Complete Guide to Shingles

Whether you want to prevent shingles or you’ve already been diagnosed, talk to your doctor about steps you can take to best protect your health.

Ask Your Doctor . . .

Preventing shingles:

Should I get a shingles vaccine?

I heard that a new shingles vaccine is available. If I already got the older shingles vaccine, do I need the new one?

If I get the vaccine, could I still get shingles?

How will I know if I have shingles?

Coping with shingles symptoms:

Do you recommend medicine for me?

How long will my symptoms last?

What do you recommend for the pain?

How can I protect friends and family from my shingles?

Could I have complications from shingles?

Will my shingles rash leave a scar?

TIP: Always share with your doctor any updates since your last visit—from new medicines to major life changes. These can impact your health. And be honest about how you’re feeling and whether you’re following your treatment plan. Your doctor can’t help you if she doesn’t know what’s really going on.

Shingles, or herpes zoster, is caused by the varicella-zoster virus, the same virus that causes chickenpox. If you’ve had chickenpox before, you’re at risk of getting shingles.

After chickenpox heals, the virus moves from your skin into nerves along your spinal cord. The virus can stay there, inactive and hidden, for many years without causing any symptoms. But if your immune system is weakened by triggers like illness or stress, the virus can become active again.

Once it’s active, the virus spreads and moves along a path of nerves from your spinal cord to your skin’s surface. This can be very painful. When the virus reaches your skin, it forms a blistery, painful rash.

TIP: Talk to your doctor about getting the shingles vaccine if you’re ages 50 or older. Almost 1 out of every 3 people will get shingles at some point in life. 

You can help prevent shingles by getting the shingles vaccine. In late 2017, the FDA approved a shingles vaccine called Shingrix® (RZV). The Centers for Disease Control and Prevention (CDC) recommends this two-dose vaccine for adults ages 50 and older, even if you’ve already had shingles or you got the older, one-dose vaccine, Zostavax® (ZVL).

If your risk of shingles is high, your doctor may suggest you get the Shingrix vaccine sooner than age 50.

If you’re 60 or older, you can use either Shingrix or Zostavax, but Shingrix is preferred.

You’ll need the two doses of Shingrix 2 to 6 months apart. If you were vaccinated with Zostavax, wait 2 months before getting Shingrix.

Talk to your doctor to decide if and when the vaccine is right for you. The vaccine doesn’t completely protect you from shingles, but it does reduce your risk. And even if you’ve had shingles, you can still get the vaccine to help reduce your risk of getting it again.

If you do get shingles, the vaccine may make symptoms less severe and less painful. It may also reduce your risk of postherpetic neuralgia (PHN), nerve pain that continues after your shingles rash heals. But keep in mind, the vaccine is not a treatment for active shingles.

When Not to Get the Vaccine

The shingles vaccine isn’t right for everyone. 

Your doctor may recommend that you NOT get the vaccine if you have a weakened immune system from one or more of the following:

• having HIV/AIDS
• having cancer, such as leukemia or lymphoma
• receiving cancer treatment like radiation or chemotherapy
• taking medicines that affect your immune system like steroids

Talk to your doctor about the best option for you and your health.

You also shouldn’t get the vaccine if you’re pregnant or if you’ve had a severe allergic reaction to gelatin or the antibiotic neomycin.

Your Risk of Shingles

Ask your doctor if you’re at risk of shingles. 

Your risk increases if:

• you’ve ever had chickenpox
• you’re over age 50—your risk increases with age
• you have certain medical conditions or take certain medicines

Your doctor can help you decide if and when the shingles vaccine is right for you.

Prevention Checklist

Over age 50? Review this checklist today to make sure you’re doing all you can to prevent shingles.

• Find out if you’re at risk of shingles. Talk to your doctor about other medical conditions you have and if you’ve ever had chickenpox.
• Talk to your doctor about the shingles vaccine. Ask if the vaccine is safe for you.
• Make a plan to get the vaccine. Get it today at your doctor’s office or pharmacy, or schedule a follow-up appointment.
• Call your doctor if you notice any side effects after you get the vaccine. The vaccine could cause redness, soreness, swelling or itching at the injection site.
• Spread the word. If you have family and friends over age 50, encourage them to get the shingles vaccine as well.

TIP: If you help care for aging family members or friends, you can play a role in helping prevent shingles. Encourage them to ask their doctor about the shingles vaccine, or tag along during their next office visit.

Paying for the Vaccine

If you have insurance, Medicare or Medicaid, call before you get the shingles vaccine to find out if it’s covered under your plan.

• Medicare Part D covers the full cost of the vaccine. Depending on your plan, you may have a copay or need to pay a certain amount and then get reimbursed.
• Medicaid may or may not cover the vaccine, so call in advance to find out if your plan does.
• Most private health insurance companies cover the vaccine, but contact yours to be sure.

Depending on the type of coverage you have, where you get the vaccine—at your doctor’s office vs. a pharmacy—can make a difference in cost. If you need help paying for the vaccine, ask your doctor to recommend programs that may be able to help you.

The most common sign of shingles is a rash, or band of blisters, on one side of your body. It usually appears on your torso or face, but can show up on any area of your body.

Several days before the rash appears, the virus moves along your nerves to the surface of your skin. 

During this time, you may have the following:

• pain
• burning
• numbness
• itching
• tingling

You might also have flu-like symptoms, including fever, chills, feeling tired, upset stomach or headaches.

