Shingles

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Anyone who has ever had chickenpox can later get shingles. Both diseases are caused by the same viruses, the so-called varicella zoster viruses. After an infection with chickenpox (varicella), these viruses remain in the body. Many years later, they can become active again and trigger shingles (herpes zoster): a mostly stripe-shaped skin rash with vesicles that is often very painful. The rash usually only appears on one side of the body.

Shingles is a fairly common disease, especially in older people. It can be very unpleasant. As long as there are no complications, it is usually over after 2 to 4 weeks.

Since 2018, vaccination against shingles has been recommended for people over the age of 60; for people with a weakened immune system or chronic illness, as early as age 50.

Shingles is contagious – but only for people who have not yet had chickenpox. The infection then initially leads only to chickenpox, not to shingles.

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Before the rash forms, you usually feel listless and tired. There may also be a slight fever and tingling under the skin. After 2 to 3 days, the typical symptoms and discomforts appear:

  • A burning or stabbing, moderate to severe pain in the affected area,
  • followed by slight reddening of the skin with small nodules,
  • From which blisters develop within a few hours, which can be itchy.

This stage lasts up to five days. Afterwards, the blisters dry out within 2 to 10 days and yellowish crusts form.

The shape of the rash and its unilateral appearance are characteristic: It streaks across the affected half of the body. On the trunk, the rash resembles a shingles, hence the name "shingles".

Graphic: Shingles: typical rash on one side of the body

Shingles: typical rash on one half of the body

The rash most often appears on the trunk or chest. However, it can develop anywhere on the body, for example on the arms, head or face. Sometimes the eyes or ears are also affected. In some people, blisters form on larger areas as well.

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After a chickenpox infection, the varicella zoster viruses nest unnoticed in the nerve roots in the area of the spinal cord or in the cranial nerves. You carry them in your body for a lifetime, usually without feeling anything from them.

If the immune system is weakened, for example by an illness, severe stress or old age, the viruses can multiply again. They then travel along the affected nerve into the skin. The multiplication of viruses in the skin cells causes inflammation and the typical skin rash. Inflammation of the nerve causes the areas of skin it supplies to ache.

Graphic: Virus-infected nerve and inflamed skin area

Virus-infected nerve and inflamed skin area

People who have not had chickenpox can become infected with the varicella-zoster virus when they come into contact with the vesicular fluid from shingles. The infection can then initially only lead to chickenpox, not to shingles. When all the blisters have dried up and the last crust has fallen off, there is no longer any risk of infection.

Shingles can also occur in people who have been vaccinated against chickenpox, although it is estimated to be less common than in people who have had chickenpox.

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It is assumed that about 2 out of 10 people who have had chickenpox will get shingles in the course of their lives. Mostly people over 50 years fall ill. The risk of shingles increases with age, as the immune system weakens with age. In Germany, more than 300.000 people.

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In a normal course without complications, it takes 2 to 4 weeks for shingles to heal in adults. In children and young people, the disease is generally uncomplicated. Most adults contract the disease only once in their lifetime.

Very rarely, the vesicles spread to neighboring skin areas or even to the entire body. This can happen in people whose immune system is very weakened, for example due to a serious illness such as cancer or AIDS. For them, shingles can become life-threatening.

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If the itchy blisters are scratched open, a bacterial inflammation of the skin can occur and scars can remain. Consequences of shingles can also be hypersensitivity of the skin or pigment disorders. In the case of a pigment disorder, the skin in the affected areas is paler or darker than the surrounding skin.

If shingles occurs on the face, it can spread to the eye and cause corneal inflammation there. When hearing and facial nerves are affected, hearing loss or facial paralysis may occur. These symptoms usually disappear once the shingles have healed.

About 10 to 20 out of 100 people still have considerable pain from the nerve inflammation after the rash has healed. This is called "post-zoster neuralgia" or "post-herpetic neuralgia". It can last for several weeks, months or even years.

People with severely weakened immune defenses have an increased risk of severe complications. They may develop pneumonia, hepatitis, or meningitis.

