What is Herpes Zoster Infection?

Herpes zoster infection, often known as shingles, is a common viral infection caused by the reactivation of the varicella-zoster virus. The varicella-zoster virus is also known as herpes zoster and is a member of the human herpesvirus family. Around one in three people in the United States will develop shingles in their lives, with 1 million cases in the country each year.^[1] All people that develop shingles will have had chickenpox at some point in their lives, usually during childhood.

The varicella-zoster virus remains dormant in the body after a person has had chickenpox. After chickenpox, which is the acute form of varicella-zoster infection, the virus lies dormant in nerves, and it can reactivate years later and cause new symptoms.^[2]

Herpes zoster infection is more likely to affect older people and people with a weak immune system. It causes burning pain, followed by a painful blistering rash, which tends to only affect one area of the body. If you think that you might have shingles.

Shingles is treated with antiviral medications.** The rash will usually begin to get better within two weeks, and although most people recover well, some may be left with persistent pain in the affected area. Effective pain management from the early stages is therefore very important. Some complications of shingles, for example, herpes zoster ophthalmicus, can lead to permanent problems with eyesight.

People with shingles should avoid contact with people who have not been vaccinated against chickenpox and people who have a weakened immune system.

Symptoms of herpes zoster infection

The first sign of herpes zoster infection is often a painful sensation in one area of the body. The pain is commonly described as:^[3][4]

• Burning
• Stabbing
• Itching
• Tingling
• Numbness

The most commonly known symptom of shingles is the rash. Where the rash appears will depend on what part of the body the herpes zoster virus has been dormant in. The rash appears on the dermatome associated with the affected nerve.

Good to know: A dermatome is the area of skin supplied by a particular nerve. The varicella-zoster virus lies dormant in the cranial and spinal nerves. When the virus is reactivated, it travels along the affected nerves to the area of the skin served by those nerves, where it causes a distinctive, stripe-like rash.^[5]

The rash is most common on the chest, back, shoulders or face. Pain and the accompanying rash can occur anywhere on the body, depending on which nerve is affected by the infection.

Several symptoms may appear before the rash develops. These are known as prodromal symptoms and include:^[5][6]

• Itching
• Burning sensations or discomfort when the skin is touched
• Flu-like symptoms such as fever, malaise and fatigue
• Upset stomach

Between one and five days after the pain begins, a rash will develop in the same area:^[2][3][4]

• The rash is vesicular; vesicles are small, blister-like sacs that appear on the surface of the skin
• The skin around the vesicular rash becomes red
• The rash is generally confined to one area of the body in a stripe-like pattern; usually one side of the body or, in some cases, the face. In immunosuppressed people the rash may be more widespread
• The rash blisters burst and scab over, usually seven to 10 days after first appearing
• The rash generally goes away after two to four weeks

About one in every ten people with shingles will experience the onset of pain and the rash simultaneously.

Good to know: If someone has a healthy immune system, they are said to be immunocompetent. If they have a weak or damaged immune system, they are said to be immunocompromised or immunosuppressed.

Most people will only experience shingles once, though less than 4 percent will have another episode.^[2] If you are concerned that you might have shingles.

Read more about Signs of Shingles »

Zoster sine herpete: shingles without a rash

Occasionally, shingles can occur without a rash of blisters: this is known as zoster sine herpete. In this form of the condition, the affected person will experience all the usual prodromal symptoms, such as fever and itching or burning, but does not then develop blisters.^[7] They may also develop a raised red area on the area of skin where they feel the itching or burning.

People with this condition experience pain and discomfort in the same dermatomal distribution as normal shingles, but the skin of the affected area may be red. Zoster sine herpete can be diagnosed using tests rather than physical examination.^[8]

Causes of herpes zoster infection

People at risk of developing shingles are those who have had chickenpox in the past. Herpes zoster infection occurs years, often decades, after a person has been infected with the varicella-zoster virus that causes chickenpox.

