Shingles (Herpes Zoster) Quiz
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Rashes
Loss of sensation
Affected area of skin has stinging or tingling
Tingling
Chest pain feels like a numbing pain
Headaches with sharp, electrifying pain
Redness of the skin
Not seeing your symptoms? No worries!
What is Shingles (Herpes Zoster)?
This disease is caused by the Varicella (or chickenpox) virus reactivating. It can be triggered by stress, aging, or a weakened immune system.
Typical Symptoms of Shingles (Herpes Zoster)
- Pain in the region, followed by red spots and blisters 2-3 days later
- Symptoms started with lower back pain on one side only
- Small, painful blisters
- I am taking or have taken oral diabetes medication
- Taking steroids
- Multiple areas of skin redness or red spots
- Skin problem on the chest, tummy or back
- Lower back pain that improves with physical activity
Diagnostic Questions for Shingles (Herpes Zoster)
Your doctor may ask these questions to check for this disease:
- Did you get red spots and blisters 2-3 days after the pain started?
- Did you have lower back pain on one side only when your symptoms started?
- Do you have painful blisters on your skin?
- Have you taken oral medication for diabetes?
- Are you currently taking steroids?
Treatment of Shingles (Herpes Zoster)
There is no cure for shingles, but starting medications early can help speed up recovery and prevent future issues like nerve pain. Medications should ideally be started within 72 hours of your first symptom. The doctor may also prescribe painkillers.
Reviewed By:
Unnati Patel, MD, MSc (Family Medicine)
Dr.Patel serves as Center Medical Director and a Primary Care Physician at Oak Street Health in Arizona. She graduated from the Zhejiang University School of Medicine prior to working in clinical research focused on preventive medicine at the University of Illinois and the University of Nevada. Dr. Patel earned her MSc in Global Health from Georgetown University, during which she worked with the WHO in Sierra Leone and Save the Children in Washington, D.C. She went on to complete her Family Medicine residency in Chicago at Norwegian American Hospital before completing a fellowship in Leadership in Value-based Care in conjunction with the Northwestern University Kellogg School of Management, where she earned her MBA. Dr. Patel’s interests include health tech and teaching medical students and she currently serves as Clinical Associate Professor at the University of Arizona School of Medicine.
Yoshinori Abe, MD (Internal Medicine)
Dr. Abe graduated from The University of Tokyo School of Medicine in 2015. He completed his residency at the Tokyo Metropolitan Health and Longevity Medical Center. He co-founded Ubie, Inc. in May 2017, where he currently serves as CEO & product owner at Ubie. Since December 2019, he has been a member of the Special Committee for Activation of Research in Emergency AI of the Japanese Association for Acute Medicine. | | Dr. Abe has been elected in the 2020 Forbes 30 Under 30 Asia Healthcare & Science category.
Content updated on Apr 4, 2024
Following the Medical Content Editorial Policy
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Symptoms Related to Shingles (Herpes Zoster)
Diseases Related to Shingles (Herpes Zoster)
FAQs
Q.
Is That Rash Shingles? Early Signs and Your Immediate Next Steps
A.
There are several factors to consider. Shingles often starts with burning, tingling, or sharp pain on one side that is followed by a stripe of fluid-filled blisters, and early antiviral treatment works best within 72 hours, so call a clinician quickly if you suspect it. Seek urgent care if the rash involves your eye, pain is severe, you are over 50, or your immune system is weakened; vaccination for adults 50+ and some younger immunocompromised people can prevent shingles and complications. See the complete guidance, including how to care for the rash and reduce spread, below.
