How Shingles Affects Your Body Now…and Later
Shingles, a.k.a. herpes zoster, is a lot more than a quick—albeit irritating—rash that strikes senior citizens. In fact, about 120,000 of the 1.2 million folks who get shingles each year develop nerve pain that can last from a couple of months to years. And anyone at any age who’s had the chickenpox or the chickenpox vaccine is vulnerable. That noted, “risk for the infection is higher starting at 50, which is why the vaccine is recommended for all people starting at that age,” says Sonja Rosen, M.D., chief of geriatric medicine at Cedars-Sinai in Beverly Hills, CA. Here, what you need to know about the now—and later—of shingles.
First Signs: Burning, Tingling, or Numbness of the Skin
“Usually, a small area of skin may burn, tingle, itch or simply feel very sensitive before any rash occurs,” says Alina G. Bridges, D.O., an associate professor of dermatology at the Mayo Clinic in Rochester, MN. This sensation can last roughly one to three days prior to skin lesions appearing—and the discomfort can be intense. “It’s often mistaken for appendicitis, a heart attack or severe headache,” says Dr. Bridges.
Week One: Rash
While a shingles rash can develop anywhere on the face or body, it most often develops exactly where the initial sensation was. (The rash follows the line of nerves in that area.) In rare cases, the rash may mirror the chickenpox rash and become more widespread. No matter where the rash appears, if you suspect shingles, see a healthcare professional ASAP. “Antiviral medications to treat shingles are most effective when started within 72 hours of the first appearance of the rash,” says Dr. Bridges, who notes that meds can shorten the course of the disease.
Week One: Hearing, Balance or Eye Issues
For those whose shingles rash is in or around the eyes, forehead, nose or ear, risk of complications is high. For instance, if shingles has caused your eye to be red or swollen, you’re at risk of a painful eye infection or vision loss. In addition, shingles infections within—or near—the ear can cause Ramsay Hunt syndrome, where facial nerve damage can bring about hearing or balance issues and even paralysis on the affected side of the face. Other early symptoms to tune into include: Ear pain or ringing, difficulty shutting one eye, a loss of taste and dry mouth/dry eye.
Week One: Stroke and Heart Attack Risk
While the risk of a post-shingles stroke is highest amongst those whose shingles outbreak impacted their eyes, overall, people with shingles have a 2.4-fold increased risk of stroke and 1.7-fold increased chance of heart attack during the first week after getting diagnosed, found a report featured in the journal PLOS Medicine. While one’s risk gradually lessened after that, it takes about 27 weeks to completely roll the risk back to baseline. It’s thought that shingles-induced inflammation may lead to blood clots that could then, in turn, cause a stroke or heart attack. Adding to the risk: A spike in blood pressure due to pain and stress associated with shingles.
Week Two: Flu-like Symptoms
Fever, fatigue, chills, an upset stomach: All of these can be concurring signs of shingles. “Flu-like symptoms can precede—or occur with—the rash,” says Dr. Bridges. “But the rash can also develop a few days after flu-like symptoms. The timeline can vary.” Another flu-like symptom associated with shingles: headache. This is especially true for those with shingles on their face or scalp. And “when shingles affects the eyeball, this can cause blurry vision, eye redness, light sensitivity and pain on the surface of the eye,” says Nakul Shekhawat, M.D., an ophthalmologist and cornea specialist at the Wilmer Eye Institute, Johns Hopkins University School of Medicine in Baltimore.
Week Two: Blisters
Soon, the rash morphs into small groupings of super-sensitive, fluid-filled blisters. Often times, the symptoms of shingles are distinctive enough to make a diagnosis sans test. However, if your blisters mimic another condition like herpes simplex—or if you’re outside the common demographic, “your healthcare provider may swab a bit of fluid from a blister and send it out for a polymerase chain reaction test, or PCR,” says Dr. Bridges. Of note: The fluid inside of the blisters contains the virus that causes shingles—and chickenpox. That means, if a person who has never had chickenpox or received the vaccine comes in direct contact with a shingles blister, they could contract chickenpox.
Week Two: Possible Infection
“It is important to wash your hands, keep the shingles rash and blisters clean and try not to scratch. Scratching blisters can cause infection,” says Dr. Bridges. Cellulitis (a bacterial infection of the deeper layers of the skin) and impetigo (an infection of the outer layers of the skin) are two secondary skin infections associated with shingles. Folks with a compromised immune system are far more likely to also develop these types of infections. If your shingles rash swells, become pus-filled or weeps, these are signs that you have, in fact, gotten a bacterial infection. “A topical antibiotic may be prescribed to apply to lesions to treat an infection,” says Dr. Bridges, noting that a topical can also help prevent infection.
Week Three: More Blisters?
If your blisters persist for more than two weeks, this is a red flag that your immune system is not functioning as it should. You should visit your healthcare professional again. And remember, if your blisters appear on your face at any time, quickly see a healthcare professional. Just like the rash, when blisters develop near or in the eye or the ear, it can cause lasting damage, such as hearing loss, blindness, facial paralysis and brain swelling, according to The National Institute on Aging.
