Shingles
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Shingles (Herpes Zoster)
What shingles is, how the rash progresses, why treatment is time-sensitive, the complications worth knowing about, and who can have the vaccine.
Part of the Access Doctor Conditions Library.
Shingles treatment is time-sensitive. Antiviral tablets work best started within three days of the rash appearing. If you think you have shingles, arrange assessment today rather than waiting to see how it develops — and contact 111 or your GP urgently if the rash is near an eye or on the nose, if you are pregnant, if you have a weakened immune system, or if you are under 18.
Key fact: Shingles is not a new infection. It is the chickenpox virus — varicella zoster — reactivating from nerve tissue years or decades later, which is why the rash appears in a band on one side of the body and why pain often arrives before anything is visible. Around one in four people will have shingles at some point.
What shingles is
Shingles, or herpes zoster, is caused by the reactivation of varicella zoster virus — the virus that causes chickenpox. After chickenpox resolves, the virus does not leave the body; it lies dormant in nerve tissue near the spinal cord. Years later, usually when immunity dips with age, illness or treatment, it can travel back down a single nerve to the skin.
That route explains the characteristic appearance. Because the virus travels along one nerve, the rash appears in a band (a dermatome) on one side of the body only, most often on the chest, abdomen or back, and stops at the midline. It also explains why pain, tingling or burning often precedes the rash by a day or three: the nerve is affected before the skin is.
You cannot catch shingles from someone. Shingles comes from a virus you already carry. What can happen is that someone who has never had chickenpox or the chickenpox vaccine catches chickenpox from contact with shingles blister fluid — which is why certain contacts should be avoided while the rash is weeping.
Symptoms and how the rash progresses
Shingles follows a recognisable sequence, and knowing it helps you act inside the treatment window.
| Stage | Timing | What happens |
|---|---|---|
| Before the rash | 1–3 days | Burning, tingling, itching or aching in a band of skin; sometimes headache, fatigue or feeling generally unwell. Pain can be mistaken for a strain, sciatica or even a cardiac or abdominal problem depending on site |
| Rash appears | Day 1–3 | Red blotches on one side, in a band, which develop into fluid-filled blisters |
| Blistering | Day 3–7 | Blisters may continue to appear for several days and can ooze — the infectious phase |
| Crusting | Day 7–10 | Blisters dry and scab over; no longer infectious once fully crusted |
| Healing | 2–4 weeks | Skin heals, sometimes with discolouration or scarring. Nerve pain can persist beyond this |
Our stage-by-stage guide covers the sequence in more detail, including how to tell shingles pain from the other things it imitates before the rash arrives.
Who gets it, and why
Age
The most important factor. Immunity to varicella zoster wanes with age, and both incidence and severity rise substantially after 50.
Weakened immunity
Blood cancers, HIV, chemotherapy, systemic steroids, immunosuppressive medicines and recent transplant all increase risk and severity.
Physical or emotional stress
Frequently reported before an episode, alongside intercurrent illness and periods of poor sleep.
Previous chickenpox
A prerequisite. Anyone who has had chickenpox carries the dormant virus and can develop shingles.
Treatment and the three-day window
Antiviral tablets do not eliminate the virus, but started early they shorten the episode, reduce the severity of the rash, and reduce the risk of prolonged nerve pain afterwards. They work best within three days of the rash appearing, which is why shingles is one of the few conditions where the timing of the appointment matters as much as the diagnosis.
Antivirals are particularly recommended where there is moderate or severe pain or rash, where the rash is anywhere other than the trunk, in older adults, and in anyone with weakened immunity. Access Doctor supplies aciclovir and valaciclovir for shingles; the doses and differences are set out in antivirals for shingles.
Pain relief matters as much as antivirals. Paracetamol and ibuprofen are the starting point, and shingles pain is nerve pain, so it may need more than that — medicines such as amitriptyline, gabapentin or pregabalin are used where pain is significant. Treating pain well early may reduce the chance of it persisting.
Self-care that helps: keep the rash clean and dry, wear loose cotton clothing, use a cool compress several times a day, and cover weeping blisters with a non-sticky dressing. Avoid adhesive dressings, antibiotic creams and scratching. Calamine or a simple emollient can ease itch.
When shingles is urgent
Contact your GP urgently or call 111 today if: the rash is near or around an eye, on the tip or side of the nose, or on the forehead; your vision changes or the eye becomes red or painful; the rash affects the ear, or you develop facial weakness, hearing change or dizziness; you are pregnant or breastfeeding with a rash on the breast; you have a weakened immune system; the rash is widespread or on both sides; or you are under 18. Go to A&E or call 999 if you are confused, have a severe headache with neck stiffness, or are very unwell.
Two situations deserve naming. Ophthalmic shingles — involving the eye or the nerve supplying it — can threaten sight and needs same-day assessment; a rash on the tip of the nose is a recognised warning sign. Ramsay Hunt syndrome, where the virus affects the facial nerve, causes ear pain with facial weakness and sometimes hearing loss or vertigo, and also needs urgent treatment.
Is it contagious?