The virus remains dormant in the body in the ganglia of the sensory cranial nerves and spinal dorsal root (see FAQs). If a person’s immunity to varicella-zoster weakens over time, either due to age or if a person is immunosuppressed, the virus can reactivate. This reactivation is called herpes zoster infection, or shingles.^[5]

Conditions and situations that can suppress the immune system and make someone more at risk of developing shingles include:^[9]

• HIV/AIDS
• Receiving chemotherapy
• Diabetes
• Having the spleen removed ‒ for example, due to damage from injury or infection
• Hypogammaglobulinemia, a condition where the body does not make enough antibodies

If you have a condition that affects your general health and are experiencing symptoms that may be those of shingles, contact your doctor Find My doctor location at any time.

Diagnosis of herpes zoster infection

A diagnosis can usually be made based on the symptoms and the appearance of the rash. If there is uncertainty, the diagnosis can be confirmed with blood tests or by taking a sample of fluid from a blister and testing for the virus.

Complications of herpes zoster infection

Shingles can cause complications if it affects the eye and the ear. It can also cause long-lasting pain even after the rash has gone.

Good to know: People who are older than 60 years of age are particularly vulnerable to complications of shingles and should visit a doctor as soon as they develop symptoms.^[10]

Rarely, shingles can lead to complications such as pneumonia, encephalitis or secondary bacterial infection of the skin.^[10]

Herpes zoster ophthalmicus

Herpes zoster ophthalmicus, or ophthalmic shingles, is a variant of shingles where the virus affects the ophthalmic nerve and eye, causing pain and inflammation in the eye and face. If not treated quickly, it has the potential to cause permanent vision problems, including:^[11][12][13]

• Glaucoma
• Scarring of the tissues of the eye
• Retinal necrosis, a condition in which the retina becomes inflamed
• Iritis or uveitis, inflammation of the tissues of the eye
• Cataracts

Secondary bacterial infections of the eye can also occur if the affected eye becomes dry and sustains small scratches as a result of the inflammation. Some people find that prescriptions gels, ointments or drops that lubricate the eye are useful in relieving discomfort caused by dry eyes.^[13]

Read more about Herpes Zoster Ophthalmicus »

Herpes zoster oticus

Herpes zoster oticus, or Ramsay Hunt syndrome, occurs when the herpes zoster virus affects facial nerves. In this way, it is like herpes zoster ophthalmics, but in this case, the pain affects the ear. HZO is a rare form of shingles that causes pain deep within the ear and facial palsy as well as the rash. With treatment, most people will recover full use of facial nerves.^[14]

Treating herpes zoster oticus involves antiviral medications and pain management. (For more information, see the treatment section.)

Postherpetic neuralgia

Some people infected with herpes zoster will continue to feel pain in the affected areas of the body. Pain that persists for three months or longer is called postherpetic neuralgia (PHN).^[2]

Postherpetic neuralgia pain is caused by damage to nerves during the shingles infection. It is more common in older people, rising to 20 percent of people 80 years and older experiencing PHN after shingles.^[5]

Symptoms and effects of postherpetic neuralgia include:

• Sharp pain
• Intermittent or constant pain
• Allodynia, which is pain caused by light touches or the feel of clothing on skin
• Difficulty sleeping

The experience of living with PHN may bring on clinical depression.

Treatment of herpes zoster infection

Herpes zoster infection is usually treated with antiviral medication in people who are immunocompetent. These drugs help shorten the duration and lessen the severity of shingles by easing the associated pain and promoting healing of the blisters. Medication should be taken as soon as possible after the rash appears.^[15]

Drugs often prescribed include:^{[16][17][18][19]}

• Acyclovir. Taken orally, acyclovir has been the traditional antiviral for use in shingles treatment. However, other drugs have been developed which can be taken less frequently and are better absorbed by the body.
• Famciclovir. Taken orally, famciclovir converts to the compound penciclovir which is effective against the varicella zoster virus.
• Valacyclovir. Taken orally, valacyclovir treats pain and itching and helps sores to heal while preventing new sores forming.

