Shingles (Herpes Zoster): Why Does It Happen, How Is It Treated, and Will the Pain Go Away?
By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia
Shingles, medically known as herpes zoster, is a painful skin condition caused by the reactivation of the chickenpox virus. In Malaysia, it is commonly called kayap in Malay or 生蛇 in Chinese.
Many patients first notice a burning, tingling, or painful sensation on one side of their body. A few days later, clusters of small fluid-filled blisters may appear.
Although the skin rash usually heals within a few weeks, some patients continue to experience nerve pain long after the blisters have disappeared.
Understanding the early symptoms and seeking timely treatment can help reduce the severity of shingles and its complications.
1. What Causes Shingles?
Shingles is caused by the varicella-zoster virus, the same virus responsible for chickenpox.
After recovering from chickenpox, the virus does not completely disappear from the body. Instead, it remains inactive within the nerve cells.
Years or even decades later, the virus may reactivate, causing shingles.
Shingles is more common in:
Adults aged 50 years and above
People with weakened immune systems
Patients receiving chemotherapy or immunosuppressive medication
Individuals with certain chronic medical conditions
However, shingles can also occur in younger, otherwise healthy adults.
Although some patients associate an episode with stress or tiredness, shingles is caused by viral reactivation rather than stress alone.
2. What Are the Early Symptoms of Shingles?
The earliest symptoms may develop several days before the rash appears.
Patients may experience:
Burning or tingling sensations
Sharp, stabbing, or shooting pain
Itching or unusual skin sensitivity
Pain even when clothing lightly touches the skin
Once the rash appears, it typically develops into clusters of small fluid-filled blisters.
Shingles commonly affects the chest, back, abdomen, or face.
The rash usually follows the distribution of a nerve and appears on one side of the body, often without crossing the midline.
Sometimes, the pain may be mistaken for muscular pain or other medical conditions before the skin changes become visible.
3. Why Is Early Treatment Important?
Antiviral treatment works best when started within the first 72 hours after the rash appears.
Commonly prescribed antiviral medications include:
Acyclovir
Valacyclovir
Famciclovir
These medications help reduce viral activity, shorten the duration of the illness, and lessen the severity of acute symptoms.
Patients should still seek medical assessment even if more than 72 hours have passed, particularly when new blisters are appearing, the rash involves the face or eye, or the immune system is weakened.
Early treatment is important, but it cannot guarantee that long-term nerve pain will be prevented.
4. How Long Does Shingles Take to Heal?
The recovery process varies between individuals.
First few days: Burning, tingling, or pain may occur before the rash.
Days 1–5 of the rash: Red patches and fluid-filled blisters develop.
Around days 7–10: Blisters begin drying and forming crusts.
Weeks 2–4: The rash gradually heals.
After healing: Some patients experience persistent nerve pain or skin discolouration.
The skin may remain darker or lighter after the rash heals, particularly in individuals prone to post-inflammatory pigmentation.
5. Why Does the Pain Continue After Shingles Has Healed?
One of the most troublesome complications of shingles is postherpetic neuralgia (PHN).
This refers to nerve pain that persists for at least three months after the shingles rash develops.
Patients may describe:
Burning or shooting pain
Electric shock-like sensations
Persistent tingling
Pain when clothing touches the skin
Sleep disturbance caused by discomfort
The risk increases with age, particularly among older adults and those who experience severe shingles.
For some individuals, the discomfort resolves gradually. In others, it may continue for months or occasionally longer.
How Is Postherpetic Neuralgia Treated?
Depending on the severity of symptoms, treatment may include:
Gabapentin
Pregabalin
Certain antidepressant medications used specifically for nerve pain
Topical lidocaine preparations for suitable patients
These medications aim to reduce nerve-related pain and improve sleep and daily functioning.
Treatment must be individualised, as some medications can cause dizziness or drowsiness. Dosage adjustments may also be necessary in patients with impaired kidney function.
