Shingles – Symptoms And Causes

Shingles, herpes zoster or zoster is a viral infection that appears as a painful rash. The varicella-zoster virus – the same virus responsible for chickenpox – causes it, and anyone who has contracted chickenpox before can get herpes zoster. This virus stays inactive in the body for many decades after getting chickenpox, typically in the cranial or spinal nerves.

When the virus reactivates as zoster, it travels along the nerves to the skin and causes rashes to erupt. While this infection is not life-threatening, it can be excruciating. The CDC (Centers for Disease Control and Prevention) claims that herpes zoster has been steadily increasing in the United States and that roughly one out of three Americans will develop the infection in their lifetime.

Vaccines can significantly minimize the risk of developing herpes zoster while prompt treatment can shorten the infection and mitigate the chances of further complications. Generally, the risk of contracting this infection increases as we age; hence, you should consider getting a vaccine if you are over 50.

Signs and Symptoms

Herpes zoster usually manifests as a row of blisters that wrap around the eye or one side of the torso, face, or neck. It usually appears unilaterally, meaning that it attacks one side of the body. However, a case report by Anne Louise Oaklander, MD, Ph.D., suggests that herpes zoster rashes may appear anywhere from the feet to the legs, buttocks, and even the genital area (Oaklander, Bowsher, Galer, Haanpää & Jensen, 2003).

Rashes tend to appear more frequently on the torso because this area of the body has at least 24 nerves capable of hosting the virus. In most patients, the sign that signals the onset of infection is the pain that accompanies the rash. Pain is among the first signs that most patients experience, roughly one to five days before the appearance of fluid-filled blisters.

In the days leading up to the rashes, patients may experience one or more flu-like symptoms, including:

  • Fever
  • Chills
  • Nausea
  • Headache

Numbness and a tingling sensation in the zones where the rash is about to develop may also occur. Some patients may experience localized pain but no rashes. The pain that comes with this infection is neuropathic, meaning that it originates from the nerves and may feel different from other kinds of pain.

Some patients describe the sensation as painful and numbing, with hypersensitive skin that is easily agitated by a gentle touch. In fact, the skin may become so sensitive that exposing the affected area to sunlight rouses a stabbing sensation.

Causes and Risk Factors

Varicella-zoster – the virus responsible for both herpes zoster and chickenpox – belongs to a group of viruses collectively called herpes viruses. This group also contains the viruses responsible for genital herpes and oral herpes (cold sores).

While you can develop herpes zoster after getting chickenpox, other viruses in this group, e.g., herpes simplex 1 (oral herpes) and herpes simplex 2 (genital herpes), do not necessarily increase the risk of getting zoster. The varicella-zoster virus stays inactive in the cranial or spinal nerves after chickenpox is over.

nausea shingles

Although the virus may reactivate by traveling along the nerves and erupting as fluid-filled blisters on the skin, the factors that trigger the reactivation are still unknown. However, reduced immunity is known to increase the risk of infection; hence, our likelihood of getting herpes zoster increases as we age. Other factors that increase the risk of getting this infection include:

  • Diabetes
  • Certain cancers like lymphoma and leukemia
  • Immunosuppressive medication, e.g., corticosteroids, prescribed for cancer patients, people straight from an organ transplant and people suffering from autoimmune conditions such as rheumatoid arthritis

According to recent research, genetics may influence your chances of getting herpes zoster. For instance, a person with first-degree relatives who have had zoster before is more likely to develop it than an individual whose first-degree relatives have no history of infection. Roughly, 44% of herpes zoster patients have family members who also develop it (Hernandez et al., 2011).

Does Stress Increase the Risk of Infection?

While some people claim to have heard stories of patients getting infected due to stressful occurrences, the current evidence is somewhat contradictory. Some studies portray stress as a possible risk factor (Lasserre et al., 2012), while others claim psychological stress is not a potential trigger.

In a 2015 study published in the Clinical Infectious Diseases Journal, the researchers reviewed over 39,000 medical records to determine whether zoster incidences increased after difficult life events. The researchers did not find any evidence suggesting that stress is a possible trigger (Harpaz, Leung, Brown & Zhou, 2014). If there is any relation between stress and zoster, it is perhaps not due to the stress itself but rather the immunity lowering effects of stress.

Treatment for Herpes Zoster

Although there is no cure for this infection, getting immediate treatment can speed up the healing process and mitigate the chances of developing complications.

Medication Options

Your doctor may prescribe a shingles cream and an antiviral drug to address the rashes and the pain. By far, the best cream for shingles is EMUAIDMAX® First Aid Ointment. This ointment can reduce the infection’s duration and severity, and is most effective when applied immediately after the rashes appear. If you are 50 years or older, consider getting a vaccine once the infection subsides.

Alternative Therapies

If you prefer home remedies before resorting to conventional medicine, try colloidal oatmeal baths to alleviate your itching temporarily. Wet compresses can also help soothe your skin symptoms.

Preventing Herpes Zoster

Shingrix, a recombinant zoster vaccine, has been the approved and preferred vaccine in the United States since 2017. Zostavax, an older vaccine, was discontinued on July 1, 2020, despite its safety. However, clinics and pharmacies can sell their existing stock before November 2020 or expiry, whichever comes first.

While it is impossible to transmit zoster from person-to-person, infected people can spread the varicella-zoster virus to people vulnerable to chickenpox. Since the virus typically spreads via direct contact with the fluid in open blisters, covering the affected area can reduce the risk of spreading the virus.

Also, until the rashes turn into scabs, an infected person can still spread the virus to other people. Zoster patients can prevent the spread of the virus by:

  • Covering their rashes
  • Washing their hands frequently
  • Not scratching the rashes


Harpaz, R., Leung, J., Brown, C., & Zhou, F. (2014). Psychological Stress as a Trigger for Herpes Zoster: Might the Conventional Wisdom Be Wrong?. Clinical Infectious Diseases, 60(5), 781-785. doi: 10.1093/cid/ciu889

Hernandez, P., Javed, S., Mendoza, N., Lapolla, W., Hicks, L., & Tyring, S. (2011). Family history and herpes zoster risk in the era of shingles vaccination. Journal Of Clinical Virology, 52(4), 344-348. doi: 10.1016/j.jcv.2011.08.014

Lasserre, A., Blaizeau, F., Gorwood, P., Bloch, K., Chauvin, P., & Liard, F. et al. (2012). Herpes zoster: Family history and psychological stress—Case–control study. Journal Of Clinical Virology, 55(2), 153-157. doi: 10.1016/j.jcv.2012.06.020

Oaklander, A., Bowsher, D., Galer, B., Haanpää, M., & Jensen, M. (2003). Herpes zoster itch: preliminary epidemiologic data. The Journal Of Pain, 4(6), 338-343. doi: 10.1016/s1526-5900(03)00637-0

Scroll to Top