A few days after you first see the rash, it will turn into fluid-filled blisters. You may experience pain that’s constant or comes and goes until the blisters dry up and crust over, usually within 7 to 10 days.

Once the blisters begin to heal, your pain should decrease. Most cases of shingles last from 2 to 4 weeks, but there can be complications.

Complications

It’s possible for shingles pain to continue in the same area even after the rash and blisters have healed. When this happens, it’s called postherpetic neuralgia (PHN). Usually it gets better in a few weeks or months, but some people can have pain for years.

Pain from PHN can range from mild to severe, and the more severe your pain, the more it can affect your daily life. Treatments are available to help, so if you think you have PHN, talk to your doctor right away.

If you’re over age 60, you have a higher risk of PHN and the pain is more likely to be severe. Taking medicine, called antivirals, at the first signs of shingles can help reduce your risk of PHN. Shingles can also lead to complications in your eyes including loss of vision. If you have any blisters around your eyes, contact your doctor right away.

TIP: See your doctor as soon as possible if you think you have shingles. Starting treatment early can sometimes help make symptoms less severe and less painful.

Dangerous Symptoms

A more serious complication—called Ramsay Hunt Syndrome—can happen if the shingles virus infects a facial nerve near your inner ear. 

The symptoms are different from typical shingles symptoms and include:

• a painful rash inside your ear, on your ear, or on your tongue or the roof of your mouth
• hearing loss on one side
• weakness on one side of your face that can make it hard to eat or smile
• vertigo (dizziness and a sense that things are spinning around you)

See your doctor right away if you experience any of these symptoms.

If you end up with shingles, treatment can help make your attack less painful and less severe. It can also help reduce your risk of long-term pain from postherpetic neuralgia (PHN). It’s important to start treatment as early as possible—within 1 to 3 days of your first symptoms—and to completely finish your medicine, even if you start feeling better. Treatments can include:

Antivirals—These medicines can lessen your pain by fighting the shingles virus. They should be started within 72 hours of your first symptoms. The earlier you start taking antivirals, the better they will work. Antivirals include famciclovir, valacyclovir and acyclovir.

Pain relievers—Depending on how severe your pain is, your doctor may recommend over-the-counter pain relievers (like ibuprofen or naproxen) or prescription pain relievers.

Nerve blocks—Your doctor may give you an injection that contains a numbing medicine if your pain is intense.

Antibiotics—If your shingles blisters get infected, you may need antibiotics to help clear the infection and prevent scarring.

If nerve pain continues after the shingles rash clears, your doctor may prescribe:

Lidocaine—This numbing medicine is available as a patch or a cream that you put on your skin to relieve pain for a short time.

Capsaicin cream—This cream, which contains an extract from hot peppers, may be used to reduce pain.

Anti-seizure drugs—For pain that lasts, medicines like gabapentin and pregabalin are often prescribed.

Antidepressants—These are medicines (such as amitriptyline or nortriptyline) that can help with both pain and depression caused by pain.

Tell your doctor if you experience any side effects from treatment or if your pain doesn’t get better. Your doctor can adjust your treatment plan.

For Treatment Success!

If you know how your medicine works, you’ll know why it’s important not to miss a dose. Ask your doctor or pharmacist these questions:

What is the name of my medicine?

What dose will I take? For how long?

How does it work to improve symptoms? When will it start working?

What do I do if I miss a dose?

What are possible side effects? And what do I do if they occur?

Are there any foods, drinks or activities to avoid while taking this medicine?

And follow these tips to help you remember to take your medicine:

• Set an alarm on your watch or cellphone.
• Use an app, pillbox or medicine tracker.

TIP: Remember to always tell your doctor about any other prescription or over-the-counter medicines or supplements you’re taking to make sure your new medicines are safe to take together.

There are many simple things you can do to help relieve the pain and itching of shingles.

Soothe your skin with water

WHY: Cool water can help reduce itching.

HOW: Take a cool bath, or place a wet washcloth or ice pack on your rash. Taking an oatmeal bath can also help. 

Avoid tight clothing

WHY: Wearing tight or rough clothing can be painful.

HOW: Wear loose, cotton clothes that won’t rub on your rash, or keep your rash covered with loose sterile bandages that don’t stick.

Use lotion or cream on your skin

WHY: The right lotion or cream can help reduce the itch.

HOW: Ask your doctor or pharmacist to recommend a product to help your skin. At the drugstore, look for calamine lotion or hydrocortisone cream.

Manage stress to reduce pain

WHY: When you’re not feeling well, stress can make you feel worse.

HOW: Practice deep breathing and give yourself permission to rest as much as you need to. Gentle exercise, like taking a walk, can also help.

Distract yourself

WHY: Focusing on an enjoyable activity can help you manage your pain.

HOW: As much as you can, try to do simple things you enjoy like watching favorite shows or working on a hobby.

Get enough sleep

WHY: Getting 7-9 hours of sleep a night will help your body fight the virus.

HOW: Ask your doctor if an antihistamine might relieve itching to help you sleep better.

Ask friends and family for help

WHY: You don’t have to do everything yourself. Asking for help will allow you to rest so your body can fight the virus.

HOW: Don’t feel bad if you need to ask for help while you get better. Just make sure the people around you have already had chickenpox or had the chickenpox or shingles vaccine.