Dose: Give it when possible rather than restarting the series.
  • During an Outbreak: Cover lesions, wash hands, avoid touching or scratching, and avoid high-risk susceptible people until crusted.

Shingrix commonly causes arm pain, fatigue, headache, muscle aches, fever, or chills for one to three days. These reactions are temporary and are not shingles.

Learn More

Shingles Vaccine Recommendations – CDC
https://www.cdc.gov/shingles/hcp/vaccine-considerations/index.html

Explains who should receive the two-dose Shingrix series and recommended timing.

Shingrix for Immunocompromised Adults – CDC
https://www.cdc.gov/shingles/hcp/vaccine-considerations/immunocompromised-adults.html

Provides vaccination guidance for adults with weakened immune systems or immune-suppressing treatment.

Recombinant Zoster Vaccine Information Statement – CDC
https://www.cdc.gov/vaccines/hcp/current-vis/shingles.html

Reviews vaccine benefits, expected reactions, precautions, and when to seek help.

Learn More About Shingles

The following video content is provided to help you better understand this condition. These resources are intended for educational purposes and should not replace personalized medical advice from your healthcare provider.

Labs

Most typical cases do not require blood tests. Possible tests include:

  • Lesion PCR: A swab or scab sample checks for varicella-zoster virus and is the preferred confirmatory test when needed.
  • Viral Culture or Direct Testing: Less sensitive alternatives used in some settings.
  • Blood Antibody Test: Can show past exposure but usually cannot confirm that a current rash is shingles.
  • HIV Test: May be offered when shingles is unusually severe, recurrent, widespread, or occurs with other risk factors.
  • Blood Count, Kidney, or Liver Tests: May guide treatment in severe illness or with certain medicines.
  • Spinal Fluid Testing: Used in the hospital when meningitis, encephalitis, or other nervous-system disease is suspected.

A negative sample from an old, dry, or poorly collected lesion may not fully rule out shingles. Testing should not delay urgent antiviral treatment when eye or neurologic disease is suspected.

Learn More

Chickenpox and Shingles Tests – NIH MedlinePlus
https://medlineplus.gov/lab-tests/chickenpox-and-shingles-tests/

Explains when lesion or other testing may be used and what results can mean.

Diagnostics

Imaging is not needed for routine skin-limited shingles. Additional evaluation may include:

  • Urgent Eye Examination: Checks the cornea, pressure, retina, and other structures when the forehead, eyelid, nose, or eye is affected.
  • Ear and Hearing Examination: Evaluates ear rash, facial weakness, hearing loss, ringing, dizziness, or balance problems.
  • Neurologic Examination: Checks strength, sensation, walking, mental status, and cranial nerves.
  • Lumbar Puncture: Tests spinal fluid when meningitis, encephalitis, or inflammation of nerves is suspected.
  • Brain or Spine Imaging: Used for stroke-like symptoms, weakness, confusion, severe headache, or spinal-cord concerns.

A rash on the tip or side of the nose can signal involvement of the same nerve that serves the eye and needs same-day eye evaluation.

Learn More

Corneal Conditions and Urgent Eye Symptoms – National Eye Institute
https://www.nei.nih.gov/eye-health-information/eye-conditions-and-diseases/corneal-conditions

Explains eye symptoms that require immediate evaluation to protect vision.

Ramsay Hunt Syndrome – NIH MedlinePlus
https://medlineplus.gov/ency/article/001647.htm

Explains shingles involving the ear and facial nerve, including facial weakness, hearing changes, and vertigo.

Treatment & Management

Treatment Options

Contact a clinician as soon as shingles is suspected. Treatment may include:

  • Antiviral Medicine: Shortens viral activity, speeds healing, and may reduce complications when started early.
  • Pain Relief: Acetaminophen, selected anti-inflammatory medicines, or prescription treatment may be used based on health history.
  • Skin Care: Cool compresses, calamine lotion, colloidal oatmeal baths, and loose clothing may reduce discomfort.
  • Nerve-Pain Treatment: Gabapentin, pregabalin, certain antidepressants, topical lidocaine, or capsaicin may help persistent nerve pain.
  • Specialist Treatment: Eye, ear, brain, widespread, or severe immune-suppressed disease may require urgent specialty or hospital care.

Antibiotics do not treat the shingles virus. They are used only if a bacterial skin infection develops.

