Shingles: When a Skin Rash Begins in the Nerves

Shingles is an unusual skin condition because, strictly speaking, the problem does not begin in the skin.

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The characteristic painful, blistering rash is the visible expression of something happening deeper in the body, in the sensory nerves. This is why shingles can cause burning, tingling or pain before there is anything to see on the skin, and why discomfort can sometimes continue long after the rash itself has disappeared. Shingles, also known as herpes zoster, is caused by the varicella-zoster virus, the same virus that causes chickenpox.

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What Causes Shingles?

 

When you recover from chickenpox, the virus is not completely eliminated from the body.

Instead, some of the virus remains dormant within sensory nerve tissue. It may remain there quietly for many years—or even decades—without causing any symptoms.

Sometimes the virus becomes active again.

Rather than causing chickenpox for a second time, it travels along a sensory nerve toward the skin. The result is shingles.

This helps explain one of the most fascinating features of the condition: the rash usually appears in a relatively narrow band on one side of the body.

The affected area corresponds to the territory supplied by a particular sensory nerve, known as a dermatome. A shingles eruption might therefore form a stripe around one side of the chest, abdomen or back rather than spreading randomly across the skin.

In shingles, we can quite literally see the relationship between the nerves and the skin.

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The First Signs of Shingles

Shingles does not always begin with a rash.

The first indication may be a strange sensation in a particular patch of skin. Someone might experience:

• burning

• tingling or pins and needles

• itching

• tenderness

• increased sensitivity to touch

• aching or stabbing pain

Even clothing brushing against the area may feel uncomfortable.

There may also be headache, tiredness or a general feeling of being unwell.

The rash usually follows several days later. Small groups of fluid-filled blisters develop on reddened or inflamed skin. The blisters eventually dry, crust over and heal, with the entire skin eruption commonly taking several weeks to resolve.

Because the nerve is involved, however, the severity of the pain does not necessarily correspond to the severity of the visible rash.

Someone may have a relatively modest-looking eruption yet experience considerable discomfort.

Why Is Shingles Usually on One Side?

The one-sided nature of shingles is one of the clues that distinguishes it from many other skin conditions.

A dermatitis, allergy or generalised infection may affect several unrelated areas of the body. Shingles normally follows the pathway of the particular nerve in which the virus has become active.

The trunk is a common location, producing the familiar band of shingles around one side of the chest or waist. But it can occur elsewhere, including the neck, scalp and face.

This neurological pattern is why I think shingles is particularly interesting when considering skin health.

The rash is on the surface, but its pattern only makes sense when we understand what is happening beneath it.

Shingles and Pain

The pain of shingles can be very different from the discomfort associated with ordinary irritated skin.

People describe burning, shooting, stabbing, throbbing or electric sensations. Others experience intense itching or hypersensitivity.

This is neuropathic pain—pain originating from an affected nerve.

For most people the discomfort gradually settles as the shingles resolves. Occasionally, however, pain remains after the skin has healed.

This is known as postherpetic neuralgia.

The affected area may continue to burn, ache or become extremely sensitive to touch for months after the blisters have disappeared. Postherpetic neuralgia becomes considerably more common with increasing age and is one of the main complications doctors try to prevent or minimise when treating shingles.

Can Children Get Shingles?

Shingles is strongly associated with older adults, particularly people over 50, but children and young adults can develop it too.

Anyone who has previously been infected with varicella-zoster virus potentially carries the dormant virus and can therefore develop shingles.

It is simply much less common in younger people.

Age is important because our immune surveillance of the dormant virus tends to decline as we get older. Reduced immunity from illness or certain medications can also make reactivation more likely.

In some people, however, there is no obvious explanation for why the virus becomes active at a particular time.

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What Does Stress Have to Do With Shingles?

 

People often report developing shingles during or following an unusually stressful period, and stress is frequently discussed as a possible contributor to viral reactivation.

It would be too simplistic, however, to say that stress causes shingles.

The immediate cause is reactivation of the varicella-zoster virus. Whether that reactivation occurs depends upon a complicated relationship between the virus and the person's immune defences.

Stress may be one influence on immune function, alongside age, illness, medication, sleep, nutrition and many other factors. But it is rarely possible to look at an individual case and confidently identify one single trigger.

This is where a whole-person approach can be useful—not as a replacement for treating the infection, but as a way of asking a broader question:

Why might this person's resilience have been reduced at this particular time?

Sometimes there is an obvious answer. Sometimes there isn't.

Is Shingles Contagious?

You cannot normally catch shingles from another person with shingles.

However, the fluid inside active shingles blisters contains varicella-zoster virus. Someone who has never had chickenpox and has not been vaccinated against it can potentially become infected and develop chickenpox.

For this reason, active lesions should generally be kept covered where possible, particularly around vulnerable people such as newborn babies, people with severely weakened immunity and pregnant women who are not immune to chickenpox.

Looking After the Skin During Shingles

Although shingles originates in the nerves, the skin still needs gentle care while the eruption heals.

Simple measures can make the area considerably more comfortable:

• keep the rash clean and dry

• wear loose, soft clothing

• avoid scratching or breaking the blisters

• use a cool compress if this feels soothing

• avoid adhesive dressings sticking directly to the affected skin

Harsh creams, strong essential oils and heavily perfumed skin products are generally best avoided on an active shingles eruption.

This is not a time to attack the skin. It is a time to protect it.

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Early Medical Treatment Matters

 

Shingles is one condition where I would particularly encourage prompt conventional medical assessment.

Antiviral medicines such as aciclovir or valaciclovir may be prescribed and are most useful when treatment begins early, generally within the first few days after the rash appears.

This is especially important for older adults, people with weakened immune systems, those experiencing severe symptoms and anyone with shingles affecting the face.

Shingles Around the Eye

A shingles eruption involving the forehead, nose or area around the eye requires particular attention.

The virus can affect structures within the eye and, in serious cases, damage vision. Eye pain, redness, light sensitivity, blurred vision or a shingles rash close to the eye therefore warrants urgent medical assessment.

Shingles around the ear can also occasionally involve the facial nerve and affect facial movement or hearing.

Looking Beyond the Rash

Shingles is a wonderful illustration of why I don't like thinking about the skin entirely in isolation.

What we see on the surface may be only the final expression of processes occurring elsewhere.

With shingles, this is not theoretical. We know that the visible eruption reflects activity within a sensory nerve. The nervous system, immune system and skin all participate in the illness.

The immediate priority during an acute attack is appropriate medical treatment, pain control and protecting the affected skin.

Once the acute illness has passed, however, it can also be worthwhile looking at the wider picture—particularly if someone has been under prolonged strain, has been sleeping poorly, has been unwell or simply feels that their general resilience is not what it once was.

My approach to skin health is therefore not based on assuming that every rash has some mysterious internal cause.

It begins with the obvious.

What is this condition? What is known to cause it? What does the skin need right now?

Then, when appropriate, we can look further: at nutrition, stress, emotional wellbeing, general health and the individual person behind the diagnosis.

Shingles makes that principle particularly clear.

Sometimes, to understand what is happening on the skin, we need to look beneath it.