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Common Conditions


General Information

Shingles is a painful skin rash that usually appears on one side of your waist, but can also affect your chest, back, legs or face. It is more common in people over the age of 40.

Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. After you have had chickenpox, the virus remains in your body and lies dormant in your spinal nerves.

You develop shingles if the virus is reactivated, which is most likely to happen in people with lowered immunity. This can be as a result of illness, surgery, ageing, HIV infection or certain medications, such as steroids. Most people will get shingles only once. Rarely, shingles may occur in young children who were either born with chickenpox or had it soon or after birth.

You cannot catch shingles from someone who has shingles or from someone who has chickenpox. However, it is possible to catch chickenpox from someone who has shingles, until the blisters have dried up. People with shingles are extremely contagious from when the rash or blisters appear till when they crust over.

Symptoms of shingles

When the virus is reactivated, it multiplies and spreads down the affected nerve. About two to five days before the rash appears, you may notice some or all of the following symptoms:

  • tingling, burning, itching, numbness or a stabbing pain on one side of the body or face
  • headachefever or nausea.

The rash – which can be itchy and intensely painful – is red and looks spotty to start with but  the blisters soon join together in bands as the virus spreads along certain nerves located off the spinal cord. The blisters crust over in about seven to 10 days and usually only occur on one side of the body, depending on which nerve the virus affects. The rash usually goes away after about one month.

Complications from shingles

Some people develop complications from shingles. The most common complication is post-herpetic neuralgia. This is when nerve pain continues or recurs more than a month after the shingles rash has cleared. The pain happens because the virus has inflamed and possibly damaged the nerve.

The pain can be burning and continuous or spasmodic and shooting. Some people complain of an itchy, crawling type pain. The overlying skin may feel numb or extremely sensitive to touch. It can be made worse by temperature changes or something touching the skin. While topical pain relievers may offer some relief, many people may need to try several different treatments, including acupuncture or transcutaneous electrical nerve stimulation (TENS) therapy. Post-herpetic neuralgia is more common in people aged over 40, but anybody with this complaint should talk to their doctor.

Other complications include loss of pigment in the skin affected by the rash. Muscle weakness, which is usually temporary, occurs in about 5% of people. It is more likely to occur if the face was affected. Shingles that affects the face may cause permanent visual impairment if the eye is involved or hearing loss.

A second attack of shingles can occur in around 4% of people, but third attacks are very rare.

See Your Pharmacist or Medical Professional

You should see your doctor as soon as possible if you think you have shingles:

  • early treatment –within one to three days of the onset of shingles – with antiviral tablets can reduce symptoms and complications, which is especially important if the rash is on your face, neck or scalp – the complications from shingles here can be more serious, including damage to your sight
  • rest and take pain relief (such as paracetamol)
  • wear loose cotton clothing that won't further irritate the skin
  • wash your hands frequently and especially after applying topical treatments or before attending to young children. The virus is very contagious and can be transferred to others until the rash crusts over
  • see your doctor again if the pain does not go away after initial treatment, particularly if it is interfering with your sleep or making you feel depressed
  • see your doctor if the rash is not healing, especially if there is swelling or pus – sometimes the rash can become infected with bacteria.

Treatment Tips

  • rest and take pain relief. Pain relief medicines often work best if they are taken regularly, rather than just when pain is bad
  • cold compresses may help ease the pain of shingles but some people with post-herpetic neuralgia may not be able to tolerate temperature changes on their skin
  • talk to your pharmacist about what creams are available to soothe blistered skin
  • remember that shingles is contagious and you should do your best to avoid transmitting the virus to others (don't share towels, don't bathe with others, wash your hands regularly) 
  • wear loose clothing.

Vaccination against shingles

  • a vaccine called Zostavax is available that reduces the likelihood of a person contracting shingles by 50-70%
  • in people who do develop shingles despite being vaccinated, the symptoms are usually less severe and post-herpetic neuralgia is less likely to develop
  • Zostavax can also be given to somebody who currently has shingles to lower the risk of post-herpetic neuralgia developing
  • may be considered in people older than 50
  • the vaccine is currently unfunded – which means you will have to pay the full cost of it – and currently difficult to get. Availability is expected to improve by 2014.

