Herpes Zoster (Shingles)

What is herpes zoster? 

Herpes zoster (shingles) is caused by the reactivation of the varicella-zoster virus, which is the same virus that causes chickenpox. After a person has had chickenpox, the virus lies dormant in the nerves, and in some people, becomes reactivated at some point in their lives, resulting in an outbreak of herpes zoster.

Herpes zoster occurs in 1 million people each year in the U.S., and approximately one in every three people. People who received the chickenpox vaccine also have a small risk of herpes zoster. Herpes zoster is more common in people with a depressed immune system, and in people older than age 50.

The virus usually results in a painful rash or small blisters on a strip of skin anywhere on the body. On some occasions, even after the rash is gone, the pain may continue for a prolonged period of time, a complication called postherpetic neuralgia (PHN).

The incidence of herpes zoster occurring in children is low, but the risk of acquiring this disease increases with age. Children who have weakened immune systems may experience the same, or more severe, symptoms as adults. Children most at risk for herpes zoster are those who had chickenpox during the first year of life or whose mothers had chickenpox very late during pregnancy. 

What are the symptoms of herpes zoster?

Herpes zoster most often occurs on the trunk and buttocks. However, it may appear on the arms, legs, or face. The following are the most common symptoms of herpes zoster. However, each person may experience symptoms differently. Symptoms may include:

  • Skin hypersensitivity and pain in the area where the herpes zoster appears

  • Mild rash, which can appear up to five days after and first looks like small, red spots that turn into blisters

  • Blisters which turn yellow and dry

  • Rash which usually goes away in two to four weeks

  • Rash is usually localized to one side of the body

  • Fever, chills, headache, nausea 

  • PHN can cause pain for weeks, months, and rarely even years after the rash resolves 

The symptoms of herpes zoster may resemble other skin conditions. Always consult your doctor for a diagnosis.

How is herpes zoster diagnosed?

Diagnosis usually involves obtaining a medical history and performing a physical examination. Diagnosis may also include:

  • Skin scrapings. Gently scraping the blisters to determine if the virus is shingles or another virus.

  • Blood tests

What is the treatment for herpes zoster?

Immediate treatment with antiviral drugs may help lessen the duration and severity of some of the symptoms. These antiviral medications (acyclovir, famciclovir and valacyclovir) are more effective the sooner they are started. Medications like acetaminophen (Tylenol®) and ibuprofen (Advil®, Motrin®) may help alleviate some of the pain, but the disease has to run its course. Use of medication will be determined by your doctor based on factors including duration and severity of the symptoms.

How can I prevent herpes zoster?

The CDC recommends vaccination at age 60 for all individuals who have had chickenpox or the chickenpox vaccine. The vaccine (Zostavax®) is approved for use at age 50 as well, but current CDC guidelines do not recommend routine vaccination between 50 and 59 years old. The herpes zoster vaccine has been shown to reduce infections by one half, and to reduce PHN by two thirds.  

Learn more about shingles and the shingles vaccine at CHOP's Vaccine Education Center.

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