It may start with burning, tingling or unusually sensitive skin. A few days later, a painful band of blisters appears, usually on one side of the body.
This is shingles, an illness caused by the same virus responsible for chickenpox.
The rash often clears within several weeks. However, the pain can sometimes continue for months or longer. Older adults and people with weakened immune systems have a higher risk of complications, making early recognition and treatment especially important.
Key Takeaways
- The reactivation of the chickenpox virus causes shingles.
- The risk of shingles and its complications increases with age.
- Antiviral treatment works best when started early.
- A rash on the face, nose or near an eye needs urgent assessment.
- Vaccination can reduce the risk of shingles and lasting nerve pain.
What Causes Shingles?
Shingles occurs when the varicella-zoster virus becomes active again.
After you recover from chickenpox, the virus remains inactive in nerve tissue. It may reactivate years or decades later and travel along a nerve towards the skin.
Anyone who has previously had chickenpox can develop shingles. The risk rises with age as the immune response that keeps the virus under control becomes weaker.
Risk is also higher when the immune system is suppressed by conditions or treatments such as:
- Certain cancers
- HIV
- Organ or stem-cell transplantation
- Chemotherapy or radiotherapy
- Long-term steroid use
- Immunosuppressant medicines
Shingles becomes considerably more common after age 50, although younger people can also develop it.
What Does Shingles Feel Like?
Pain or unusual skin sensitivity may begin before the rash appears.
Symptoms can include:
- Burning, stabbing or tingling pain
- Itching or numbness
- Pain triggered by clothing or light touch
- A rash on one side of the body or face
- Groups of fluid-filled blisters
- Headache, fever, chills or tiredness
Because discomfort can begin before the blisters appear, early shingles may be mistaken for muscle pain, skin irritation or another condition.
Why Is Shingles More Serious for Older Adults?
Age increases both the chance of developing shingles and the risk of pain continuing after the rash heals.
The most common complication is postherpetic neuralgia, or PHN. This is nerve pain that remains after the skin has healed.
It may feel like:
- Burning
- Stabbing
- Throbbing
- Electric shocks
- Extreme sensitivity to touch
Persistent pain can interfere with sleep, mood, movement and everyday activities. PHN is more common in older adults and may last for months or, in some cases, longer.
Less common complications include:
- Bacterial infection of the blisters
- Scarring
- Facial weakness
- Hearing loss
- Eye damage or vision loss
- Inflammation affecting the brain or lungs
People with weakened immune systems have a greater risk of severe, prolonged or widespread shingles.
Is Shingles Contagious?
You cannot catch shingles directly from someone who has it.
However, someone with active shingles can spread the varicella-zoster virus to a person who has never had chickenpox or received the chickenpox vaccine. That person may then develop chickenpox, not shingles.
Active shingles lesions can spread the virus until the blisters have dried and crusted.
Until then:
- Keep the rash covered where possible.
- Avoid touching or scratching the blisters.
- Wash your hands regularly.
- Do not share towels or clothing that touches the rash.
- Avoid close contact with people who may be especially vulnerable.
This includes newborns, people with weakened immune systems and pregnant women who do not have chickenpox immunity.
When Should You See a Doctor?
Seek medical advice as soon as possible if you think you have shingles.
Antiviral medicines work best when treatment begins early, commonly within about 72 hours of symptoms or the rash appearing. They can reduce the development of new blisters, speed up healing and lessen acute pain.
| Seek prompt medical care if | Why it matters |
| You develop a painful rash on one side of the body | Early assessment gives antiviral treatment the best chance to help |
| You are aged 50 or above | The risk of complications rises with age |
| You have a weakened immune system | The illness may become more severe or widespread |
| The rash affects your face, forehead, nose or eye | Eye involvement may threaten vision |
| The rash is widespread | This may indicate a more serious infection |
| You develop facial weakness, confusion or a severe headache | These symptoms require urgent assessment |
Do not wait for the rash to become severe.
Even when more than three days have passed, seek medical advice if new blisters are still appearing, the face or eye is affected, pain is severe, or your immune system is weakened. Antiviral treatment may still be considered in people at higher risk of complications.
How Is Shingles Treated?
Treatment may include:
- Antiviral medicine
- Pain relief
- Medicine for nerve-related pain
- Advice on caring for the rash
- Treatment if the blisters develop a bacterial infection
Antiviral medicines do not remove the virus from the body. They help reduce the severity and duration of the current episode when used appropriately.
Keep the rash clean and dry. Avoid scratching it or applying strong chemicals, extreme heat or unproven home remedies that may irritate the skin.
Can Shingles Be Prevented?
Vaccination is the most effective way to reduce the risk of shingles and its complications.
In Singapore, the recombinant herpes zoster vaccine is included in the National Adult Immunisation Schedule. It is recommended for:
- All adults aged 60 and above
- Adults aged 18–59 with specified immunocompromising conditions
The vaccine is given in two doses.
For adults aged 60 and above, the doses are generally given two to six months apart. For eligible immunocompromised adults, the interval may be shortened to one to two months when earlier protection is needed.
People who have previously had shingles may still be advised to receive the vaccine because shingles can recur. Eligibility and timing should be discussed with a healthcare professional.
Eligible Singapore Citizens and Permanent Residents can receive subsidies for nationally recommended shingles vaccination. MediSave may also be used towards eligible costs after subsidies. Check with a participating clinic for current eligibility and charges.
The Bottom Line
Shingles is more than a skin rash.
It is a nerve-related illness that can cause severe pain—and that pain may continue after the blisters disappear.
Recognise the signs. Seek medical advice early. Treat a rash near the eye as urgent.
And if you are eligible, discuss shingles vaccination with a healthcare professional.
Sources
- World Health Organization. Shingles (Herpes Zoster).
https://www.who.int/news-room/fact-sheets/detail/shingles-%28herpes-zoster%29 - Centers for Disease Control and Prevention. About Shingles.
https://www.cdc.gov/shingles/about/index.html - Centers for Disease Control and Prevention. Clinical Overview of Shingles.
https://www.cdc.gov/shingles/hcp/clinical-overview/index.html - Centers for Disease Control and Prevention. Clinical Features of Shingles.
https://www.cdc.gov/shingles/hcp/clinical-signs/index.html - HealthHub Singapore. Shingles (Herpes Zoster) Vaccine.
https://www.healthhub.sg/medication-devices-and-treatment/medications/shingles-herpes-zoster-vaccine - Ministry of Health Singapore. Shingles Vaccination.
https://www.vaccine.gov.sg/shingles - Ministry of Health Singapore. Healthier SG Vaccinations.
https://www.moh.gov.sg/managing-expenses/schemes-and-subsidies/healthier-sg-vaccinations/ - Ministry of Health Singapore. Subsidies and MediSave Coverage for Shingles Vaccine.
https://www.moh.gov.sg/newsroom/subsidies-and-medisave-coverage-for-shingles-vaccine-/ - Lee C, et al. A Systematic Literature Review of the Epidemiology and Burden of Herpes Zoster in Selected Locales in Asia Pacific. Human Vaccines & Immunotherapeutics. 2024;20(1):2344983.
https://pubmed.ncbi.nlm.nih.gov/38767209/
Editorial Note
This article is intended for general information and should not replace personalised medical advice. Seek prompt assessment for a painful blistering rash, particularly if it affects the face or eye, becomes widespread or occurs in an older or immunocompromised person. Vaccination recommendations and eligibility vary between countries and may change over time.