(1) What is shingles and how is it caused?

Shingles is an often-painful outbreak of rash or blisters on the skin. It is caused by a reactivation of the varicella-zoster virus, the same virus that causes chickenpox.

(2) What causes the varicella-zoster virus to reactivate?

Scientists do not know exactly what triggers a reemergence of the varicella-zoster virus. However, scientists do know that it more commonly occurs in people over age 50, and in those who have a weakened immune system brought on by an illness such as cancer and certain medical treatments such as chemotherapy.

(3) Who can get shingles?

Anyone who has had chickenpox can get shingles, although it is most common in individuals over the age of 50. Individuals who have conditions, or are undergoing medical treatments, that weaken their immune systems are also more likely to develop shingles. These include: HIV infection; chemotherapy or radiation therapy; corticosteroids; transplant operations and possibly stress. National Shingles Foundation estimates that nearly one million individuals develop shingles in the U.S. each year.

(4) What are the signs and symptoms of shingles?

The early signs of a shingles outbreak are so vague, they can easily be mistaken for another illness. They include: burning or shooting pain, numbness, tingling or itching in an isolated region on one side of the body or face. Mild flu-like symptoms, such as headache, fever, chills and nausea, may also be present. Lesions (the rash) appear on the skin from one to 14 days later, usually in a band on one side of the body, or clustered on one side of the face (where there previously was pain). In two to four days, these lesions become fluid-filled blisters. In two to four weeks, they slowly crust, scab and heal. Once the blisters heal, one may continue to have pain for a month or longer. The skin may also become discolored where the rash once was.

(5) Can shingles occur without a rash?

Yes, but this is rare. It is called zoster sine herpete. The shingles rash may also go unnoticed. Shingles typically starts out without the rash. The patient may experience burning or shooting pain, numbness, tingling, itching, headache, fever, chills and nausea. While the rash almost always follows, it may be disregarded or mistaken for something else.

(6) How is shingles treated?

One of three oral, antiviral medications is usually prescribed for shingles: acyclovir, famciclovir and valaciclovir. Early treatment with one of these drugs—ideally within 72 hours of the appearance of the rash—can lessen the duration of shingles and lower the risk for post-herpetic neuralgia (PHN).

(7) Can a person get shingles twice? If so, does it appear in the same place twice?

Yes, a person can get shingles twice – it recurs in an estimated one to five percent of patients – and it can reappear many years after the initial episode of shingles. If shingles strikes a second time, it will usually not appear in the same location. Most people who seem to experience multiple episodes of shingles are probably having recurrent infection with a related herpes simplex virus and not true shingles.

(8) Can a person who has never had chickenpox develop shingles?

No. To get shingles, one must already have had a case of chickenpox and therefore harbor the varicella-zoster virus in the nervous system. However, the case of his or her chickenpox may have been very mild and unrecognized.

(9) Is shingles contagious?

Shingles cannot be caught from a shingles sufferer. Nor can a person catch shingles if exposed to someone with chickenpox. However, a person who has never had chickenpox can come down with chickenpox if he or she is exposed to the shingles rash.

(10) What should I do if I suspect I have shingles?

See a doctor (e.g., general practitioner, family physician, internist, dermatologist or neurologist) immediately if you are experiencing any of the symptoms of shingles or if there is any unexplained rash or pain in any part of your body. Shingles treatment is most effective if administered by a doctor within 24 to 72 hours of the appearance of the rash. If a doctor cannot determine the cause of a shingles-like condition, the patient can suggest that it could be shingles. If a rash is present, the doctor can conduct a test to determine whether it is shingles.

(11) What is PHN and how is it caused?

PHN (post-herpetic neuralgia) is the name given to the pain that lingers for months or even years after the shingles rash has healed. PHN results from injury to the nervous system caused by the varicella-zoster virus during the shingles infection. The pain of PHN may be sharp, burning, throbbing or stabbing.

(12) What are the signs and symptoms of PHN?

If an individual, whose shingles rash has healed, experiences significant pain in the area where the shingles rash occurred, or beyond that area, it could be PHN. In addition, if touching the skin causes pain, the patient may be experiencing allodynia, a frequent symptom of PHN. Allodynia is a condition in which the skin is unusually sensitive to normally painless stimuli, such as the touch of clothing or a gust of wind.

(13) How long does PHN last? Will it ever go away?

The duration of PHN varies widely. In some patients, it can last for months or even years. However, for many patients, the pain will lessen over time. Furthermore, there are a growing number of pain relief options for PHN that are proving to be effective for many patients.

(14) What type of physician should be consulted to treat PHN?

If one suspects PHN, a physician should be seen as soon as possible. The physician may make a referral to a pain specialist, neurologist or anesthesiologist who has experience in working with PHN patients.

(15) Can PHN be cured?

Currently, PHN cannot be cured. The relief of the pain it causes is the focus of treatment. However, the effectiveness of treatment for PHN varies widely among patients.

(16) Can PHN be prevented?

Currently, PHN cannot be prevented in all patients. However, prompt medical treatment for shingles can lessen the duration of shingles and lower the risk for PHN. Specifically, the effectiveness of antiviral medication (acyclovir, famciclovir or valaciclovir) is well established if it is taken within 72 hours after the appearance of the shingles rash. There is a major study underway – The Shingles Prevention Study – whose aim is to determine if vaccination can decrease the incidence and/or severity of shingles and its complications in older adults. The study is also trying to determine if vaccination can protect against PHN. The outcome of this study will help scientists determine whether PHN prevention is a valid strategy using this vaccine.

(17) What is chickenpox?

Chickenpox is a very contagious disease primarily affecting children. It is caused by the varicella-zoster virus (VZV).

(18) Can chickenpox be prevented?

Yes. In March 1995, the U.S. Food and Drug Administration (FDA) approved the country’s first chickenpox vaccine.

(19) Why should chickenpox be prevented?

Chickenpox is not simply a mild childhood illness, but, rather, a potentially serious infection. While its most common complications are bacterial skin infections, other complications include inflammation of the brain (encephalitis) or pneumonia, although these are rare in otherwise healthy people. According to the Centers for Disease Control and Prevention (CDC), each year, in the U.S. alone, chickenpox complications result in the estimated hospitalization of 11,000 individuals—the majority of whom were otherwise healthy—and 105 deaths—the majority of whom are children.

(20) Is the chickenpox vaccine safe and effective?

Experience and research to date have shown the vaccine to be safe and effective. A five-year, active surveillance study of varicella incidence and hospitalization conducted between 1995 and 1999 at three sites by the CDC reported an 80 percent reduction in varicella incidence, with the greatest decline among children one-to-four years of age.