Brief overview
- Causes and risk factors:Infection with the varicella zoster virus first triggers chickenpox, then years later sometimes shingles. Stress or psychological causes, immunodeficiency and other infections contribute to this
- Symptoms: General feeling of illness, headache and aching limbs, slight fever, skin tingling, shooting pain (burning, stinging), belt-shaped rash with fluid-filled blisters that later crust over
- Diagnosis: Recognizable by the rash, PCR and antibody tests
- Treatment: Relieves symptoms with painkillers, ointments or tinctures; causative therapy with antivirals
- Course and prognosis: Usually heals on its own; complications such as pigmentation disorders, signs of paralysis, skin and brain inflammation and neuropathies possible
- Prevention: Vaccination against chickenpox and shingles
What is shingles?
Shingles (herpes zoster) is a disease caused by an infection with the varicella zoster virus (VZV). This virus triggers another disease in addition to shingles: chickenpox (varicella). Chickenpox occurs as an initial infection, so you only get shingles if you have already had a chickenpox infection.
The “awakened” viruses then spread along nerve tracts and cause inflammation of the affected nerve tissue. In the affected skin area, the typical painful rash of shingles develops as a reaction.
In rare cases, chickenpox can pass without the typical symptoms and years after the unnoticed infection, shingles breaks out with itching and a rash.
Normally, shingles does not recur, but it is possible to get it twice or even more. The symptoms of such “recurrent” shingles are usually no different from the previous ones. Whether you can get shingles more often or how often you get it depends on the strength of your immune system.
How contagious is shingles?
Only people who have previously had chickenpox get shingles. The chickenpox pathogen is also the cause of shingles. This is important to know when it comes to the risk of infection with shingles. Ultimately, the infectiousness of chickenpox is the decisive factor – and this is extremely high:
But what does “contact with a sick person” mean? In the case of chickenpox, it means that an infectious person is within several meters of a sick person. Varicella is passed on via droplet infection. The pathogens spread through the air, for example by coughing or breathing.
There is another way in which shingles is contagious: the varicella zoster viruses are transmitted via direct contact with the virus-containing contents of the skin blisters of a person with shingles. This happens, for example, when a healthy person touches a patient’s rash or objects that the patient has previously held.
However, if a person who has never had chickenpox comes into contact with the contents containing the virus, they are not infected with shingles, but with chickenpox.
Direct infection with shingles is not possible, as it only breaks out when viruses that have become embedded in nerve cells are reactivated.
How long is shingles contagious?
Shingles patients often ask themselves when shingles is contagious. People with shingles are contagious from the time the skin blisters appear until they have completely crusted over, for example to partners or children. This generally takes five to seven days.
In comparison: chickenpox patients are already contagious one to two days before the rash appears. The risk of infection exists until the skin blisters crust over. Here too, this usually takes five to seven days after the first blisters appear.
Many sufferers ask themselves “Can I work with shingles?”. Due to the risk of infection, the answer is no. However, how long you have to take sick leave and rest with shingles depends on the individual. It is not possible to make general statements about how long shingles lasts.
What triggers shingles?
Normally, it keeps the “dormant” varicella zoster viruses in the body of former chickenpox patients in an inactive state. If the body’s defenses are weakened, the pathogens “wake up”, resulting in shingles. The typical skin rash of shingles appears after a delay due to severe stress, for example.
There are many reasons for the gap in the immune defense and therefore the risk factors for shingles. The most important triggers for shingles are
- Age: As we get older, the efficiency of the immune system decreases and the risk of shingles increases.
- Major stress and psychological strain as a cause
- UV radiation: In excessive doses, UV radiation triggers shingles. It is quite common for herpes zoster to follow a severe sunburn.
- Other infections that precede herpes zoster promote shingles.
- HIV disease: In this disease caused by the HI virus, certain cells of the immune system, the so-called T cells, are destroyed. At an advanced stage, this leads to immunodeficiency.
- Cancer also often weakens the immune system.
- Chemotherapy: The drugs used to fight cancer affect the immune cells, among other things.