Learn More

Shingles – NIH MedlinePlus
https://medlineplus.gov/shingles.html

Offers patient-friendly information about symptoms, antiviral treatment, pain, home care, and prevention.

Shingles Aftercare – NIH MedlinePlus
https://medlineplus.gov/ency/patientinstructions/000560.htm

Provides practical instructions for skin care, pain relief, activity, and warning signs during recovery.

Lifestyle Changes

During recovery:

  • Rest and drink enough fluids.
  • Wear loose, soft clothing over the rash.
  • Keep nails short and avoid scratching or picking.
  • Use gentle bathing and pat the rash dry.
  • Choose light activity as tolerated and avoid activities that increase pain or fall risk.
  • Protect sleep with a consistent schedule and adequate pain control.
  • Avoid smoking and excessive alcohol, which can interfere with healing and medicine safety.
  • Ask for emotional support if pain, appearance, or isolation is distressing.

Do not return to close-contact work or activities when uncovered, draining lesions could expose high-risk people. Follow workplace and healthcare infection-control instructions.

Medications

Common medicines include:

  • Valacyclovir: An oral antiviral often taken several times daily for a prescribed course.
  • Acyclovir: An oral or intravenous antiviral; IV treatment may be used for severe or widespread disease.
  • Famciclovir: Another oral antiviral option.
  • Pain Medicines: Acetaminophen or selected NSAIDs may help; kidney, liver, heart, ulcer, bleeding, and medicine risks must be reviewed.
  • Nerve-Pain Medicines: Gabapentin, pregabalin, duloxetine, or certain tricyclic antidepressants may be used for postherpetic neuralgia.
  • Topical Pain Treatment: Lidocaine or capsaicin may help after lesions have healed; do not apply irritating products to open blisters.

Antiviral doses may need adjustment with kidney disease, older age, or dehydration. Steroids do not cure shingles and should never be used without antiviral and clinician-directed planning when considered.

Learn More

Shingles – NIH MedlinePlus
https://medlineplus.gov/shingles.html

Offers patient-friendly information about symptoms, antiviral treatment, pain, home care, and prevention.

Postherpetic Neuralgia Aftercare – NIH MedlinePlus
https://medlineplus.gov/ency/patientinstructions/000555.htm

Reviews long-lasting nerve pain after shingles and available pain-management approaches.

Procedures

Most cases do not need a procedure. Selected care may include:

  • Eye Procedures or Treatments: An ophthalmologist may use prescription drops, pressure treatment, or other care for eye inflammation.
  • Nerve Block: An anesthetic or steroid injection may be considered by a pain specialist for severe selected pain.
  • Wound Care: Clinicians may clean and dress extensive, infected, or difficult-to-cover lesions.
  • Lumbar Puncture: Collects spinal fluid for suspected nervous-system infection.
  • Hospital IV Therapy: Provides intravenous antiviral medicine, fluids, and monitoring for severe, widespread, eye, neurologic, or immune-suppressed cases.

Blisters should not be intentionally popped or drained. Opening them increases pain, infection risk, and exposure of others to blister fluid.

What Should You Expect Long-Term?

New blisters usually stop forming within several days, then crust and heal over two to four weeks. Skin color changes, itching, sensitivity, or numbness may last longer.

Postherpetic neuralgia is pain that continues after the rash heals and can last months or years. Risk increases with age and severe early pain or rash. Persistent pain is treatable and should not be dismissed.

Learn More

About Shingles – CDC
https://www.cdc.gov/shingles/about/index.html

Explains causes, symptoms, complications, contagiousness, protection of others, and vaccination.

Postherpetic Neuralgia Aftercare – NIH MedlinePlus
https://medlineplus.gov/ency/patientinstructions/000555.htm

Reviews long-lasting nerve pain after shingles and available pain-management approaches.

What Can You Do At Home?

To ease symptoms and protect others:

  • Take antiviral medicine exactly on schedule and complete the course.
  • Keep the rash clean, dry, and covered with a nonstick dressing when practical.
  • Wash hands after touching the rash or changing a dressing.
  • Use cool wet compresses for 15–20 minutes at a time.
  • Try calamine lotion or a colloidal oatmeal bath for itch.
  • Use pain medicine only as directed and avoid combining products with the same ingredient.
  • Do not share towels, clothing, bedding, or personal items while blisters are open.
  • Call promptly for spreading redness, pus, fever, worsening pain, or new blisters after initial improvement.