Treatment Options

Antiviral medicines, prescribed by a doctor are the best medicine for shingles.

  • Oral pain relief medicines may also be taken to relieve pain.

Always discuss treatment options with your pharmacist to ensure the best outcome.

Antiviral agents

eg, aciclovir (Lovir, Valtrex)

  • aciclovir is usually taken five times a day for seven days
  • see your doctor as soon as you suspect shingles, as it is preferable to start the course of antiviral medicine in the first few days.

Topical pain relief products

eg, lignocaine preparations (Soov spray), capsaicin cream (Zostrix HP)

eg, lignocaine preparations (Emla), aspirin in chloroform mixture (prepared by the pharmacist)

  • topical pain relievers can be used in addition to oral pain relief medicines
  • lignocaine is a local anaesthetic and numbs the skin
  • capsaicin cream may not be suitable for everybody (some people find it can worsen the neuralgic pain) and should only be used once the skin has healed
  • aspirin in chloroform can be made by your pharmacist.

Oral pain relief medicines (analgesics)

eg, paracetamol – packets of 20 or fewer (Panadol range, Paracare range), aspirin (Aspro range, Disprin range), ibuprofen – packets of 25 or fewer (Advil, Nurofen range)

eg, paracetamol, ibuprofen – larger pack sizes (Panadol range, Nurofen range), diclofenac (Voltaren Rapid 12.5), naproxen (Sonaflam), paracetamol + ibuprofen (Maxigesic, Nuromol)

eg, diclofenac (Voltaren Rapid 25)

  • paracetamol is the first choice for pain relief in people with shingles
  • aspirin and NSAIDs (non-steroidal anti-inflammatories), which include ibuprofen, diclofenac and naproxen, should only be used with viral illnesses if recommended by a doctor
  • paracetamol is a safe choice for most people but it is important not to take more than recommended. Paracetamol is an ingredient in many cold and flu remedies so be careful not to double dose.
  • the maximum daily dose of paracetamol for an adult is 4g (4000mg) – and no more than 1g (1000mg) every four hours.

Asprin and NSAIDs are not suitable for everyone. Children under 12 years old must not take aspirin because it can cause Reye’s syndrome – a serious condition. It should also be avoided by adolescents under 16 years old who have a viral illness.

Check with your pharmacist before taking aspirin or NSAIDs if you:

  • have a history of stomach problems, such as ulcers or indigestion
  • have asthma – some asthmatics find their condition is made worse by these types of medicines
  • have kidney problems or a heart condition
  • take other medications
  • have an allergy to aspirin or NSAIDs
  • are pregnant or breastfeeding
  • are elderly – you may be at more risk of side effects
  • are dehydrated.

Sometimes aspirin and NSAIDs can cause side effects. If you develop indigestion, or unusual or increased bleeding or bruising, stop taking them and talk to your pharmacist.

Stronger (prescription) pain relief medicines


  • stronger pain relief medicines available on prescription include codeine and morphine
  • some antidepressants (eg, amitriptyline) and anticonvulsants (eg, carbamazepine, gabapentin) are also used to treat nerve pain and can be prescribed for post-herpetic neuralgia – they may take two weeks or more to reach their full effect.

Natural/Herbal products/Supplements

eg, papain, DMSO (dimethylsulfoxide), calendula ointment, zinc cream, Malcolm Harker Shingles & Itch

  • papain and DMSO can help improve the symptoms of shingles
  • calendula or zinc cream may help skin healing
  • Malcolm Harker Shingles & Itch contains natural ingredients in an olive oil base to moisturise and relieve the itch of shingles.

More Information

Availability of medicines

  • GENERAL SALE available through pharmacies and possibly other retail outlets.
  • PHARMACY ONLY available for sale through pharmacies only.
  • PHARMACIST ONLY may only be sold by a pharmacist.
  • PRESCRIPTION ONLY available only with a prescription from your doctor or other health professional.

Consumer Medicine Information on some medicines is available at the government website

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