- Drugs that dampen the body’s immune system, known as immunosuppressants: for example TNF blockers as part of rheumatism therapy.
- Congenital immunodeficiencies: Here, certain components of the body’s defenses are reduced or completely absent from birth.
Shingles: What are the symptoms?
The signs of shingles are not uniform. How shingles manifests itself therefore varies from case to case – especially in terms of its severity. However, the symptoms of shingles usually follow a certain pattern:
In the early stages of shingles, there are no specific symptoms yet. Patients only report general signs of shingles such as mild fever, tiredness, headaches, back pain or aching limbs. The affected area of skin sometimes experiences discomfort such as tingling. This turns into pain after two to three days. The typical shingles rash develops.
In contrast to other herpes infections, there is no scientific evidence to date that a persistent state of exhaustion is more common as a long-term consequence after shingles has healed.
Pain
The pain occurs before, during and – in unfavorable cases – also after the rash. As the viruses in shingles attack the nerves, this is known as neuropathic pain. This is manifested by a burning or stinging sensation, is sometimes dull and always comes on suddenly. How long the pain from shingles lasts varies from case to case. Shingles without pain is rare.
What does shingles look like?
Many sufferers wonder what the onset of shingles looks like. The typical first sign to recognize shingles is the characteristic skin rash, also known as zoster. How this rash of shingles usually begins is with a non-specific redness on the affected area with small skin nodules. These nodules in the initial stage of shingles develop into small itchy skin blisters within hours as a symptom. They are initially filled with a clear fluid that becomes cloudy as the disease progresses.
The phase of skin blisters lasts up to five days. After bursting, the blisters dry out within two to ten days. Yellowish crusts often form and the rash finally disappears when they fall off. This is the final stage or final phase of shingles. It generally takes two to four weeks for the skin changes caused by shingles to disappear.
It is also possible for shingles to occur without a rash or blisters (only with pain) and for the shingles to only have an internal effect. Doctors then speak of a “zoster sine herpete”.
Which part of the body is affected?
The rash is most commonly found as a symptom of shingles on the abdomen (including the navel) or groin, on the back or in the chest area or under the breast. On the upper body, the rash of shingles often looks like a belt. This is where the German name for the disease comes from.
In principle, however, it is possible for herpes zoster to affect all areas of the body. The head, scalp or neck are often affected. In other people, shingles develops on the legs (for example on the thigh, hip or back of the knee), on the foot (sole of the foot), on the arm (forearm, crook of the arm, elbow), under the armpits, on the bottom or on the hand (back of the hand, wrist, fingers). The painful rash is usually limited to one side of the body. Sometimes several areas of skin are affected at the same time.
The appearance of shingles on the leg, for example, is not very different from the rash on the trunk, except that the pustules do not form the typical girdle shape.
If the immune system is severely weakened, the shingles rash can spread over the entire surface of the body. This generalized herpes zoster is then difficult to distinguish from chickenpox.
Regardless of the area, shingles is equally contagious, regardless of whether the symptoms occur on the back, abdomen or away from the upper body on the head or face, for example on the mouth or forehead.
Read everything you need to know about herpes zoster on the face and the possible complications in the article Shingles on the face.
Shingles: examinations and diagnosis
A shingles self-test based on typical signs of the disease is not sufficient – if shingles is suspected, it is always advisable to go to your GP or dermatologist. If the eye or ear area is affected, consult an ophthalmologist or ear, nose and throat specialist (ENT).
The typical clinical picture, which even a layperson can recognize as shingles, usually leads the doctor quickly to a suspected diagnosis of shingles: the course and nature of the symptoms are characteristic of the secondary disease caused by the varicella zoster virus.
However, due to the way in which shingles starts, diagnosis is sometimes difficult in the initial stages of shingles. The general signs of the disease and an initial rash have many potential causes. Certain tests then help to reliably identify herpes zoster and rule out other diseases with similar symptoms (such as herpes simplex). There are two main ways of recognizing shingles:
How is shingles treated?
