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Shingles (Herpes Zoster)

Shingles is a painful, blistering rash caused by the chickenpox virus waking up again years later. Antiviral medicine works best when started within about three days of the rash, and a rash near the eye or in someone with a weakened immune system needs care right away. A vaccine can help prevent it.

Get medical care quickly for shingles — do not wait for an appointment with a chiropractor, acupuncturist or massage therapist. The NHS in the UK says antiviral medicine works best if started within 3 days of the rash appearing (NHS), and CDC says treatment is most effective within 72 hours of symptom onset (CDC). Contact a doctor or urgent care right away if:

  • The rash is on or near an eye, or on the nose, or your vision changes. The NHS says this needs urgent advice (NHS). CDC says shingles on the face can affect the eye and cause vision loss (CDC), and MedlinePlus says the vision loss may be temporary or permanent (MedlinePlus).
  • The face or ear is involved — intense ear pain, a rash around the ear, mouth, face or scalp, a drooping or weak side of the face, hearing loss, ringing in the ears or vertigo (NINDS, NHS).
  • Your immune system is weakened by cancer, HIV, chemotherapy, steroids or transplant medicines. The NHS asks people in this situation to seek urgent help (NHS), and CDC says complications, including a more severe and longer-lasting rash, are more likely (CDC).
  • The pain is severe, or the rash covers a wide area. The NHS says antiviral tablets may be offered for moderate or severe pain or rash, or when the rash reaches beyond the chest, tummy and back (NHS). CDC says a widespread rash that looks like chickenpox is rare and usually occurs in people with weakened immune systems (CDC).
  • You have a fever with the rash. The rash can become infected with bacteria (NHS); MBHA suggests fever is a reason to call promptly.
  • You are pregnant, or the person with the rash is 17 or younger. The NHS asks for an urgent appointment in these cases (NHS).

Very rarely, shingles leads to pneumonia or brain inflammation (encephalitis) (CDC). If you have trouble breathing, confusion or other sudden, severe symptoms, call 911.

What is shingles?

CDC describes shingles as a painful rash illness. It happens when the varicella-zoster virus — the virus that causes chickenpox — reactivates in the body of someone who has already had chickenpox (CDC). After chickenpox clears, the virus can stay dormant for years and wake up later in life (MedlinePlus). About 1 million people in the United States get shingles each year, and about 1 in 3 Americans will have it in their lifetime; most people have it only once, but you can have it more than once (CDC).

More than 99% of Americans born before 1980 had chickenpox, even if they do not remember it (CDC). Children can get shingles, but it is not common (CDC).

Who is more likely to get it?

CDC says the chance of shingles, and of serious complications, rises with age, with conditions that weaken the immune system (such as leukemia, lymphoma and HIV), and with medicines that suppress the immune system (such as steroids and drugs given after an organ transplant) (CDC). A 2020 meta-analysis of 88 studies also found a higher risk with a family history of shingles and physical trauma, and a smaller increase with psychological stress and conditions such as diabetes and lupus; this shows an association, not a cause (Marra et al., 2020). See our guides to HIV/AIDS and cancer.

What does shingles feel like?

  • Before the rash: pain, itching or tingling where the rash will appear can start several days earlier, and fever may occur (CDC). The NHS notes that some people have the pain without ever getting a rash (NHS).
  • The rash: typically a single stripe of blisters around the left or right side of the body, or on one side of the face. The blisters scab over in about 7 to 10 days and the rash clears in about 2 to 4 weeks (CDC).
  • Other symptoms: fever, headache, chills and an upset stomach (CDC).

Doctors usually diagnose shingles from the rash. CDC notes that diagnosis can be hard without one (CDC), so early pain is easy to mistake for a back, neck or chest problem — see the chiropractic section below.