Common side-effects of these drugs can include:^[17][18][19]

• Headache
• Nausea and vomiting
• Upset stomach
• Diarrhea
• Constipation
• Tiredness
• Painful menstruation

Some doctors may prescribe steroid tablets to reduce swelling and itching, but this is not recommended in most cases. Anti-inflammatory medications, such as ibuprofen, or other analgesics, may also help to reduce the pain and swelling.

People with shingles should try to avoid scratching at the rash. Calamine lotion and wet compresses can help soothe the itching.

Treatment of herpes zoster infection in the immunosuppressed

People whose immune systems are compromised are more likely to experience complications from shingles, which can include:^[20][21]

• The rash spreading across the body
• Infection of the lesions, usually due to Staphylococcus aureus
• Pneumonia
• Encephalitis, inflammation of the brain
• Blindness
• Deafness caused by herpes zoster oticus

It is even more important to treat immunosuppressed people with antiviral drugs to limit complications, potentially requiring hospitalization to administer drugs intravenously. Antiviral drugs are the same as those given to immunocompetent people.

Treatment of postherpetic neuralgia

Early prescription of painkillers to people with herpes zoster infection is advised to try and prevent the development of postherpetic neuralgia. Types of painkillers prescribed may include:

• Ibuprofen
• Paracetamol (acetaminophen)
• Codeine
• Tramadol
• Oxycodone
• Morphine

Good to know: Codeine, tramadol, oxycodone and morphine are opioid painkillers and should only be used if ibuprofen and paracetamol alone prove ineffective.

If postherpetic neuralgia develops, it can also be treated with:^[5]

• Topical creams, such as lidocaine and capsaicin, to ease pain and allodynia in particular
• Antidepressants, such as tricyclics or selective serotonin (SSRIs) and norepinephrine reuptake inhibitors (SNRIs) to relieve pain and counter effects of clinical depression
• Anticonvulsants, such as pregabalin or gabapentin, to relieve neuropathic pain

Prevention of herpes zoster infection

People who have shingles should keep away from people who have not been vaccinated against chickenpox, especially newborns, pregnant people, and people who have a weak immune system.

People who need to be especially cautious around people with shingles include:

• Pregnant people who are not vaccinated against varicella zoster or who have not had chickenpox
• People with compromised immune systems as a result of organ transplants, leukemia, cancer or HIV
• People with compromised immune systems as a result of medication, such as steroids or chemotherapy
• Newborn babies
• Young, unvaccinated children
• The elderly, especially those with existing health conditions

Although shingles itself cannot be passed from person to person, the varicella-zoster virus which causes chickenpox can be transmitted by contact with the fluid in the rash blisters.^[22] If you or someone you care for have recently been around someone with shingles and are concerned that you or they may have contracted chickenpox

Vaccination for herpes zoster infection

Vaccination against chickenpox (the varicella vaccination) and herpes zoster (a herpes zoster vaccination) can help to prevent and reduce the severity of some cases of shingles.

The Centers for Disease Control recommends that all healthy adults aged 50 and older should receive a shingles vaccine. This is especially recommended because older adults are more at risk of developing complications from shingles.

Depending on the age of the person receiving the vaccine, it is between 89 and 97 percent effective at preventing shingles and postherpetic neuralgia.^[23]

FAQs for herpes zoster infection

• People who have not had chickenpox and are not vaccinated against it
• People who are pregnant and have had neither chickenpox nor the vaccine against it
• People who have weakened immune systems due to medications such as steroids or organ-transplant drugs, or medical conditions such as cancer, HIV or leukemia. People undergoing chemotherapy should also avoid contact with someone affected by shingles.
• The elderly
• Unvaccinated children
• Newborns and very young infants

