How Do You Get Herpes Zoster?

Herpes zoster is the virus that causes chickenpox. It lives in your nerve cells dormant, and may reemerge as shingles, most commonly in adults over 50. Luckily, there are effective vaccines against chickenpox (typically administered to children) and shingles for adults.

Herpes zoster, better known as shingles, is a painful band or belt-like patterned rash caused by varicella-zoster virus (the same virus that causes chickenpox). Shingles can affect anyone at any age, but it is more common in adults over 50 years of age and in people with conditions that weaken the immune system.

The varicella-zoster virus is a type of herpesvirus. Other herpesviruses include herpes simplex virus, which causes cold sores and genital herpes.

What Are Symptoms of Herpes Zoster?

Early symptoms of herpes zoster (shingles) include: 

• Unusual sensations such as itching, burning, or tingling feelings in an area of skin on one side of the body
• Fever
• Feeling unwell (malaise)
• Headache

After one to two days, symptoms of herpes zoster (shingles) include: 

• A rash of blisters on one side of the body in a band-like pattern
  • Most commonly affects the trunk (chest, abdomen, and back) but can appear on almost any part of the body
  • A rash near the eye can permanently affect vision if not treated
  • After three to four days, blisters become open sores (ulcers)
  • In about 7 to 10 days sores crust over and are no longer contagious (in people with healthy immune systems)
• Pain
  • Can range from mild to severe
  • Usually has a sharp, stabbing, or burning quality
  • May begin several days before the rash appears
  • Only involves the parts of the skin affected by the rash, but it can be severe and interfere with daily activities and sleep
  • Often worse in older adults than in younger people

Changes in skin color and scarring may occur after shingles has gone away.

Shingles is caused by the varicella-zoster virus. After a person has had chickenpox, the varicella-zoster virus remains dormant in the body and causes no symptoms. The virus can become reactivated later in life, causing the shingles rash. 

Risk factors for developing herpes zoster (shingles) include: 

• Age: more common in adults 50 years of age and older
• People who are immune compromised by:
  • Certain cancers
  • Diseases that interfere with the body's normal immune response
  • Chemotherapy to treat cancer
  • Immune-suppressing medications used to treat certain conditions (such as rheumatoid arthritis) or to prevent rejection after an organ transplant
  • Human immunodeficiency virus (HIV)

Shingles is not transmitted from person-to-person, however, a person who never had chickenpox or the chickenpox vaccine can get chickenpox from a person who has shingles.

A diagnosis of herpes zoster (shingles) can often be made by physical examination and patient history. 

A polymerase chain reaction (PCR) test may be used to confirm a diagnosis.

Treatment of herpes zoster (shingles) generally involves a combination of antiviral and pain-relieving medications. 

• Antiviral medications
  • Acyclovir (Zovirax)
  • Famciclovir (Famvir)
  • Valacyclovir (Valtrex)
• Pain medications
  • Nonsteroidal anti-inflammatory drugs 
    • Ibuprofen (Advil, Motrin)
    • Naproxen (Aleve, Anaprox) 
  • Acetaminophen (Tylenol) 
  • Prescription pain relievers such as opioids 
• Other treatments
  • Antibiotics, if the rash becomes infected
  • Wet compresses, calamine lotion, and colloidal oatmeal baths are home remedies that may be used to help relieve itching

Treatment for postherpetic neuralgia (long-term nerve pain, a complication due to shingles) includes: 

• Anti-seizure medications to reduce the pain of postherpetic neuralgia
  • Gabapentin (Neurontin) 
  • Pregabalin (Lyrica)
• Tricyclic antidepressants to treat the pain of postherpetic neuralgia
  • The dose of TCAs is lower than what is used to treat depression
• Capsaicin cream (Zostrix) to treat pain
• Topical anesthetics
  • Lidocaine (Xylocaine gel, Lidoderm skin patch)
• Prescription pain medications (opioids) 
• Steroid injections 

Complications of herpes zoster (shingles) include: 

• Postherpetic neuralgia (PHN): long-term nerve pain 
• Skin infection 
• Eye complications 
  • Eye inflammation (herpes zoster ophthalmicus) 
  • Retinal damage (acute retinal necrosis)
  • Can lead to vision loss if not treated promptly with antiviral medications
• Ear inflammation (herpes zoster oticus or Ramsay Hunt syndrome)
  • Symptoms include weakness of the facial muscles on the affected side, ear pain, hearing problems, and blisters inside the ear canal 
• Pneumonia
• Brain inflammation (encephalitis)
• Death (very rare)

The main way to help prevent herpes zoster (shingles) is vaccination. There are two vaccines available for adults 50 years and older to reduce the chance of developing shingles.

One form of the vaccine is available in a single dose, and the other requires two doses (given two to six months apart). The two-dose vaccine is preferred because it is more effective.