Shingles: Symptoms, Treatment and Vaccination

Shingles happens when the chickenpox virus (varicella-zoster virus) becomes active again in the body. After chickenpox, the virus stays quietly in the nerve tissue for many years without causing any problems. Sometimes it becomes active again and travels along a nerve to the skin — that is shingles.

It is not caused by catching chickenpox a second time, and it is not a sign that someone did anything wrong. Shingles can follow a period of illness, stress or reduced immunity, but very often there is no obvious reason at all.

Before any rash appears, many people notice something unusual in one area of the body:

• burning, tingling or itching of the skin
• tenderness, or pain that feels sharp, aching or like a band
• skin that feels sensitive to light touch, such as clothing
• headache, tiredness or feeling generally unwell
• sometimes a mildly raised temperature

The pain can begin a few days before the rash shows, which is why shingles is sometimes mistaken for something else at first. Occasionally — though this is uncommon — the nerve pain happens without any visible rash at all.

Shingles usually appears as a band or patch of red or darkened skin with small blisters, on one side of the body only. It does not normally cross the middle line of the body.

• most often on the chest, ribs, abdomen or back
• sometimes on the face, around an eye, or near an ear
• occasionally on an arm, leg, buttock or the neck

The blisters usually weep, then dry and form scabs over a week or two. On brown and black skin the rash may look darker or purplish rather than red, and can be easier to feel than to see.

Please contact a GP as soon as possible if shingles is suspected, even if the symptoms seem mild. Early advice matters because antiviral medicine works best when started promptly — usually within about three days of the rash appearing.

If more than three days have passed, it is still worth getting advice. A clinician may still decide antiviral treatment is appropriate in some circumstances, for example where the rash is on the face, where the person has a weakened immune system, where new blisters are still appearing, or where the pain is severe.

We do not give medicine names, doses or prescriptions. Any treatment decision is for a GP, pharmacist or other qualified clinician.

A GP, nurse or other clinician can usually recognise shingles from the symptoms and the appearance of the rash, particularly the way it follows a band on one side of the body. No special test is normally needed.

Occasionally further assessment or a swab of fluid from a blister may be arranged — for example when the rash is unusual, widespread, slow to settle, or when the person has a weakened immune system. If the eye may be involved, an urgent eye assessment may be arranged.

Treatment for shingles usually focuses on three things:

• Antiviral medicine. This may be prescribed to help reduce how severe and how long the episode is, and to lower the chance of complications. It works best when started early.
• Pain relief. A GP or pharmacist can advise on suitable pain relief for the person's own circumstances and other medicines.
• Treatment for nerve pain. Where pain is severe or lasting, a clinician may consider medicines used specifically for nerve pain, or refer on for further help.

Sixpence Support UK does not diagnose, recommend prescription-only medicines or give dosages. Please follow the advice of a GP, pharmacist or other qualified clinician, and tell them about any other medicines, allergies, pregnancy or immune-system problems.

Alongside any treatment from a clinician, these simple steps often help:

• keep the rash clean and dry to reduce the risk of infection
• wear loose, comfortable clothing so the skin is not rubbed
• use a cool compress — a clean, cool, damp cloth — for short periods to soothe the area
• avoid adhesive dressings and plasters directly on the rash, as removing them can damage the skin
• try not to scratch or pick at the blisters
• get plenty of rest and drink enough fluids

Please ask a pharmacist or clinician before using any cream, ointment, antiseptic or medicine on or near the rash — some products are not suitable, particularly near the eyes.

No — you cannot catch shingles from another person. Shingles only happens when a virus already in someone's own body becomes active again.

However, the fluid inside shingles blisters does contain the chickenpox virus. If that fluid reaches someone who has never had chickenpox and has not had the chickenpox vaccine, that person could develop chickenpox — not shingles.

Once the blisters have dried and formed scabs, this risk has passed.

Until the blisters have dried and scabbed over, it helps to:

• keep the rash covered with loose clothing or a non-sticky dressing
• avoid touching or scratching the rash
• wash hands regularly, especially after touching the area
• avoid sharing towels, flannels or bedding
• avoid swimming pools and contact sports while the rash is weeping

Also avoid close, direct contact with:

• pregnant people who have never had chickenpox
• people with a severely weakened immune system
• very young babies, particularly newborns

Many people with shingles feel able to carry on with everyday life, especially once the pain is under control and the rash can be covered.