Avoid contact with pregnant people without chickenpox immunity, premature or low-birth-weight infants, and people with weakened immune systems until every blister has crusted.

Learn More

About Shingles – CDC
https://www.cdc.gov/shingles/about/index.html

Explains causes, symptoms, complications, contagiousness, protection of others, and vaccination.

Shingles Aftercare – NIH MedlinePlus
https://medlineplus.gov/ency/patientinstructions/000560.htm

Provides practical instructions for skin care, pain relief, activity, and warning signs during recovery.

Frequently Asked Questions

Is shingles the same as herpes simplex?

No. Shingles is caused by varicella-zoster virus. Oral and genital herpes are caused by herpes simplex viruses.

Can I give someone shingles?

No. Someone without chickenpox immunity can develop chickenpox after direct contact with shingles blister fluid.

When am I contagious?

From the time blisters appear until all lesions have dried and crusted. Risk is lower when the rash is fully covered.

Can shingles cross the middle of the body?

Typical shingles stays on one side. A widespread or two-sided rash needs prompt evaluation, especially with immune suppression.

Can I shower?

Yes. Use gentle water and mild soap, avoid scrubbing, and pat dry with a clean towel.

Should I get Shingrix if I already had shingles?

Yes, if you meet age or immune-risk recommendations. Do not vaccinate during an active episode; ask when to schedule it after recovery.

Can Shingrix cause shingles?

No. Shingrix is not a live-virus vaccine and cannot cause shingles.

What if my second vaccine dose is late?

Get it as soon as possible. The series generally does not need to be restarted.

Questions To Ask Your Provider

Consider asking:

  • Can I start an antiviral today?
  • Does this rash involve my eye, ear, or nervous system?
  • Do I need a lesion PCR test?
  • How should my kidney function or other medicines affect the antiviral dose?
  • Which pain medicines are safe for me?
  • How should I cover and care for the rash?
  • When am I no longer contagious?
  • When can I return to work or close-contact activities?
  • What should I do if pain remains after the rash heals?
  • When should I receive Shingrix after recovery?
  • Do my immune condition or treatment change vaccine timing?
  • Which symptoms require emergency care?

Specialist Referrals

Primary care can manage many cases. Referral may be made to:

  • Ophthalmologist: Same-day or urgent care for forehead, eyelid, nose, or eye involvement and any vision symptom.
  • Ear, Nose, and Throat Specialist or Audiologist: For ear rash, hearing loss, ringing, vertigo, or facial weakness.
  • Neurologist: For weakness, severe headache, confusion, walking problems, or suspected brain, spinal-cord, or nerve complications.
  • Infectious Disease Specialist: For widespread, severe, recurrent, or immune-suppressed disease.
  • Pain Specialist: For severe acute pain or postherpetic neuralgia that remains difficult to control.
  • Dermatologist: For an uncertain rash or complicated skin disease.
  • Physical or Occupational Therapist: For weakness, balance problems, or functional recovery.

Learn More

Corneal Conditions and Urgent Eye Symptoms – National Eye Institute
https://www.nei.nih.gov/eye-health-information/eye-conditions-and-diseases/corneal-conditions

Explains eye symptoms that require immediate evaluation to protect vision.

Ramsay Hunt Syndrome – NIH MedlinePlus
https://medlineplus.gov/ency/article/001647.htm

Explains shingles involving the ear and facial nerve, including facial weakness, hearing changes, and vertigo.

Is Shingles Curable?

There is no medicine that removes varicella-zoster virus from the body, but the active shingles episode usually resolves. Antivirals help the outbreak heal faster and reduce severity when started early.

Shingles can happen again. Shingrix lowers the risk of another episode and serious complications even after a person has already had shingles.

Learn More

Shingles – NIH MedlinePlus
https://medlineplus.gov/shingles.html

Offers patient-friendly information about symptoms, antiviral treatment, pain, home care, and prevention.

Shingles Vaccine Recommendations – CDC
https://www.cdc.gov/shingles/hcp/vaccine-considerations/index.html

Explains who should receive the two-dose Shingrix series and recommended timing.