For some patients, nerve pain may continue long after the shingles rash has healed. This condition, known as postherpetic neuralgia (PHN), can affect sleep, daily activities and quality of life.
To learn more about why nerve pain persists and the available treatment options, read my related article: Postherpetic Neuralgia: Why Does Nerve Pain Continue After Shingles and How Is It Treated?
6. Can Shingles Spread to Other People?
Shingles itself is not passed directly from one person to another.
However, someone who has never had chickenpox or received the chickenpox vaccine may develop chickenpox after exposure to the virus from shingles blisters.
Until all lesions have dried and crusted, patients should:
Keep the affected rash covered where possible.
Avoid scratching or touching the blisters.
Wash their hands regularly.
Avoid direct contact with susceptible pregnant women, newborn babies, and individuals with weakened immune systems.
Shingles is generally no longer contagious once all blisters have crusted.
7. When Should You Seek Urgent Medical Attention?
Although most uncomplicated cases can be managed with oral antiviral medication, certain situations require urgent assessment.
These include:
Shingles affecting the forehead, eyelid, or near the eye
Eye redness, eye pain, or blurred vision
Facial weakness, hearing changes, or severe ear pain
Extensive or rapidly spreading blisters
Severe headache, confusion, or neurological symptoms
Shingles occurring in patients with significantly weakened immune systems
Shingles involving the eye can cause serious complications, including permanent visual impairment, if not treated promptly.
8. Can Shingles Come Back?
Yes. Although many patients experience shingles only once, the virus remains within the body and can reactivate again.
Repeat episodes are more likely in older individuals and those with weakened immune systems.
If a patient experiences repeated episodes of a blistering rash, further assessment may be necessary to confirm the diagnosis and exclude other conditions, such as herpes simplex infection.
9. Can Shingles Be Prevented?
Vaccination can significantly reduce the risk of developing shingles and its complications.
The recombinant shingles vaccine, Shingrix, is available in Malaysia for adults aged 50 years and above, as well as adults aged 18 years and above who are at increased risk of shingles.
It is usually administered as two doses, commonly separated by 2–6 months. Different intervals may be recommended for certain immunocompromised individuals.
Even individuals who have experienced shingles previously may benefit from vaccination after recovering from the acute episode.
Vaccination does not treat an active shingles infection, but it helps reduce the likelihood of future episodes and long-term nerve pain.
10. Frequently Asked Questions
Is shingles caused by eating certain foods?
No. Shingles is caused by reactivation of the chickenpox virus. There is no convincing evidence that particular foods trigger the infection.
Can I shower if I have shingles?
Yes. Gentle washing is generally safe. Avoid vigorous scrubbing and keep the affected skin clean and dry afterward.
Can I apply steroid cream to shingles?
Steroid creams are not the primary treatment for shingles and should not replace antiviral medication. Use them only when specifically advised by a doctor.
Does every patient need medication for nerve pain?
No. Many patients improve as the rash heals. Additional treatment may be considered when pain persists or interferes with sleep and everyday activities.
Can younger adults develop shingles?
Yes. Although shingles becomes more common with increasing age, younger adults can also develop the condition.
Final Thoughts
Shingles is more than just a blistering skin rash. For some patients, the nerve pain can be more troublesome than the skin lesions themselves.
Recognising the early symptoms and receiving appropriate antiviral treatment can help shorten the illness and relieve acute symptoms.
If you develop a painful blistering rash, particularly on one side of the body or face, seek medical assessment as early as possible.
About the Author
Dr Lim Tzyy Huei (林子辉医生) is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia.
His clinical practice includes the assessment and treatment of shingles, persistent nerve-related discomfort and other blistering skin conditions.
Medical Disclaimer: This article is intended for general patient education and does not replace individual medical consultation. Diagnosis, treatment suitability and recovery may vary according to each patient's condition. Please consult a qualified healthcare professional for appropriate assessment and treatment.