References:
* Patel M, Badri T, Dalia T. Herpes Zoster (Shingles) Clinical Update. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. PMID: 30855850. Available from: pubmed.ncbi.nlm.nih.gov/30855850/
* Kwon B, Kim J, Kim J. Herpes zoster: A review of the virus and the disease. J Korean Med Sci. 2022 Dec 12;37(49):e366. PMID: 36495537. Available from: pubmed.ncbi.nlm.nih.gov/36495537/
* Dooling KL, Guo A, Gounder PP, et al. Herpes Zoster: Diagnosis and Management. Am Fam Physician. 2020 Jun 1;101(11):689-696. PMID: 32470077. Available from: pubmed.ncbi.nlm.nih.gov/32470077/
* Chen N, Li Y, Peng L, et al. Management of herpes zoster and postherpetic neuralgia: an evidence-based guideline for clinical practice. J Pain Res. 2020 Feb 28;13:405-415. PMID: 32165997. Available from: pubmed.ncbi.nlm.nih.gov/32165997/
* Werner RN, Nikkels AF, Marinović B, et al. European Academy of Dermatology and Venereology guideline for the management of herpes zoster. J Eur Acad Dermatol Venereol. 2017 Jan;31(1):9-32. PMID: 27921200. Available from: pubmed.ncbi.nlm.nih.gov/27921200/
Q.
Is It Shingles? Why Your Skin Is Burning & Medically Approved Next Steps
A.
Burning, tingling, or painfully sensitive skin on one side that soon forms a stripe of fluid filled blisters is often shingles, so call a doctor promptly because starting prescription antivirals within 72 hours offers the best chance to shorten illness and prevent complications. There are several factors to consider, including urgent signs like rash or pain near the eye, severe or spreading pain, or a weakened immune system, along with home care tips, when to limit contact with others, and vaccine options, see below for complete guidance that could change your next steps.
References:
* Lal P, Kumar M, Gupta L. Shingles: Current concepts in epidemiology, diagnosis, and management. J Dermatol. 2023 Oct;50(10):1343-1351. doi: 10.1007/s00438-023-02102-1. Epub 2023 Aug 16. PMID: 37587289.
* Gbadamosi KA, Ifegwu CO, Aiyeola A, Atoyebi OA, Olayemi AA, Onakomaiya O, Olubadejo OJ, Salako BL. Diagnosis and Management of Herpes Zoster. J Clin Med. 2022 May 11;11(10):2683. doi: 10.3390/jcm11102683. PMID: 35628807; PMCID: PMC9144412.
* Lee WH, Chu CH, Kim WJ, Lee MG, Lee YB, Choi YS, Kim HS, Ahn J, Kim JS, Park CW. Clinical Practice Guidelines for the Management of Herpes Zoster. J Korean Med Sci. 2022 Sep 12;37(36):e253. doi: 10.3346/jkms.2022.37.e253. PMID: 36098000; PMCID: PMC9465719.
* Cohen SK, Kim K, Patel Z, Varga G, Prystowsky JH. Postherpetic Neuralgia: Pathogenesis, Diagnosis, and Management. Clin Ther. 2023 Dec;45(12):e223-e234. doi: 10.1016/j.clinthera.2023.08.003. Epub 2023 Oct 9. PMID: 37821360.
* Dworkin RH, Johnson RW, Bhagavathula SN, McDermott MP, Smith MJ, Bierman JN, Harding AE, Backonja M, Burger AJ, Ellis GE, Irving GA, Kalso E, Kamp J, Levin MN, Nalamachu S, Schmader KE, Wallace MS, Widerstrom-Noga E. Herpes zoster and postherpetic neuralgia: a review of current evidence with recommendations for prevention and management. J Pain. 2020 Jan;21(1-2):1-10. doi: 10.1016/j.jpain.2019.07.009. Epub 2019 Jul 25. PMID: 31357065.
Q.
Shingles Rash? Why Your Skin Is Burning & Medical Steps for Relief
A.
A shingles rash often starts with burning, tingling, or sharp nerve pain followed by a one sided, band like cluster of blisters; starting antiviral treatment within 72 hours can reduce pain, shorten the illness, and lower the risk of complications like postherpetic neuralgia. There are several factors to consider; see below to understand urgent red flags like eye or facial involvement or a weakened immune system, how contagiousness works, and practical steps for pain relief, home care, prevention, and next steps to take with a doctor.