Other names for herpes zoster infection

• Shingles

---

1. Centers for Disease Control and Prevention. “Shingles (Herpes Zoster).” October 2017. Accessed May 15, 2018. ↩

2. MSD Manual: Professional Version. “Herpes Zoster.” February 2018. Accessed May 15, 2018. ↩ ↩ ↩ ↩

3. BMJ Best Practice. “Herpes zoster infection.” April 2018. Accessed May 15, 2018. ↩ ↩

4. Centers for Disease Control and Prevention. “Shingles: Signs & Symptoms.” January 2018. Accessed May 15, 2018. ↩ ↩

5. Mayo Clinic Proceedings. “Herpes Zoster (Shingles) and Postherpetic Neuralgia.” March 2009. Accessed May 15, 2018. Accessed May 15 2018. ↩ ↩ ↩ ↩ ↩

6. Ada Health. “Signs of Shingles: Herpes Zoster”. Accessed 31 December 2018. ↩

7. Medscape. “What is herpes zoster sine herpete?”. 6 March 2018. Accessed 30 December 2018. ↩

8. Medscape. “Herpes Zoster Clinical Presentation”. 6 March 2018. Accessed 29 December 2018. ↩

9. MedlinePlus. “Immunodeficiency disorders.” March 2016. Accessed May 15, 2018. ↩

10. Mayo Clinic. “Shingles”. Accessed 29 December 2018. ↩ ↩ ↩ ↩

11. Oregon Eyes. “Shingles and the Eye”. 19 September 2013. Accessed 29 December 2018. ↩

12. Eyecare Trust UK. “Herpes Zoster (Shingles) Eye Infections”. Accessed 29 December 2018. ↩

13. British Medical Journal. “Managing ophthalmic herpes zoster in primary care”. 16 July 2005. Accessed 30 December 2018. ↩ ↩

14. Patient Info. “Herpes Zoster Oticus.” September 2015. Accessed June 19, 2018. ↩

15. Centers for Disease Control and Prevention. “Shingles: Prevention & Treatment.” January 2018. Accessed May 15, 2018. ↩

16. UpToDate. “Treatment of herpes zoster in the immunocompetent host.” April 2018. Accessed May 15, 2018. ↩

17. MedlinePlus. “Acyclovir.” June 2017. Accessed May 15, 2018. ↩ ↩

18. MedlinePlus. “Famciclovir.” December 2017. Accessed May 15, 2018. ↩ ↩

19. MedlinePlus. “Valacyclovir.” February 2018. Accessed May 15, 2018. ↩ ↩

20. Centers for Disease Control and Prevention. “Shingles: Complications.” January 2018. Accessed May 15, 2018. ↩

21. MedlinePlus. “Herpes zoster (shingles) disseminated.” September 2017. Accessed May 15, 2018. ↩

22. Centers for Disease Control and Prevention. “Shingles: Transmission.” January 2018. Accessed May 15, 2018. ↩

23. Centers for Disease Control and Prevention. “Shingles Vaccination.” January 2018. Accessed May 15, 2018. ↩

24. Centers for Disease Control and Prevention. “Shingles (Herpes Zoster): Transmission”. 19 January 2018. Accessed 29 December 2018. ↩ ↩

25. NIH MedlinePlus. “Protecting Yourself From Shingles”. 2010. Accessed 29 December 2018. ↩ ↩ ↩ ↩

26. Antranik. “Peripheral Nervous System: Spinal Nerves and Plexuses”. Accessed 29 December 2018. ↩

27. Indiana University Bloomington. “Neurons”. Accessed 29 December 2018. ↩

28. Get Body Smart. “Spinal Nerve Roots”. Accessed 30 December 2018. ↩

29. Clinical Infectious Diseases. “Increased risk of Guillain-Barré Syndrome following recent herpes zoster: a population-based study across Taiwan.”. September 2010. Accessed 29 December 2018. ↩

30. National Institute of Neurological Disorders and Stroke. “Guillain-Barré Syndrome Fact Sheet”. 6 July 2018. Accessed 29 December 2018. ↩

