Shingles
A shingles rash is caused by a virus called herpes zoster and starts as tiny red bumps or blotches that become weeping blisters (known as vesicles). This often appears on the chest, back, stomach, neck, or face. People sometimes notice a tingling or burning in the days before the rash appears and may have a headache, mild fever, or feel otherwise unwell.
It is distinctive in that it will only appear on one half of the body and usually only covers a small area. This virus was originally caught as chickenpox (varicella-zoster virus), usually in childhood. While your body recovers from this, the virus lays asleep, or dormant, in the nerves and is reactivated under stress or illness, usually in those over 60 years old. Following the pathway of nerves means the virus is only activated from the nerves leading off the spine to one side or the other - a so-called dermatomal distribution.
Doctor’s advice
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Symptoms of shingles
Common symptoms of shingles include:
- Pain - often a burning or shooting pain
- Rash - a red rash that usually develops into blisters
- Itching
- Fever
- Headache
- Sensitivity to touch
Stages of the rash
Pain and tingling (prodromal stage)
Often, shingles start with pain, itching, or tingling in a specific area. This stage may precede the appearance of the rash by a few days to a week. Some people describe it as a burning or shooting pain.
Rash development
A red rash then typically appears in the same area. The rash evolves into clusters of fluid-filled blisters. The rash is usually unilateral (on one side of the body) and follows a dermatomal pattern (along a nerve pathway).
Blisters and ulcers
The blisters may merge and form larger ulcers. The fluid inside the blisters is initially clear but may become cloudy over time.
Scabbing and crusting
The blisters eventually crust over and form scabs. The scabs may take a few weeks to heal and fall off.
Pain intensity
The pain can range from mild to severe and may persist even after the rash has healed. Some individuals may experience postherpetic neuralgia, a condition where pain continues for months or even years.
Is chickenpox contagious?
You can't "catch" shingles from other people with shingles or chickenpox, but if the blisters are still weeping, you can pass it on to people who have never had chickenpox, most likely young children, and there is a risk to an unborn child if a woman has not had chickenpox and catches it in pregnancy.
When should I see my doctor?
Book an urgent appointment with your doctor, who will assess this and may give you anti-viral tablets. Anti-viral tablets will not rid you of the virus, but they can help reduce the time taken until recovery and the severity of symptoms.
They may also reduce the risk of post-herpetic neuralgia, where pain can last for weeks or months afterward, even though the rash and vesicles have cleared.
There is urgency as the anti-viral tablets have more chance of working the sooner they are taken, ideally within 72 hours of symptoms starting. Shingles near the eye or ear can be a serious cause for concern - see your doctor or call 911, or go to your Emergency Department if this is outside working hours.
Am I fit for work?
You may be fit for work if you feel well enough but should avoid work until the vesicles have dried out if there is any chance you will come into contact with young children, those with a weakened immune system, or pregnant women, as you may pass it on as chickenpox.
Can I protect myself from shingles?
A shingles vaccine (Shingrix) is available as a two-dose series for people with certain serious medical conditions or those over 50 - check with your doctor's practice to see if you are eligible.
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