The unpleasant symptoms of shingles can be alleviated with medication: For example, painkillers such as ibuprofen or paracetamol can help with the pain. These also have an antipyretic effect. If necessary, the doctor will also prescribe stronger painkillers.
Depending on the stage, the rash is treated with skin care products. As shingles is often terribly itchy, ointments or tinctures, for example, are available to soothe the itching. Some preparations also help the blisters to dry out or the crusts to come off.
Due to the painful rash, showering is permitted during shingles, but the frequency should be reduced if possible. Sweat-inducing activities such as sport should also be avoided during shingles at least until the blisters have healed.
In addition to these purely symptomatic measures, a causative treatment is also used for shingles: patients are given antiviral medication (antivirals) to combat the varicella zoster virus. For safety reasons, this is only recommended for pregnant women and children if the course of the disease is complicated.
You can read more about the different treatment options for shingles in the article Shingles – treatment.
How does shingles progress?
The prognosis for shingles is usually good. In most people with a healthy immune system, it heals within a few weeks. After the blisters have burst, they crust over and the scab falls off after a few days. In contrast to chickenpox, patients are usually not embarrassed to scratch because the pain prevents them from doing so.
After the shingles rash has healed, scars or spots sometimes form that are lighter or darker than the surrounding skin if a so-called pigment disorder has occurred.
Sometimes shingles can lead to complications. These include, among others:
- Post-zoster neuralgia: Nerve pain in the previously affected skin region (post-herpetic neuralgia)
- Secondary bacterial infection: the areas of skin damaged by the zoster also become infected with bacteria.
- Pigmentation disorders, bleeding and melting of the skin as well as scarring
- Paralysis (paresis) and sensory disturbances (paraesthesia) in the affected region
- inflammation of the meninges and brain (meningitis or encephalitis) if the zoster affects the central nervous system
Disseminated herpes zoster and infestation of the central nervous system are particularly feared. Older people (over 50) and people with an immune deficiency are particularly susceptible to shingles complications. These include HIV-positive people and cancer patients.
In people with extremely weakened immune systems, shingles can sometimes be fatal. Doctors therefore recommend that those affected are vaccinated against shingles.
Although some people develop a fear of cancer when they are diagnosed with shingles, no strong link has been found between tumors and shingles. Therefore, while testing for HIV is recommended in younger patients, experts do not use shingles as a tumor marker.
Post-herpetic neuralgia
In up to 30 percent of patients, neuropathic zoster pain persists or flares up repeatedly after the rash has healed. Doctors refer to such pain, which sometimes occurs years after shingles, as post-zosteric neuralgia or post-herpetic neuralgia (PHN). This nerve pain after shingles is particularly common as a late effect in older patients on the shoulder, neck or trunk. This consequence of shingles occurs slightly more frequently in women than in men.
Shingles: Pregnancy and newborns
If pregnant women get shingles, this is usually not a problem for the unborn child. Even if shingles occurs around the due date, there is usually no danger, as the antibodies pass from the pregnant woman to the unborn child. How dangerous shingles is depends heavily on the immune system. Therefore, an initial infection with the varicella zoster virus during pregnancy is dangerous for the unborn child because neither the pregnant woman nor the child have immunity.
In this case, however, it is not an infection with shingles during pregnancy, but an infection with the same virus that triggers chickenpox when first contracted. In the first half of pregnancy, there is an increased risk of chickenpox causing malformations and damage to the unborn child. Even if shingles itself is not contagious for the baby, a new infection with the virus that causes shingles is dangerous for babies, as their immune system is not yet fully developed.
Read our article “Chickenpox and shingles during pregnancy” to find out why first-time varicella can be dangerous for mother and baby, why this is not the case with shingles and how to treat pregnant women who have contracted the disease.
Shingles: prevention
Further information on immunization against varicella can be found in the article Chickenpox vaccination.
There is now an inactivated vaccine against shingles. It offers good protection against the disease. Unlike the previously used live vaccine, it consists of killed pathogens.
You can read more about the vaccination against shingles in the article Shingles vaccination.
Shingles or a varicella zoster infection cannot be prevented with a certain diet.