It may be necessary to stay away from work, school or nursery if the rash is weeping and cannot be covered, or until it has dried and scabbed over.

Anyone who works with pregnant people, newborn babies, or people with weakened immune systems — for example in healthcare, care homes, childcare or schools — should ask a clinician, occupational health or their employer for guidance before returning.

If time away from work causes worry about pay, sick notes or how an employer or the DWP is handling things, we can help with letters and complaints.

Sometimes pain carries on after the skin has healed. This is called post-herpetic neuralgia — in plain English, nerve pain left behind by shingles. It becomes more likely with increasing age.

It can feel like:

• burning, aching or stabbing pain in the area where the rash was
• itching or odd skin sensations
• skin that is painfully sensitive to light touch, such as clothes or bedding
• pain that comes and goes, or disturbs sleep

This is a recognised problem, not something to put up with quietly. Please contact a GP if pain continues after the rash has healed, or if it is difficult to manage. There are treatments and referral options that can help.

Most people recover from shingles without lasting problems. Complications are less common, but they are worth knowing about so help can be sought early:

• skin infection, if the rash becomes more painful, hot, swollen or spreads
• scarring, or lighter or darker patches of skin where the rash was
• eye problems, if shingles affects the eye or the nerve around it
• hearing changes or dizziness, if a nerve near the ear is affected
• facial weakness, which usually improves but may need urgent treatment
• long-lasting nerve pain (post-herpetic neuralgia)

If something is getting worse rather than better, that is a good reason to contact a GP or NHS 111 rather than wait.

Shingles is more likely in people who:

• are older — the risk rises steadily with age, particularly from around 50 onwards
• have a weakened immune system
• have certain illnesses or conditions that affect immunity
• are having treatments that lower immunity, such as chemotherapy, some medicines after a transplant, high-dose steroids or certain immune-suppressing medicines

Even so, younger and otherwise healthy people can also develop shingles. Having shingles does not automatically mean something else is wrong — but if it happens more than once, or is unusually severe, it is worth mentioning to a GP.

Vaccination reduces the risk of developing shingles and of serious complications such as lasting nerve pain. It cannot guarantee that someone will never get shingles, but it makes it less likely and usually less severe.

Eligibility is not identical across the UK, and it changes over time. Please check with a GP practice or the official service for your nation.

• England. The NHS runs a phased age-based programme using a two-dose vaccine. It is offered to people as they reach the eligible age, and to those in the eligible older age range, with the programme gradually widening over a number of years. Adults aged 18 or over who are severely immunosuppressed are also eligible. Because the ages included change as the programme is phased in, please check the NHS page or ask your GP practice whether you are eligible now.
• Scotland. Shingles vaccination is offered through NHS Scotland, with its own eligibility arrangements. Check NHS inform or your GP practice.
• Wales. Shingles vaccination is offered through NHS Wales. Check with your GP practice or NHS 111 Wales.
• Northern Ireland. Shingles vaccination is offered through HSC services. Check nidirect or your GP practice.

If you are not sure whether you have been invited, it is always reasonable to ask your GP practice directly — being eligible does not always mean an invitation has arrived.

Yes — having had shingles does not necessarily rule out vaccination. People who have recovered from an episode may still be offered the vaccine, depending on their eligibility and clinical advice.

There is usually a sensible gap after recovery before vaccination, and the right timing depends on the individual. Please ask a GP practice or vaccination service when it would be appropriate.

A short note before the appointment or call makes the conversation much easier:

• when the symptoms started — including any pain or tingling before the rash
• where the pain or rash is, and whether it is on one side only
• whether it is close to an eye, the nose or an ear
• any changes to vision, hearing, balance or facial movement
• all current medicines, including anything bought over the counter
• whether the person is pregnant or might be
• any immune-system problems or treatments that lower immunity
• any contact with pregnant people, newborn babies or people with weakened immunity
• how the pain is affecting sleep and daily life