Emergency Symptoms / When To Seek Immediate Help

Seek urgent or emergency care for:

  • Rash on the forehead, eyelid, nose, or near the eye; eye pain, redness, light sensitivity, or vision change
  • Ear rash or severe ear pain with facial weakness, hearing loss, ringing, dizziness, or inability to close one eye
  • Severe headache, stiff neck, confusion, unusual sleepiness, weakness, trouble walking, or seizure
  • A widespread rash, high fever, breathing difficulty, or severe illness—especially with immune suppression
  • Rapidly spreading redness, pus, severe swelling, or signs of bacterial infection
  • Inability to drink, very little urine, fainting, or severe dehydration
  • A severe medication reaction with trouble breathing, facial swelling, fainting, or widespread blistering

Eye, ear, brain, and widespread shingles can cause permanent disability or become life-threatening. Do not wait for a routine appointment.

Learn More

Corneal Conditions and Urgent Eye Symptoms – National Eye Institute
https://www.nei.nih.gov/eye-health-information/eye-conditions-and-diseases/corneal-conditions

Explains eye symptoms that require immediate evaluation to protect vision.

Ramsay Hunt Syndrome – NIH MedlinePlus
https://medlineplus.gov/ency/article/001647.htm

Explains shingles involving the ear and facial nerve, including facial weakness, hearing changes, and vertigo.

Clinical Overview of Shingles – CDC
https://www.cdc.gov/shingles/hcp/clinical-overview/index.html

Provides clinical information about rash patterns, complications, diagnosis, and early treatment.

CALL 911

APNS does not provide emergency medical services. If you believe you are experiencing a medical emergency, including (but not limited to) chest pain, difficulty breathing, stroke symptoms, severe allergic reactions, anaphylaxis, uncontrolled bleeding, seizures, loss of consciousness, or any other potentially life-threatening condition, you are instructed to call 911 immediately or go immediately to the nearest emergency department.

Official Resources / External Links

About Shingles – CDC
https://www.cdc.gov/shingles/about/index.html

Explains causes, symptoms, complications, contagiousness, protection of others, and vaccination.

Clinical Overview of Shingles – CDC
https://www.cdc.gov/shingles/hcp/clinical-overview/index.html

Provides clinical information about rash patterns, complications, diagnosis, and early treatment.

Shingles Vaccine Recommendations – CDC
https://www.cdc.gov/shingles/hcp/vaccine-considerations/index.html

Explains who should receive the two-dose Shingrix series and recommended timing.

Shingrix for Immunocompromised Adults – CDC
https://www.cdc.gov/shingles/hcp/vaccine-considerations/immunocompromised-adults.html

Provides vaccination guidance for adults with weakened immune systems or immune-suppressing treatment.

Recombinant Zoster Vaccine Information Statement – CDC
https://www.cdc.gov/vaccines/hcp/current-vis/shingles.html

Reviews vaccine benefits, expected reactions, precautions, and when to seek help.

Shingles – NIH MedlinePlus
https://medlineplus.gov/shingles.html

Offers patient-friendly information about symptoms, antiviral treatment, pain, home care, and prevention.

Shingles Aftercare – NIH MedlinePlus
https://medlineplus.gov/ency/patientinstructions/000560.htm

Provides practical instructions for skin care, pain relief, activity, and warning signs during recovery.

Chickenpox and Shingles Tests – NIH MedlinePlus
https://medlineplus.gov/lab-tests/chickenpox-and-shingles-tests/

Explains when lesion or other testing may be used and what results can mean.

Postherpetic Neuralgia Aftercare – NIH MedlinePlus
https://medlineplus.gov/ency/patientinstructions/000555.htm

Reviews long-lasting nerve pain after shingles and available pain-management approaches.

Corneal Conditions and Urgent Eye Symptoms – National Eye Institute
https://www.nei.nih.gov/eye-health-information/eye-conditions-and-diseases/corneal-conditions

Explains eye symptoms that require immediate evaluation to protect vision.

Ramsay Hunt Syndrome – NIH MedlinePlus
https://medlineplus.gov/ency/article/001647.htm

Explains shingles involving the ear and facial nerve, including facial weakness, hearing changes, and vertigo.

This guide is for education only and does not replace professional medical advice, examination, diagnosis, or treatment. Antiviral treatment is most effective when started promptly. Seek urgent care for rash or pain near the eye or ear, vision or hearing changes, facial weakness, severe headache, confusion, weakness, seizure, widespread rash, serious infection, dehydration, or a severe medication reaction. People with weakened immune systems should contact a clinician promptly for any suspected shingles.

Get personalized care for Shingles

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