Shingles (Herpes Zoster): Symptoms, Causes, Treatment and Prevention Explained
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Shingles (herpes zoster) is a viral infection caused by the varicella-zoster virus, the same virus that causes chickenpox [1]. It usually appears as a painful stripe of blisters on one side of the torso, face or neck [1]. It is not life-threatening, but its most common complication is long-lasting nerve pain called postherpetic neuralgia [1]. Early antiviral treatment may speed healing and lower the risk of complications, and the two-dose Shingrix vaccine can lower your risk of getting shingles [1] [3].
Quick Answer: What is shingles and what causes it?
Shingles is a viral infection caused by the varicella-zoster virus, the same virus that causes chickenpox, which can reactivate years later and produce a painful rash, typically a stripe of blisters on one side of the torso [1]. There is no cure, but early antiviral treatment may speed healing [2]. The Shingrix vaccine is recommended for adults 50 and older [1].
What the research says
Shingrix cut the risk of shingles by more than 90% in a large trial. In the ZOE-50 phase 3 trial of 15,411 adults aged 50 and older, shingles was confirmed in 6 vaccinated participants versus 210 given placebo, an overall vaccine efficacy of 97.2% (95% CI 93.7 to 99.0); reactions were more common after vaccination, with grade 3 symptoms reported by 17.0% of vaccine recipients and 3.2% of placebo recipients (a manufacturer-funded trial) (Lal et al., New England Journal of Medicine, 2015 [3]).
Protection held in people 70 and older and included nerve pain after shingles. In the companion ZOE-70 trial of 13,900 adults aged 70 and older, efficacy against shingles was 89.8% (95% CI 84.2 to 93.7); pooling both trials (16,596 participants aged 70 and older), efficacy was 91.3% against shingles and 88.8% against postherpetic neuralgia (95% CI 68.7 to 97.1), and injection-site or body reactions in the first 7 days were more frequent with the vaccine (79.0% vs 29.5%) (Cunningham et al., New England Journal of Medicine, 2016 [4]).
What Is Shingles?
Shingles is a viral infection that causes a painful rash. It can occur anywhere on your body, but it typically looks like a single stripe of blisters that wraps around the left side or the right side of your torso [1].
Shingles is not life-threatening, but it can be very painful, and the pain sometimes starts before any rash appears [1]. Vaccines can help lower the risk of shingles, and early treatment may shorten the infection and lessen the chance of complications [1].
The condition is also known as herpes zoster. The varicella-zoster virus belongs to a group called herpes viruses, which also includes the viruses that cause cold sores and genital herpes [1]. But the virus that causes chickenpox and shingles is not the same virus that causes cold sores or genital herpes, which is a sexually transmitted infection [1].
What does shingles look like, and what are its warning signs?
Shingles symptoms usually affect only a small section on one side of your body. The classic picture is pain or a tingling sensation in a limited area on one side of the face or torso, followed by a red rash with small, fluid-filled blisters [1].
Symptom | What it feels or looks like |
Pain, burning or tingling | Usually the first symptom, and it can be intense |
Sensitivity to touch | Even light contact can hurt |
Red rash | Begins a few days after the pain starts |
Fluid-filled blisters | Break open and crust over |
Itching | Common during the blister phase |
Some people also have fever, headache, sensitivity to light and fatigue [1]. Depending on where the pain occurs, it can sometimes be mistaken for a problem with the heart, lungs or kidneys, and some people have shingles pain without ever developing the rash [1]. Most commonly the rash is a stripe of blisters that wraps around either the left or right side of the torso, but it can also occur around one eye or on one side of the neck or face [1].
When should you see a doctor for shingles?
Contact your health care provider as soon as possible if you suspect shingles, especially in the situations below [1]. Timing matters: early antiviral treatment may shorten the infection and lower your risk of complications [1].
Situation | Why it matters |
Pain and rash near an eye | If left untreated, this infection may lead to permanent eye damage |
You are 50 or older | Age increases your risk of complications |
You or a family member has a weakened immune system | This may be due to cancer, medicines or chronic illness |
The rash is widespread and painful | It needs prompt medical attention |
What causes shingles, and how is it linked to chickenpox?
Shingles is caused by the varicella-zoster virus, the same virus behind chickenpox, which stays inactive in the nervous system and can later reactivate along nerve pathways to the skin [1]. Anyone who has had chickenpox may develop shingles [1]. The process works like this:
Not everyone who has had chickenpox will develop shingles [1]. The reason for reactivation is unclear, but it may be due to lowered immunity to infections as people get older [1]. Shingles is more common in older adults and in people with weakened immune systems [1]. The shingles rash is associated with inflammation of nerves beneath the skin [1].
Is Shingles Contagious?