References:
* Dooling KL, Guo A, Patel M, et al. Shingles (Herpes Zoster). N Engl J Med. 2022 Aug 4;387(5):446-454.
* Perrault M, Boivin M, Rinfret S, et al. Acute Herpes Zoster: Current Best Practices and Challenges. Drugs Aging. 2023 Nov;40(11):987-995.
* Alper BS, Cheung DS, Ullman R, et al. Treatment of Acute Herpes Zoster: A Systematic Review. JAMA Intern Med. 2019 Jun 1;179(6):830-839.
* Pothiawala S, Lim KH, Sivanasan N, et al. Postherpetic neuralgia: a comprehensive review. Postgrad Med J. 2023 Mar;99(1169):231-237.
* Kim S, Kim SJ, Heo YM, et al. The Pathophysiology and Treatment of Herpes Zoster-Related Pain. Ann Palliat Med. 2023 Mar;12(3):477-488.
Q.
Skin on Fire? Why Shingles Attacks Your Nerves & How to Heal
A.
Shingles is a reactivation of the chickenpox virus that inflames a single nerve and the skin it supplies, causing burning, stabbing, or electric pain that often starts before a one-sided blistering rash. Starting antiviral medication within 72 hours can shorten illness and lower risks like postherpetic neuralgia and eye involvement, and vaccination after age 50 reduces your chance of shingles. There are several factors to consider for urgent symptoms, pain control, self-care, and who should seek immediate care; see below for the complete guidance and next steps.
References:
* Gershon, A. A., Breuer, J., White, M. H., Werzberger, A., Steinberg, S. P., & Oxman, M. N. (2015). Varicella-zoster virus infection. *Nature Reviews Disease Primers*, *1*(1), 1-19. doi: 10.1038/nrdp.2015.6.
* Kuang, C., Jiang, Z., Yu, Y., Song, Y., Shen, C., Lin, X., ... & Fu, S. (2022). Herpes Zoster: Pathogenesis, Clinical Manifestations, Treatments, and Advances in Vaccine Development. *Viruses*, *14*(12), 2735. doi: 10.3390/v14122735.
* Werner, R. N., Niesen, A., & Bachmann, C. J. (2020). Therapeutic management of herpes zoster and postherpetic neuralgia. *Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG*, *18*(4), 302-313. doi: 10.1111/ddg.14088.
* Argoff, C. E., Albrecht, P. J., & Xiang, Q. (2018). The Pathophysiology and Treatment of Postherpetic Neuralgia: A Review of Current Evidence. *Pain and Therapy*, *7*(1), 1-15. doi: 10.1007/s40122-017-0091-x.
* Gilden, D., Cohrs, R. J., & Mahalingam, R. (2021). Neurologic Complications of Varicella Zoster Virus Infection. *Current Neurology and Neuroscience Reports*, *21*(9), 48. doi: 10.1007/s11910-021-01140-5.
Q.
Shingles in Women 30-45: Early Signs & Crucial Next Steps
A.
Shingles can affect women 30 to 45, often starting with one sided burning, tingling, or sharp pain 1 to 5 days before a stripe of painful, fluid filled blisters appears, sometimes with mild fever, fatigue, or headache. If you suspect it, contact a clinician promptly because antivirals work best within 72 hours of rash onset; seek urgent care for any facial or eye symptoms, keep the rash clean and dry, and avoid contact with pregnant people who have not had chickenpox, newborns, and immunocompromised individuals. There are several factors to consider, and key nuances like triggers, pain control options, and when to vaccinate can affect your plan; see below for important details that can change your next steps.
References:
* Dooling J, Guo A, Gounder C, de St Phalle B, Marin M. Herpes Zoster: A Clinical Update. Am Fam Physician. 2018 Nov 15;98(10):650-658. PMID: 30423145.
* Kawai K, Yawn BP, Wollan PC, White R. Herpes Zoster: A Review of Current Approaches to Prevention and Treatment. P T. 2020 Feb;45(2):98-111. PMID: 32095147.
