Shingles

Also called Herpes zoster

Chickenpox virus reactivating along a nerve. Treatment within 72 hours substantially reduces the risk of lasting pain.

What it is

If you have had chickenpox, the virus never leaves. It lies dormant in nerve tissue, and years later it can reactivate as shingles, usually when the immune system is under strain or simply older.

Around one in four people will get shingles in their lifetime. It causes a painful rash in a band on one side of the body, following the territory of a single nerve.

The reason this entry emphasises timing: antiviral treatment started within 72 hours of the rash appearing reduces the severity and, importantly, reduces the risk of post-herpetic neuralgia, which is nerve pain that can last months or years.

There is a free NHS vaccination programme, and uptake is lower than it should be.

Signs you might notice

Pain, burning, tingling or itching in a band on one side, often for a few days before anything is visible.

Then a rash of blisters, in that same band, never crossing the midline.

Fever and feeling unwell.

Shingles affecting the eye or the tip of the nose is an ophthalmic emergency and can threaten sight.

Shingles affecting the ear with facial weakness is Ramsay Hunt syndrome and needs urgent treatment.

How it can affect day-to-day life

Post-herpetic neuralgia is the complication that changes lives. Persistent burning nerve pain in the affected area, sometimes so severe that clothing is intolerable, and it is much harder to treat than to prevent.

Risk rises steeply with age, which is exactly the argument for vaccination and for early antivirals.

In care settings, shingles is infectious to people who have never had chickenpox or been vaccinated, through contact with the fluid in the blisters. Covering the rash is the practical measure.

Supporting someone well

Get antivirals started within 72 hours. Do not wait for a routine appointment: this is a same-day matter.

Treat pain properly and early, including nerve pain agents where indicated. Under-treating early pain is associated with worse persistent pain later.

Keep the rash covered, and keep the person away from anyone pregnant, any newborn, and anyone immunosuppressed until the blisters have crusted.

Take the vaccination when offered. The NHS programme covers specific age groups and immunosuppressed adults, and eligibility has been widening.

Any eye involvement, or facial weakness, needs same-day specialist assessment.

Where to get help

A GP or pharmacist, same day, for suspected shingles.

Eye involvement is an emergency: go to an eye casualty or A and E.

Ask about the shingles vaccination if you are approaching or within an eligible age group.