31. University of California San Francisco. “Varicella-Zoster Virus and HIV”. November 2011. Accessed 30 December 2018. ↩ ↩

32. Medline Plus. “Herpes zoster (shingles) disseminated”. 5 June 2018. Accessed 29 December 2018. ↩

33. Phytotherapy Research. “Comparative study on the antiviral activity of selected monoterpenes derived from essential oils.”. May 2010. Accessed 29 December 2018. ↩

34. Evidence-based Complementary Alternative Medicine. “Commercial Essential Oils as Potential Antimicrobials to Treat Skin Diseases”. Accessed 4 May 2017. Accessed 29 December 2018. ↩

35. Medscape. “What is the risk of fatality in patients with herpes zoster (shingles)?”. 6 March 2018. Accessed 29 December 2018. ↩

**Q:⁤ What⁣ is Herpes Zoster Infection?**



**A:** Herpes zoster ⁢infection, commonly‌ known⁢ as⁤ shingles, is a viral infection that causes a painful rash ‌on one side of the body. It is caused by the varicella-zoster‍ virus (VZV), the same virus that causes chickenpox. After a person has chickenpox, the virus remains dormant in the nervous ⁤system. Years or decades later, the virus⁤ can‌ reactivate and ‍cause shingles.



**Q: What are the Symptoms of Herpes​ Zoster Infection?**



**A:** ‍The most⁢ common‌ symptom of⁢ herpes ⁣zoster infection is a painful rash. ⁣The rash⁤ usually appears on one side of the body⁣ and can be accompanied by:



* Tingling​ or burning ⁢sensation

* ​Itching

*​ Blisters that break open ⁣and crust over

*​ Sensitivity to touch

* ​Fever

* Headache

* Fatigue



**Q:‍ Who⁢ is at Risk for Herpes Zoster Infection?**



**A:**‌ Anyone who has had ⁣chickenpox is at ⁤risk ​for developing ​shingles, but the risk is ⁤highest ⁢in:



* People over the age ‍of 50

* People with weakened immune​ systems

* People who take certain​ medications, such ​as steroids



**Q: How is Herpes Zoster‌ Infection Diagnosed?**



**A:** ​Herpes​ zoster infection is diagnosed by a⁢ physical ‌examination and a review ‌of the patient’s medical history. ‍In some cases, a blood test or‍ a skin biopsy may be necessary to confirm ⁣the diagnosis.



**Q: How⁤ is ⁣Herpes Zoster Infection Treated?**



**A:**⁤ Antiviral medications, such ​as acyclovir, valacyclovir, and⁣ famciclovir, are used to treat herpes zoster infection. These medications can help ⁢shorten the duration and severity of the infection if ⁢they are started within 72 hours of the onset of symptoms.



**Q: Can Herpes ⁣Zoster‌ Infection Be Prevented?**



**A:** There is a vaccine available to prevent herpes zoster infection. The vaccine is recommended for people over the age ⁣of 50 and people with weakened immune ⁢systems.



**Q: What are the Complications of Herpes Zoster Infection?**



**A:** In some cases, herpes zoster infection can lead to‌ serious complications, such as:



* Postherpetic neuralgia (PHN): A chronic pain condition that can develop after the rash ⁢has​ healed

* ‍Encephalitis: Inflammation of the brain

* ⁢Meningitis: Inflammation of the⁢ membranes that cover the brain and spinal cord



**Additional​ Information:**



Herpes zoster infection is a‍ common viral infection that can cause a painful rash. It is important to‌ seek medical‌ attention if⁣ you develop‌ symptoms of herpes zoster ⁤infection, as early​ treatment can help reduce the risk of ⁤complications. ⁢There are ⁣vaccines available to‍ prevent ⁤herpes zoster infection, and it is recommended ‍for people ‌over​ the age of 50 and people with weakened⁤ immune systems.