The Bottom Line

Shingles is a painful rash caused by the same virus that causes chickenpox — it reactivates decades later when your immune system weakens. About 1 in 3 Americans will get shingles in their lifetime. Starting antiviral medication within 72 hours of the rash appearing greatly reduces pain and the risk of long-term nerve pain. The shingles vaccine (Shingrix) is over 90% effective at preventing it and is recommended for adults 50 and older.

What Is Shingles?

Shingles (herpes zoster) is a painful skin condition caused by the varicella-zoster virus — the same virus that causes chickenpox. After you recover from chickenpox, the virus does not leave your body. It stays dormant (sleeping) in nerve cells near your spinal cord and brain. Years or decades later, if your immune system weakens — due to age, stress, illness, or certain medications — the virus can reactivate and travel along a nerve to the skin, causing shingles.

Shingles most commonly affects adults over 50 and people with weakened immune systems. About 1 million cases occur in the US each year. Most people only get shingles once, though recurrence is possible.

Signs and Symptoms

Shingles typically follows a progression:

  • Before the rash (prodrome): Burning, tingling, itching, or shooting pain on one side of the body — often on the torso, face, or around one eye. This may last 1–5 days before the rash appears.
  • The rash: A red, blistering rash appears in a band or strip on one side of the body, following the path of a nerve. Blisters fill with fluid and then crust over within 7–10 days.
  • Pain: Often severe — many patients describe it as burning, stabbing, or electric-shock-like.
  • Fever, headache, and fatigue may accompany the rash.
  • The rash typically affects the torso, but can involve the face, eye area (ophthalmic zoster — a medical emergency), or ear.

What Causes Shingles?

Shingles occurs when the dormant varicella-zoster virus reactivates. The trigger is usually a weakening of the immune system. Common reasons include:

  • Aging — risk increases significantly after age 50
  • High stress or illness
  • Medications that suppress the immune system (chemotherapy, steroids, biologics)
  • HIV/AIDS or other immune-compromising conditions

You cannot "catch" shingles from someone who has it. However, someone with active shingles blisters can transmit the varicella-zoster virus to a person who has never had chickenpox or the vaccine, causing chickenpox in that person.

Treatment Options

  • Antiviral medications: Valacyclovir, acyclovir, or famciclovir are most effective when started within 72 hours of rash onset. They shorten the duration of the rash and, most importantly, reduce the risk of long-term nerve pain (postherpetic neuralgia). These are prescribed by a doctor.
  • Pain relief: Over-the-counter options include acetaminophen and ibuprofen. Prescription options include gabapentin, pregabalin, tricyclic antidepressants, and opioids for severe pain.
  • Topical treatments: Calamine lotion or cool compresses soothe itching. Lidocaine patches or capsaicin cream help with nerve pain after the rash heals.
  • Corticosteroids: Sometimes added to antivirals to reduce inflammation, particularly in cases involving the face or eye.

Postherpetic Neuralgia: The Main Complication

Postherpetic neuralgia (PHN) is nerve pain that continues after the rash heals — sometimes for months or years. It affects about 10–15% of shingles patients and is much more common in older adults. Starting antiviral treatment early is the most effective way to reduce PHN risk.

Prevention: The Shingrix Vaccine

The Shingrix vaccine (recombinant zoster vaccine) is highly effective — over 90% effective at preventing shingles and postherpetic neuralgia in adults 50 and older. It is given as two doses, 2–6 months apart. The CDC recommends it for all adults 50 and older, including those who have previously had shingles or received the older Zostavax vaccine.

When to See a Doctor Immediately

  • Rash or pain is near your eye — this can threaten your vision (ophthalmologist needed urgently)
  • Rash involves the ear, face, or mouth area
  • You have a weakened immune system
  • You have a severe rash or severe pain
  • It has been less than 72 hours since your rash appeared — start antivirals as soon as possible

Frequently Asked Questions

Can shingles spread to other parts of my body?

In healthy adults, shingles stays confined to one band or stripe along a nerve on one side of the body. In people with very weak immune systems, the rash can occasionally spread more widely. This is one reason shingles is taken seriously in immunocompromised patients.

Can I get shingles if I never had chickenpox?

No. Shingles is caused by reactivation of the varicella-zoster virus, which you can only carry if you had chickenpox (or the chickenpox vaccine). However, exposure to someone with shingles blisters can cause chickenpox in a person who has never been infected or vaccinated.

Is it too late to get treatment after 72 hours?

Antivirals work best when started within 72 hours, but your doctor may still prescribe them later — especially if you have severe pain, a widespread rash, eye involvement, or a weakened immune system. Never wait to see a doctor if you suspect shingles.

Does having shingles mean my immune system is failing?

Not necessarily. Many healthy adults get shingles as they age simply because immune function naturally declines over time. However, if you get shingles before age 50 — especially if it recurs — your doctor may want to check for underlying immune problems.

References

  1. Cohen JI. Clinical practice: herpes zoster. N Engl J Med. 2013;369(3):255-263.
  2. Dooling KL, et al. Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR Morb Mortal Wkly Rep. 2018;67(3):103-108.
  3. Johnson RW, et al. Herpes zoster and postherpetic neuralgia. Exp Rev Neurother. 2010;10(4):645-653.

Trusted Resources

Always consult a board-certified dermatologist for personalized advice about your skin condition and treatment options.