Week Four: Healing Scabs
Most people with shingles do not develop a blister-related infection. Instead, scabs appear once the blisters dry up and crust over. That typically occurs seven to 10 days post-blistery outbreak, according to the Centers for Disease Control and Prevention. It’s important to remember that until scabs appear, your blisters contain the virus, which can cause others to catch the chickenpox. It’s also important to continue to wash the area with a fragrance-free cleanser daily until the rash, blisters and scabs are completely clear. Within a month, your skin’s appearance will most likely return to normal, though some people are left with darker or lighter spots where the shingles rash occurred.
Month Two to Three: Lingering Itch
The lasting itch one can experience once the shingles rash clears is called postherpetic itch and it most commonly develops on the face and on skin that’s already suffered sensory loss. Translations: Your skin is likely already feeling numb there. And since individuals are more likely to scratch numb skin too long and too vigorously, it’s important to turn to your healthcare provider for advice. He or she will likely suggest topical local anesthetics to help quell the urge to itch.
Month Three to Multiple Years: Long-term Nerve Pain
Most people’s pain decreases within two to three months, but for some the pain lingers longer. That persistent pain, called postherpetic neuralgia, is the most common complication of shingles, impacting up to 18% of folks with the infection. PHN develops when nerve fibers are damaged at the site of the shingles rash. The pain may be constant or intermittent, moderate, severe or even incapacitating—and it may last for months or even years. “It’s experienced as burning, itching, a stabbing pain or an altered sensation,” says Dr. Rosen. While anyone can suffer with post herpetic neuralgia, your risk increases with age and with a history of chronic illness, such as asthma or diabetes.
Year Five: Chronic or Recurrent Eye Disease
When shingles (herpes zoster) impacts the eyes it’s called herpes zoster ophthalmicus, or HZO. And according to a report in the journal Ophthalmology, 25% of patients experience chronic or recurrent eye disease within five years of HZO. “Although most patients with HZO do not experience recurrence, it is important for patients to remain vigilant for recurrences due to potential for long-term damage to their eyes,” says Dr. Shekhawat. Recurrent HZO can cause severe dry eye, corneal nerve damage and inflammation and scarring on the inside of the eye, “which can damage vision and cause elevation of intraocular pressure leading to glaucoma,” says Dr. Shekhawat.
How Many People Are Diagnosed With Shingles Annually? Ophthalmology. 2018. “Herpes Zoster Eye Disease: New Ways to Combat an Old Foe?” aaojournal.org/article/S0161-6420(18)31918-3/pdf
Shingles and Chickenpox: How They’re Related: Centers for Disease Control and Prevention. 2019. “Shingles: Signs & Symptoms.” cdc.gov/shingles/about/symptoms.html
Complications of Shingles: National Institute of Neurological Disorders and Stroke. 2015. “Shingles: Hope Through Research.” ninds.nih.gov/disorders/patient-caregiver-education/hope-through-research/shingles-hope-through-research#3223_11
When Shingles Impact Your Ear: Mayo Clinic. 2019. “Ramsay Hunt syndrome.” mayoclinic.org/diseases-conditions/ramsay-hunt-syndrome/symptoms-causes/syc-20351783
More About Shingles Blisters: Merck Manual Consumer Version. 2020. “Shingles.” merckmanuals.com/home/infections/herpesvirus-infections/shingles?query=Herpes%20Zoster
Is Shingles Contagious? Centers for Disease Control and Prevention. 2019. “Shingles: Transmission.” cdc.gov/shingles/about/transmission.html
It’s Important to Act Fast: National Institute on Aging. 2018. “Shingles.” nia.nih.gov/health/shingles
Shingles’ Lingering Effects on the Heart: PLOS Medicine. 2015. “Acute Cardiovascular Events after Herpes Zoster: A Self-Controlled Case Series Analysis in Vaccinated and Unvaccinated Older Residents of the United States.” journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001919
Caring for Your Rash and Blisters: Kaiser Permanente. 2020. “Shingles: Care Instructions.” healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.shingles-care-instructions.uh3267
What Will Your Skin Look Like After? Harvard Medical School. 2019. “Shingles (Herpes Zoster)” health.harvard.edu/a_to_z/shingles-herpes-zoster-a-to-z
Your Postherpetic Neuralgia Need-to-know: Centers for Disease Control and Prevention. 2019. “Shingles: Complications.” cdc.gov/shingles/about/complications.html
Who’s Most at Risk for Extended Pain? Neurology. 2016. “Quantification of risk factors for postherpetic neuralgia in herpes zoster patients: A cohort study.” ncbi.nlm.nih.gov/pmc/articles/PMC4932239/
What About the Itch That Won’t Quit? Seminars in Cutaneous Medicine and Surgery. 2011. “Neuropathic Itch.” rsds.org/wp-content/uploads/2014/12/Neuropathic-itch.pdf
Long-term Impact on the Eyes: Ophthalmology. 2015. “Epidemiology of Herpes Zoster Ophthalmicus: Recurrence and Chronicity.” aaojournal.org/article/S0161-6420(16)00342-0/fulltext