Shingles
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Shingles key facts
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
Medical Disclaimer
NowPatient has taken all reasonable steps to ensure that all material is factually accurate, complete, and current. However, the knowledge and experience of a qualified healthcare professional should always be sought after instead of using the information on this page. Before taking any drug, you should always speak to your doctor or another qualified healthcare provider.
The information provided here about medications is subject to change and is not meant to include all uses, precautions, warnings, directions, drug interactions, allergic reactions, or negative effects. The absence of warnings or other information for a particular medication does not imply that the medication or medication combination is appropriate for all patients or for all possible purposes.
Service Guide
Everything you need to know about NHS Pharmacy First
What is NHS Pharmacy First?
What conditions do you treat with NHS Pharmacy First?
We assess and treat the following conditions:
- Sinusitis
- Sore throats
- Infected insect bites
- Impetigo
- Shingles
- Uncomplicated urinary tract infections in women
If treatments are prescribed, they are dispensed and delivered to your home or workplace from NowPatient’s online pharmacy.
Is this a safe service?
How will I know that the service is being provided by a trustworthy clinician?
Our clinicians are board-certified pharmacists who can also prescribe selected medications for six common treatable conditions, which is set out by the NHS. Our clinicians are registered with their respective regulatory bodies. For example, a pharmacist is registered with the General Pharmaceutical Council (GPhC). Each clinician undergoes an extensive background check including a disclosure and barring service check (DBS). In addition, they undergo a rigorous license verification process. When you book an appointment with one of our clinicians you will see their full name, license number, and any specialized credentials they have.
Is the service available in the United States and the United Kingdom?
No. At the moment, it is only available in England.
Can I use NowPatient’s NHS Pharmacy First feature if I live in Scotland, Wales or Northern Ireland?
This service is commissioned by NHS England and is only available to patients in England. You will not be able to use the feature if you live in Scotland, Wales, or Northern Ireland.
Do I need to pay for this service?
This is a FREE service for NHS-registered users. If you are prescribed medication at the end of your assessment and you are not exempt from NHS prescription charges, then you will need to pay a single NHS prescription charge, which is currently £9.90. If you are exempt from prescription charges, for example, if you are on Income Support or aged over 60, then you will not be charged.
How do I know if I qualify?
- Sore throats
- Sinusitis
- Infected insect bites
- Impetigo
- Shingles
- Uncomplicated urinary tract infections in women
What are the next steps, if I qualify?
Will you have access to my GP records?
Yes, as an NHS patient, our pharmacists will be able to access to your GP record including medications, observations, and investigations. This ensures we are able to assess and treat your condition safely and appropriately.
What happens during the remote video consultation?
During the consultation, the clinician will ask you a series of questions that will allow the clinician to diagnose your health condition and consider possible treatment options. At the end of the consultation, the clinician will decide if a treatment plan is a safe and appropriate option for you.
If it is, the clinician will discuss the various treatment options that may be available, so that you can jointly agree on the option that is most suited to you. Once you have jointly agreed on a treatment plan, the clinician will issue a prescription order which will be available in your ‘shopping cart’ at the end of the consultation.
Also, with your consent, the clinician may wish to inform your GP of the treatment that was prescribed. We recommend that you agree to this since your GP is responsible for your overall care and they should have a record of this consultation and medication prescribed. In addition, our clinician may take the opportunity to advise you on your overall health including advice on healthy living or stop smoking.
What happens at the end of the consultation?
At the end of the consultation, you will receive a notification which will summarise the outcome. It will also advise if any signposting to other NHS services were made or if referrals were made to your GP, along with any other advice that was given to you by the clinician.
If a GP referral letter was issued, you will be able to view a copy of this in the ‘My Documents’ section of your dashboard.
If you were prescribed a treatment plan, it will now be available in your shopping cart. When you go to your shopping cart, you will be able to checkout and make a payment or claim an exemption. Remember, you only make a payment If you are NOT exempt from NHS prescription charges. Once the checkout is complete, your prescription order will be sent to our NHS online pharmacy for processing.
What if the clinician does not prescribe a treatment?
We operate a safe and effective service. This means that our clinicians always exercise their clinical judgment when prescribing. Unfortunately, we do not operate a service where you can demand a certain medication. If you are not prescribed anything, then you will not be charged.
Will I get status updates for my order?
Yes. When you place an order with NowPatient, we will keep you fully updated with the status of your order. Every time the status of your order changes, you will be notified immediately. These notifications will appear in your ‘My Notifications’ section on your dashboard. You can click the notification and it will take you to your active orders screen which will give you a timeline overview of the progress of your order. This can also be accessed using the ‘My Orders’ quick action widget which is on your dashboard. Here, you can access active and past orders.
How will my order be delivered?
All orders are shipped in discreet and unmarked packaging. This means it is suitable for delivery wherever you require (home, work, or a neighbour). For thermo-sensitive orders (e.g. Insulin or weight loss injections) we use cold chain-validated packaging. Your parcel will normally receive an estimated delivery window from the courier on the day of delivery.
For your protection and safety, your first order can only be delivered to the address that is registered with the NHS. Future orders can be delivered to any other address, for example, your workplace.
Do you ship cold-chain or temperature sensitive products?
Yes. We use a specialist courier service for all thermo-sensitive deliveries. This is to ensure that cold chain integrity is always maintained and thus the product quality, safety and efficacy.
Learn more about how we handle the delivery of temperature sensitive products.
Where do you deliver?
We currently deliver to all postcodes in England. Some postcodes in rural areas may have a slightly longer delivery time.
When will my order arrive?
- Royal Mail Standard Tracked & Signed for Delivery for NHS prescriptions – 2/3 day delivery (normally 48 hours)
- DHL Express Tracked Delivery – 1/2 day delivery (normally 24 hours)
- Royal Mail Special Delivery – Next working day (Royal Mail Guaranteed before 1pm)
What should I do if my order has not arrived?
Delivery is normally made promptly after your dispatch notification is received. You can check the tracking details of your order in the ‘My Notifications’ section of your dashboard, at any point after dispatch.
Unfortunately, packages can sometimes get lost in the delivery system, if after 10 days you have not received your delivery, please contact us and we will do all we can to resolve the problem.
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NowPatient’s Pharmaceutical services in the UK are provided by Infohealth Limited trading as ‘Infohealth Pharmacy’.
Our dispensing pharmacy is regulated and authorized for internet sales by the General Pharmaceutical Council (GPhC), registration number 1036487. You can view our license credentials on the General Pharmaceutical Council website. Our superintendent pharmacist who is responsible for the safe and effective oversight of medicines supplies is Mr Amish Patel (Registration Number 2042705).
Medicines are not ordinary items of commerce. All medicines or healthcare product sales are made under the supervision of a registered pharmacist who is licensed by the GPhC. At all times, we endeavour to provide a professional and transparent service whose primary goal is to ensure that the best interests of the patient are served.
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