A person with shingles can pass the varicella-zoster virus to anyone who is not immune to chickenpox [1]. This usually happens through direct contact with the open sores of the shingles rash [1]. Once infected, though, the person will develop chickenpox rather than shingles [1].
Chickenpox can be dangerous for some people. Until your shingles blisters scab over, you are contagious [1]. During that time, avoid physical contact with anyone who has not had chickenpox or the chickenpox vaccine, including people with weakened immune systems, pregnant women and newborns [1].
Who Is Most at Risk of Shingles?
Anyone who has ever had chickenpox can develop shingles [1]. Most adults in the United States had chickenpox as children, before the routine childhood vaccination that now protects against chickenpox became available [1].
Risk factor | Details |
Age | Risk rises with age. Shingles typically occurs in people older than 50, and people over 60 are more likely to have more severe complications |
Some diseases | Diseases that weaken the immune system, such as HIV/AIDS and cancer, can increase risk |
Cancer treatments | Radiation or chemotherapy can lower resistance to disease and may trigger shingles |
Some medicines | Drugs that prevent rejection of transplanted organs can increase risk, and long-term use of steroids such as prednisone may also increase risk |
What complications can shingles cause, including postherpetic neuralgia?
The most common complication is postherpetic neuralgia, a painful condition in which shingles pain continues long after the blisters have cleared [1].
Complication | What happens |
Postherpetic neuralgia | Shingles pain continues long after the blisters clear, because damaged nerve fibers send confused and exaggerated pain messages from the skin to the brain |
Vision loss | Shingles in or around an eye (ophthalmic shingles) can cause painful eye infections that may result in vision loss |
Neurological problems | Shingles may cause inflammation of the brain (encephalitis), facial paralysis, or problems with hearing or balance |
Skin infections | If shingles blisters are not properly treated, bacterial skin infections may develop |
How Is Shingles Diagnosed?
Health care providers usually diagnose shingles from the history of pain on one side of your body, together with the telltale rash and blisters [2]. Your provider may also take a tissue sample or culture of the blisters and send it to a lab [2].
How is shingles treated with antivirals and pain relief?
Shingles has no cure, but early treatment with prescription antiviral drugs may speed healing and lower the risk of complications [2]. Because shingles can cause severe pain, your provider may also prescribe pain-relieving options [2].
Category | Medicines |
Antiviral drugs (early treatment) | Acyclovir (Zovirax), famciclovir, valacyclovir (Valtrex) |
Topical patch | Capsaicin patch (Qutenza) |
Anticonvulsants | Gabapentin (Neurontin, Gralise, Horizant) |
Tricyclic antidepressants | Amitriptyline |
Numbing agents | Lidocaine, as a cream, gel, spray or skin patch |
Injection | Corticosteroids combined with local anesthetics |
Talk with your health care provider or pharmacist about the benefits and possible side effects of any medicine you are prescribed. Shingles generally lasts between 2 and 6 weeks [2]. Most people get shingles only once, but it is possible to get it two or more times [2].
What home care helps while shingles heals?
Taking a cool bath or using cool, wet compresses on your blisters may help relieve itching and pain [2]. If possible, try to lower the amount of stress in your life [2].
How can the shingles vaccine help prevent shingles?
A shingles vaccine may help prevent shingles. People who are eligible should get the Shingrix vaccine, which has been available in the United States since its approval by the U.S. Food and Drug Administration in 2017 [1]. The Zostavax vaccine is no longer available in the U.S., but other countries may still use it.
Vaccine detail | What to know |
Who it is recommended for | People age 50 and older, whether or not they have had shingles |
Previous Zostavax recipients | May also receive Shingrix |
Unknown chickenpox history | May also receive Shingrix |
Weakened immune systems | Recommended for people 19 and older with weakened immune systems due to disease or medication |
Type of vaccine | A nonliving vaccine made of a virus component |
Dosing | Two doses, with 2 to 6 months between doses |
Most common side effects | Redness, pain and swelling at the injection site; some people also have fatigue, headache and other side effects |
How well it works | It does not guarantee you will not get shingles, but will likely reduce the course and severity of the disease and lower the risk of postherpetic neuralgia |
Duration of protection | Studies suggest protection for more than five years |
The shingles vaccine is used only to prevent shingles. It is not meant to treat people who currently have the disease [1]. Talk to your health care provider about your vaccination options if you have had an allergic reaction to any component of the shingles vaccine, have a weakened immune system due to a condition or medicine, have had a stem cell transplant, or are pregnant or trying to become pregnant [1].
How should you prepare for a shingles appointment?
To prepare for a shingles appointment, usually with a primary care provider, list your symptoms, key personal information, medicines and questions to ask [2]. When you make the appointment, ask whether there is anything you need to do in advance, such as fasting before a specific test. Make a list of:
Take a family member or friend along, if possible, to help you remember what you are told [2]. Some basic questions to ask your doctor include:
What is likely causing my symptoms?