Complications

The most common complication is long-term nerve pain called postherpetic neuralgia (PHN), pain in the area where the rash was, which can last months or years. CDC says about 10% to 18% of people with shingles develop it; the risk rises with age, and PHN is rare in people under 40 (CDC). Other complications include bacterial infection of the rash, vision loss and hearing problems (CDC), and scarring or muscle weakness (NHS). There is no cure for shingles; antiviral medicines may shorten and lessen the illness (MedlinePlus).

Can I catch shingles from someone?

No, but someone who has never had chickenpox or the vaccine can catch chickenpox from shingles blisters (CDC). See Protecting other people below.

Shingles is a different illness from cold sores, which come from the herpes simplex virus; see Cold Sores and Herpes. Nothing here is medical advice, and nothing replaces care from your own doctor.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Antiviral medicines (acyclovir, valacyclovir or famciclovir) started as early as possible; over-the-counter or prescription pain relievers, cool compresses, calamine lotion and oatmeal baths; specialist nerve-pain medicines or skin treatments if pain lingers (postherpetic neuralgia); and the shingles vaccine to help prevent it. Medicare Part D covers the shingles vaccine with $0 cost-sharing for the vaccine, per Medicare.gov. Other costs (visits, antivirals, nerve-pain treatments): being researched. Antivirals can shorten and lessen the illness, and work best when started within about 3 days of the rash. The rash usually clears in 2 to 4 weeks. Some people are left with nerve pain for months or years. There is no cure.
Chiropractic No role in treating shingles, which is a viral infection. We found only individual case reports. The main lesson is diagnostic: the early pain can mimic a back, neck or leg problem. About $55 to $100 per follow-up visit and $90 to $200 for a first visit paying cash, per The Pricer. Medicare covers only spinal adjustments to correct a subluxation. Never a reason to delay seeing a doctor within about 3 days of the rash. Tell your chiropractor about any one-sided burning pain, tingling or rash.
Acupuncture Needle treatments (sometimes with moxibustion, cupping or fire needles) used mostly in China for the rash and for postherpetic neuralgia, in studies that compared it with drug treatment. About $90 to $185 per follow-up visit and $125 to $230 for a first private visit, per The Pricer; community acupuncture about $50 to $90. Medicare covers acupuncture only for chronic low back pain. Reviews report pain relief and fewer cases of postherpetic neuralgia, but the studies were small and low quality, and the authors call for better trials. Use it as an add-on, never instead of antivirals.
Herbal medicine Mostly home soothing (oatmeal baths) and a safety question. A 2024 review of Chinese herbal patches applied to acupuncture points looked at postherpetic neuralgia. No herb has been shown to replace antiviral medicine. Cost estimate being researched. Evidence is limited and mostly from China. “Natural” does not mean safe; tell your doctor and pharmacist about every herb and supplement, especially if you take antivirals or have kidney disease.
Massage therapy We found little research on massage for shingles. Gentle massage away from the rash may help with stress and sleep once your doctor agrees; the rash itself should not be rubbed. One national chain: about $70 to $90 a month on a membership with a 12-month initial term, per The Pricer. Not a treatment for shingles. Skip any area with blisters or open skin, and reschedule if you have a fever or a rash that is still oozing.
MBHA Wellness Coach Help planning the shingles vaccine, knowing the early signs so you call for care within days, a pain and sleep diary, stress and relaxation habits, and the habits that protect other people. Cost estimate being researched. Supports your medical care; never replaces antivirals, the vaccine or a doctor’s visit for the warning signs above.

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Conventional medicine (AMA)

Treatment for shingles depends on how severe it is and whether you are at risk of complications. The NHS says a mild rash may need no treatment, while antiviral tablets may be offered if you have a weakened immune system, moderate or severe pain or rash, or a rash beyond the chest, tummy and back (NHS). We do not list doses; your prescriber and pharmacist set those.

Antiviral medicines

Pain relief and skin care

CDC lists over-the-counter or prescription pain relievers, wet compresses, calamine lotion and warm oatmeal baths for itching (CDC). The NHS suggests paracetamol (called acetaminophen in the US), keeping the rash clean and dry, loose clothing, and a cool compress a few times a day, and advises against dressings that stick to the rash or rough fabrics (NHS). Treatment can also include stronger painkillers, steroid tablets or nerve-pain medicines (NHS), though a Cochrane review is uncertain whether oral steroids during the rash prevent postherpetic neuralgia (Cochrane review, 2023).