In contrast to chickenpox, shingles during pregnancy is not dangerous for the child.

Know more

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Because pain often appears first, followed by typical skin changes, diagnosis can be difficult at first. Depending on where the shingles occurs, other causes for the pain are sometimes first suspected, for example appendicitis or gall bladder inflammation, a slipped disc or even a heart attack .

Also, many people do not initially consider the rash to be a contagious disease, but rather eczema, for example . This can lead to the fact that they do not consider a visit to the doctor necessary.

Doctors recognize shingles by the typical one-sided skin rash and the associated pain or sensory disturbances. In case of doubt, it is examined whether the vesicular fluid contains viruses. In addition, it can be checked whether there are increased antibodies against the varicella zoster virus in the blood.

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Since the end of 2018, the Standing Commission on Vaccination (STIKO) recommends vaccination for all persons over 60 years of age with an inactivated vaccine. That is, the vaccine contains only viral components, not attenuated viruses. For people with chronic diseases such as diabetes mellitus , rheumatoid arthritis or an immune deficiency, vaccination is recommended from the age of 50. It consists of two vaccination doses at an interval of at least 2 to at most 6 months.

Studies show vaccine significantly reduces risk of shingles in healthy people. It is not yet possible to say for sure whether the vaccine will last longer than four years, because the inactivated vaccine is still relatively new. After vaccination, you may experience side effects such as skin redness and rashes, pain at the injection site, or swelling.

The vaccination costs are covered by the statutory health insurance funds.

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Discomforts such as pain and fever can be relieved with analgesics and antipyretics such as acetaminophen. Prescription pain medications, such as opioids, are sometimes prescribed for severe pain.

In case of shingles, careful skin care is recommended. Antiseptic or antipruritic lotions, gels, or powders are often used to relieve itching and dry out the blisters. Mostly they contain tannins, zinc, menthol or polidocanol. If blisters have already formed, cooling moist compresses are sometimes also advised. However, how well these treatments help with shingles has not been well studied scientifically.

Special drugs against the herpes zoster virus (virustatics) are only recommended for:

  • Persons over 50 years,
  • a shingles in the head and neck area,
  • a weakened immune system ,
  • a kidney weakness ,
  • severe courses or an increased risk of complications.

Taken early, they can speed healing and shorten the duration of pain in shingles cases. Therefore, it is useful to start antiviral therapy within 72 hours after the onset of the rash. In the case of a severe course of the disease, the medication can also be given as an infusion into the vein (intravenously). If the ear is involved, additional treatment with cortisone is often given. The advantages and disadvantages of such a combination therapy are still unclear.

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It is important to avoid scratching the blisters as much as possible: The blister fluid is contagious and scratched blisters can leave scars behind. As long as shingles is contagious – that is, until the last blisters are completely healed – people with the disease should avoid direct physical contact with others unless they know if they are protected from chickenpox. This is especially true for people with weakened immune systems and for pregnant women. The risk of infection can be reduced by covering the blisters with a bandage.

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The family doctor’s office is usually the first place to go when you’re sick or need medical advice for a health problem. We provide information on how to find the right doctor’s office, how best to prepare for a doctor’s visit, and what’s important in the process.

Chen N, Li Q, Yang J, Zhou M, Zhou D, He L. Antiviral treatment for preventing postherpetic neuralgia . Cochrane Database Syst Rev 2014; (2): CD006866.

German Dermatological Society (DDG). Diagnosis and treatment of zoster and postzoster neuralgia (S2k guideline). AWMF Registry No.: 013-023. 24.05.2019.

Gagliardi AM, Andriolo BN, Torloni MR, Soares BG. Vaccines for preventing herpes zoster in older adults . Cochrane Database Syst Rev 2016; (3): CD008858.

Han Y, Zhang J, Chen N, He L, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia . Cochrane Database Syst Rev 2013; (3): CD005582.

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Updated on 06. November 2019
Next planned update: 2022

Institute for Quality and Efficiency in Health Care (IQWiG)

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