Not in the way people assume. You cannot give someone shingles. You can pass varicella zoster to someone who has never had chickenpox or been vaccinated, and they would develop chickenpox, not shingles. Transmission requires contact with fluid from the blisters, so the infectious period runs from when blisters appear until they have all crusted over.
While the rash is weeping, avoid contact with anyone who has not had chickenpox — particularly pregnant women without immunity, babies under one month old, and anyone immunosuppressed. Keeping the rash covered substantially reduces the risk. Our guide to shingles and contagiousness covers work, school and family contact in practical terms.
Complications
| Complication | What it is |
|---|---|
| Postherpetic neuralgia | Nerve pain persisting after the rash heals, typically defined as pain continuing three months or more from onset. The most common complication, and more likely with age and with severe initial pain — see postherpetic neuralgia |
| Eye involvement | Inflammation of structures in and around the eye, which can threaten vision and needs urgent assessment — see shingles on the face and eye |
| Ramsay Hunt syndrome | Facial nerve involvement causing ear pain, facial weakness and sometimes hearing or balance symptoms |
| Skin infection | Bacterial infection of the rash, suggested by spreading redness, increasing pain or pus |
| Scarring and pigment change | More likely where blisters were extensive or became infected |
| Disseminated shingles | Widespread rash beyond one dermatome, mainly in immunosuppressed people — needs urgent care |
The shingles vaccine
Vaccination is the only measure that meaningfully prevents shingles, and the NHS programme is age-based. It is offered to adults turning 65 from 1 September 2023 onwards, and to those aged 70 to 79; people who turned 65 before September 2023 become eligible at 70. Eligibility continues until the 80th birthday, with the second dose available until 81. Two doses are given, normally 6 to 12 months apart.
Adults aged 18 and over with severely weakened immune systems are also eligible — including people with blood cancers, HIV, recent transplant, or on immunosuppressive treatment — with the two doses given 8 weeks to 6 months apart. Your GP surgery normally invites you. Full detail is in our shingles vaccine guide.
The vaccine is prevention, not treatment. It does not treat an active episode, and having had shingles does not make you ineligible — vaccination is still offered to reduce the chance of another episode, once the current one has settled.
Where to go next
Shingles is one of the conditions where acting within days changes the outcome. If a painful band of blisters has appeared on one side of your body, the priority is assessment today, whether through your GP, a pharmacy, or an online consultation.
Where to go next
Shingles needs assessing within days, not weeks. Your GP, a pharmacy or NHS 111 can all help, and Access Doctor is a GPhC-registered pharmacy whose pharmacist independent prescribers can assess you online — the shingles page explains how that works and what is available.
Shingles at Access Doctor →Frequently Asked Questions
What is shingles?
Shingles is caused by the chickenpox virus — varicella zoster — reactivating after lying dormant in nerve tissue, often for decades. Because the virus travels back along a single nerve, the rash appears as a band on one side of the body and stops at the midline. Around one in four people will have shingles at some point.
How soon do I need treatment for shingles?
Antiviral tablets work best started within three days of the rash appearing, so shingles should be assessed the same day you suspect it rather than after a few days of watching. Treatment shortens the episode, reduces the severity of the rash, and lowers the chance of prolonged nerve pain afterwards.
Is shingles contagious?
You cannot pass shingles to anyone. You can pass varicella zoster to someone who has never had chickenpox or been vaccinated, and they would develop chickenpox rather than shingles. Transmission needs contact with fluid from the blisters, so the infectious period lasts from when blisters appear until they have all crusted over.
How long does shingles last?
The rash usually takes two to four weeks to heal. Pain often starts one to three days before the rash appears and can outlast the rash by weeks — and when it persists three months or more from onset it is called postherpetic neuralgia, the most common complication.
When is shingles an emergency?
Seek urgent advice the same day if the rash is near an eye, on the forehead or on the tip or side of the nose, if your vision changes, if the ear is affected or you develop facial weakness, if you are pregnant, immunosuppressed or under 18, or if the rash is widespread or on both sides. Call 999 or go to A&E if you are confused, very unwell, or have a severe headache with neck stiffness.
Who can have the shingles vaccine on the NHS?
Adults turning 65 from 1 September 2023 onwards and those aged 70 to 79, with eligibility continuing until the 80th birthday. People who turned 65 before September 2023 become eligible at 70. Two doses are given, normally 6 to 12 months apart. Adults aged 18 and over with severely weakened immune systems are also eligible, with doses 8 weeks to 6 months apart.
Can you get shingles more than once?
Yes, though most people have a single episode. Repeat episodes are more likely in people with weakened immunity. Having had shingles does not make you ineligible for vaccination — it is still offered to reduce the chance of another episode once the current one has settled.
References
- NHS. Shingles. nhs.uk
- NHS. Shingles vaccine. nhs.uk
- National Institute for Health and Care Excellence. Clinical Knowledge Summary: Shingles. cks.nice.org.uk
- National Institute for Health and Care Excellence. Neuropathic pain in adults: pharmacological management (CG173). nice.org.uk
- UK Health Security Agency. Shingles: guidance and vaccination programme. gov.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Shingles treatment is time-sensitive and needs assessment by a clinician. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.