Other than the most likely cause, what are other possible causes?
What tests do I need?
Is my condition likely temporary or chronic?
What is the best course of action?
I have other health conditions. How can I best manage them together?
Are there restrictions I need to follow?
Should I see a specialist?
Your provider is likely to ask you questions such as:
When did your symptoms begin?
Have your symptoms been continuous or occasional?
How severe are your symptoms?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Do you know if you have ever had chickenpox?
In the meantime, avoid doing anything that seems to worsen your symptoms [2].
Conclusion
Shingles is the return of a childhood virus. The varicella-zoster virus that caused your chickenpox never really left. It has been resting in your nervous system, and a weakening of immunity can wake it up as a painful, one-sided stripe of blisters.
Learn the early signs, which are one-sided burning or tingling pain followed by a rash, and act quickly. Early antiviral treatment may shorten the infection and lower your risk of complications, and pain near an eye is a medical urgency because untreated infection may cause permanent eye damage [1]. Take the vaccine conversation seriously once you reach eligibility, and avoid contact with open blisters until they scab over to protect people who have never had chickenpox.
Next step: Talk to a health care provider about any rash you suspect could be shingles, and ask whether the shingles vaccine is right for you.
Frequently Asked Questions
What is shingles in simple terms?
Shingles is a viral infection that causes a painful rash. It is caused by the varicella-zoster virus, the same virus that causes chickenpox. After you have had chickenpox, the virus stays in your body for life and may reactivate years later as shingles.
Is shingles contagious to other people?
A person with shingles can pass the varicella-zoster virus to anyone who is not immune to chickenpox, usually through direct contact with the open sores of the rash. The infected person would develop chickenpox, not shingles. You are contagious until your blisters scab over.
How long does shingles last?
Shingles generally lasts between 2 and 6 weeks. There is no cure, but early treatment with prescription antiviral drugs may speed healing and lower your risk of complications.
What does shingles pain feel like?
Pain is usually the first symptom. It can feel like burning or tingling, and for some people it is intense. It affects a small section on one side of the body and can sometimes be mistaken for a problem with the heart, lungs or kidneys.
Can you have shingles without a rash?
Yes. Some people experience shingles pain without ever developing the rash.
Why does shingles happen years after chickenpox?
After you recover from chickenpox, the virus enters your nervous system and stays inactive for years. Sometimes it reactivates and travels along nerve pathways to the skin. The exact reason is unclear, but it may be due to lowered immunity as people get older.
Who is most at risk of getting shingles?
Shingles typically occurs in people older than 50, and people over 60 are more likely to have more severe complications. Other risk factors include diseases that weaken the immune system (such as HIV/AIDS and cancer), cancer treatments such as radiation or chemotherapy, and medicines such as transplant anti-rejection drugs or long-term steroids.
What is postherpetic neuralgia?
Postherpetic neuralgia is the most common complication of shingles. Shingles pain continues long after the blisters have cleared because damaged nerve fibers send confused and exaggerated pain messages from the skin to the brain.
Is shingles near the eye dangerous?
Yes. If pain and rash occur near an eye and the infection is left untreated, it may lead to permanent eye damage, and shingles in or around the eye can cause painful eye infections that may result in vision loss. Contact a provider as soon as possible.
Can you get shingles more than once?
Most people get shingles only once, but it is possible to get it two or more times.
How well does the shingles vaccine work?
Shingrix does not guarantee you will not get shingles, but it will likely reduce the course and severity of the disease and lower your risk of postherpetic neuralgia. In a large trial of adults 50 and older, vaccine efficacy against shingles was 97.2%, and studies suggest protection lasts for more than five years.
Related Reading
Shingles Vaccine (Shingrix): Who Needs It, Doses and Side Effects explains who should get the shingles vaccine and how well it works.
References
Mayo Clinic Staff. Shingles: Symptoms & causes. Mayo Clinic. Last updated August 20, 2022. https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054
Mayo Clinic Staff. Shingles: Diagnosis & treatment. Mayo Clinic. Last updated August 20, 2022. https://www.mayoclinic.org/diseases-conditions/shingles/diagnosis-treatment/drc-20353060
Lal H, Cunningham AL, Godeaux O, et al. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. New England Journal of Medicine. 2015;372(22):2087-2096. PMID 25916341. https://doi.org/10.1056/NEJMoa1501184
Cunningham AL, Lal H, Kovac M, et al. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. New England Journal of Medicine. 2016;375(11):1019-1032. PMID 27626517. https://doi.org/10.1056/NEJMoa1603800
Medical disclaimer
The information provided in this article is for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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