Shingles

Shingles is a viral infection that affects a nerve or skin around it and is caused by the virus Varicella-Zoster. Varicella-Zoster is incidentally the same virus that causes Chickenpox. You will more than likely have had chickenpox during your childhood. Even though you would have recovered, the virus that caused Chickenpox remains inert and inactive in the body. When it becomes reactivated in adulthood, it causes Shingles.

Shingles typically lasts between two to six weeks and symptoms usually subside between two and four weeks. Most people get shingles only once, but it’s possible to get it two or more times. It’s important to note that not everyone who has had Chickenpox will develop Shingles.

What are the causes of Shingles?

Any factor that compromises your immune system, can trigger shingles:

• Stress
• Other illnesses or conditions
• Treatments like chemotherapy

It’s possible to have shingles more than once, but it’s very rare to get it more than twice.

What are the symptoms of Shingles?

The first signs that may indicate you have Shingles are:

• A general feeling of malaise
• Intense pain and tingling sensation in a particular area of your skin
• Fever (high temperature)
• Headache
• Chills
• Sensitivity to light

What is a Shingles rash?

A few days (2-3 days) after you experience the first symptoms, you may notice a blotchy red rash developing that wraps from the middle of the back to your breastbone. However, it can also appear anywhere on your body including your eyelids, face or genitals. The rash follows the path of the nerve where the virus has been dormant. The rash usually presents on one side of the torso only. If you notice it is on both sides, then it is unlikely to be Shingles.

This blotchy rash then develops into itchy fluid-filled blisters that eventually flatten, become yellowish in colour, dry out and scab. The skin can remain painful until the rash has gone and scabs may leave some slight scarring.

What is Shingles pain?

Pain is usually one of the first signs that may indicate you have shingles. The pain is usually localised in the affected area. The pain experienced can vary from individual to individual but it is generally constant, dull or burning; and the intensity of the pain can vary from being severe to mild. Also, it is notable that some people can experience pain without a rash ever developing.

When to get advice from a GP

You should contact your GP if you suspect you have Shingles and you:

• Haven’t had chickenpox before
• Have been exposed to someone who has chickenpox or shingles and you:
  • Are pregnant
  • Have a weakened immune system (the body’s natural defence system)
  • Are under 18 years old

If your GP is closed, phone 111.

Check if you qualify for FREE treatment with NHS Pharmacy First, without seeing your GP

You may qualify for treatment under the NHS Pharmacy First service, if you suspect you have shingles and you:

• Are 18 years or over

The NHS Pharmacy First service may not be suitable if:

Serious complications are suspected such as:

• Meningitis (neck stiffness, photophobia, mottled skin)
• Mastoiditis (pain, soreness, swelling, tenderness behind the affected ear(s))
• Brain abscess (severe headache, confusion or irritability, muscle weakness)
• Sinus thrombosis (headache behind or around the eyes)
• Facial nerve paralysis

Shingles affects the eyes

• Hutchinson’s sign — a rash on the tip, side, or root of the nose
• Visual symptoms
• Unexplained red eye

You are immunocompromised

• Shingles in severely immunosuppressed patient
• Shingles in immunosuppressed patients where the rash is severe, widespread or the patient is systemically unwell

There’s no cure for shingles, however, when identified early, shingles can be treated with prescription medications to shorten the infection and reduce the risk of complications. The NHS Pharmacy First service is available to all NowPatient users who are registered with the NHS in England. If you are exempt from paying for your prescriptions, the service and the treatments are provided free of charge. If you are not exempt from paying prescription charges, treatments are provided at the prevailing NHS prescription charge rate. There is no charge for consultations.

What NHS Pharmacy First treatments are available for Shingles?

Anti-viral treatments like aciclovir are very effective in reducing the intensity of pain and duration of Shingles. It can also help with reducing the chances of developing post-herpetic neuralgia (burning pain in nerves and skin). Treatment with aciclovir is most effective if started quickly.

How can I manage the symptoms of Shingles?

In addition to treating Shingles with antivirals like aciclovir, you can also treat the discomfort caused by shingles. Painkillers to ease discomfort caused by shingles. This includes:

• Paracetamol (over-the-counter)
• Ibuprofen (over the counter)
• Opioids (prescribed for severe pain)
• Antidepressants (prescribed for severe pain)

Other tips to manage the discomfort include:

• Use a cool damp cloth to soothe the skin and keep blisters clean
• Try calamine lotion to help relieve itching
• Keep the rash as clean and dry as possible
• Do not let dressings or plasters stick to the rash
• Do not use antibiotic cream – this slows healing
• Wear loose-fitting clothing

Should I avoid people if I have Shingles?

Always wash your hands after touching the blisters, as these are very infectious. In addition, during the infection, you should avoid:

• Pregnant women who have not had chickenpox
• Newborns or babies less than 1 month old (unless it’s your own baby)
• Immune-compromised people (weak immune system)
• People taking therapies including disease-modifying anti-rheumatic drugs (DMARDs, e.g. methotrexate) and biologic therapies (e.g. Adalimumab) or any other medication that reduces the immune system such as JAK-inhibitors, e.g. Baricitinib, Filgotinib, Tofacitinib and Upadacitinib

How can I prevent the spread of Shingles?

You can’t spread shingles to other people. However, people can catch chickenpox from you if they haven’t had it before. You are contagious until the last blister has dried and scabbed over. During the contagious phase, you should:

• Not go swimming
• Not play contact sports
• Not go work or school if your rash is weeping (oozing fluid) and can’t be covered
• Not share towels or flannels
• Avoid people who are at risk such as newborns, immunocompromised individuals, people taking immunocompromising drugs and pregnant women

What happens if I do not get treatment for Shingles?

Symptoms will persist for longer, there is a greater risk of post-herpetic neuralgia afterwards. The risk of complications is larger, such as blindness if the infection affects the face/eyes.

Is there a vaccine that can prevent Shingles?

Yes, the NHS recommends that adults turning 65, those aged 70 to 79 and those over 50 who are immunocompromised should be vaccinated.

The vaccine is called SHINGRIX and it is administered in two doses, two months apart. After vaccination, you may still develop Shingles, however, it will be milder and you will be less likely to get post-herpetic neuralgia.

What are the complications of Shingles?

Complications, although not common, can arise as a result of shingles. In fact, 1 in every 1000 cases of Shingles in adults over the age of 70, results in fatal complications. These complications are more likely if you have a compromised immune system, are taking immunocompromising drugs or are elderly.

Complications can include:

• Postherpetic neuralgia
• Eye problems
• Ramsay Hunt syndrome
• The rash becoming infected with bacteria
• White patches (a loss of pigment) or scarring in the area of the rash

Rare complications can include:

• Pneumonia (lungs)
• Encephalitis (brain)
• Transverse myelitis (spinal cord)
• Meningitis (brain, spinal cord)

Sources

• Mayo Clinic – Shingles, not just a band of blisters
• NHS Scotland – Shingles information page
• NHS – Shingles condition