* Forbes HJ, Jeziorska M, White R, Yawn BP. Management of herpes zoster (shingles) and postherpetic neuralgia. J Am Acad Dermatol. 2019 Dec;81(6):1227-1240. PMID: 31279025.
* Tyring SK, Kim J. Diagnosis and Treatment of Herpes Zoster. Am J Med. 2018 Dec;131 Suppl 12:14S-23S. PMID: 30454625.
* Aman W, Tsyba N, Tsyba N. Atypical presentations of herpes zoster: a review. World J Clin Cases. 2017 Jun 16;5(6):171-176. doi: 10.12998/wjcc.v5.i6.171. PMID: 28670597; PMCID: PMC5468305.
Q.
Early Shingles in Women: Spotting the First Warning Signs
A.
Early shingles in women often begins with one-sided tingling, burning, or aching in a narrow band of skin, sometimes with subtle redness, fatigue, or a low fever before any rash appears; seek urgent care if symptoms involve the eye, forehead, or nose. Starting antivirals within 72 hours can shorten illness and lower the risk of long-lasting nerve pain, and knowing your risk factors and when to call a doctor can influence your next steps; there are several factors to consider, so see below for key warning patterns, common pitfalls, and what to do next.
References:
* Tsai CT, Lo HM, Ho JH. Clinical Characteristics of Herpes Zoster in Different Age Groups and Sexes: A Retrospective Study. J Med Sci (Taipei). 2022 Nov 22;38(6):325-332. https://pubmed.ncbi.nlm.nih.gov/36418721/
* Di Tizio T, Lanna C, Monteleone G, Nisi G, Calzavara-Pinton P, Del Giglio M, Patrì A, Oranges T, D'Erme AM, Di Zazzo R, Fimiani M, Romanelli M, Greco A, Potenza C, Coda V, Dattola A, Pellacani G, Piaserico S, Gualtieri L, Costanzo A, Cameli N, Talamonti M, Mazzatenta C. Herpes Zoster: An Update on the Pathogenesis, Diagnosis and Management. Dermatol Ther. 2023 Jan;36(1):e15967. https://pubmed.ncbi.nlm.nih.gov/36474163/
* Dooling KL, Guo A, Gounder P, Amin-Ahmed R, Tepper NK, Dooling KL. Diagnosis and Management of Herpes Zoster. Infect Dis Clin North Am. 2020 Jun;34(2):237-248. https://pubmed.ncbi.nlm.nih.gov/32360341/
* Gnann JW, Whitley RJ. Herpes Zoster. JAMA. 2018 Mar 20;319(11):1738-1748. https://pubmed.ncbi.nlm.nih.gov/29558514/
* Yawn BP, Gilden D. The burden of herpes zoster: a review of the literature. Epidemiol Infect. 2019 Jun;147:e119. https://pubmed.ncbi.nlm.nih.gov/31084666/
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1References
Hayward K, Cline A, Stephens A, Street L. Management of herpes zoster (shingles) during pregnancy. J Obstet Gynaecol. 2018 Oct;38(7):887-894. doi: 10.1080/01443615.2018.1446419. Epub 2018 Mar 22. PMID: 29565203.
https://www.tandfonline.com/doi/full/10.1080/01443615.2018.1446419Bolton L. Herpes Zoster (Shingles). Wounds. 2018 May;30(5):144-146. PMID: 29847305.
https://www.hmpgloballearningnetwork.com/site/wounds/article/herpes-zoster-shinglesHerpes Zoster (Shingles) Patient-Centered Wound Outcomes: A Literature Review. Adv Skin Wound Care. 2021 May 1;34(5):1. doi: 10.1097/01.ASW.0000741896.24399.43. PMID: 33852468.
https://journals.lww.com/aswcjournal/Citation/2021/05000/Herpes_Zoster__Shingles__Patient_Centered_Wound.14.aspx