The vaccine and treatments for lingering nerve pain have their own sections below. Tell your pharmacist about everything you take; see our medication safety guide.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating shingles, which is a viral infection of a nerve and the skin it serves. If you have a one-sided band of burning, tingling or shooting pain, with or without a rash, see a doctor promptly, because antivirals work best in the first days (NHS, CDC).

What the research shows

The research we found on chiropractic and shingles consists of individual case reports, not trials, so it cannot tell us whether chiropractic care helps. Two lessons come up, both about diagnosis:

  • A 2024 case report describes a 27-year-old woman with thigh numbness first thought to be a pinched nerve; blisters appeared two weeks later, and an antiviral led to full resolution. The authors urge practitioners to keep shingles in mind for nerve-related symptoms (case report, 2024).
  • A 2026 case report describes a 40-year-old man with chronic low back pain who developed a gluteal rash and radiating leg pain after a chiropractic session. The rash was first labeled eczema and the leg pain blamed on the back, delaying the diagnosis; he improved quickly on an antiviral. The authors stress that shingles can mimic sciatica (case report, 2026).

Another report describes a man with both a neck disc problem and a shingles rash who improved after spinal manipulation, but one case cannot show that manipulation helped the shingles (case report, 2019).

Safety take-away

MBHA suggests telling your chiropractor right away about any new one-sided band of burning pain or any rash, and seeing a medical doctor within about 3 days of the rash.

What it costs

The Pricer lists a typical first chiropractic visit at about $90 to $200 and self-pay follow-ups at about $55 to $100 (The Pricer). Medicare Part B covers spinal adjustments to correct a subluxation but not other services a chiropractor orders (Medicare.gov).

Find a chiropractor in our directory

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Acupuncture

Acupuncture is widely used in China for shingles and for the nerve pain that can follow it. The reviews below come mostly from trials done there, usually comparing acupuncture with drug treatment rather than with fake (sham) needling, which limits what we can conclude.

What studies found

  • For the shingles rash: a 2021 review of 21 randomized trials found that, compared with antiviral therapy, acupuncture was associated with lower pain scores, faster crusting and a lower rate of postherpetic neuralgia; the authors called for larger, high-quality trials (Cui et al., 2021). A 2022 review of 11 trials (1,156 people) found faster healing and less nerve pain afterward compared with Western medicine, but no clear difference in pain scores (Qi et al., 2022).
  • For postherpetic neuralgia: a 2018 review of seven trials, all done in China, compared acupuncture with drug therapy; pooled results from two suggested lower pain scores and no adverse effects were reported, but the studies were low quality and the authors called the results not conclusive (Wang et al., 2018). A 2019 review found acupuncture may reduce pain, ease anxiety and improve quality of life, rating the evidence for pain intensity as moderate, and also asked for larger, better trials (Pei et al., 2019).

Acupuncture may help as an add-on, but the evidence is not strong enough to replace antiviral medicine in the first days of shingles.

Safety

NCCIH says relatively few complications have been reported, mostly from nonsterile needles or improper technique, and that the FDA requires acupuncture needles to be sterile and single-use (NCCIH). MBHA suggests telling your acupuncturist about the shingles rash and asking how they will work around blisters or open skin.

What it costs

The Pricer lists about $90 to $185 for a private follow-up visit and about $125 to $230 for a first visit, with community acupuncture about $50 to $90 (The Pricer). Medicare covers acupuncture only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

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Herbal medicine

None of the government and medical sources we read describe an herb or supplement as a treatment for shingles. For the rash they point instead to antiviral medicine, cool compresses, calamine lotion and warm oatmeal baths (CDC, NHS). Oatmeal baths are a plant-based comfort measure for itching, not a treatment for the virus.

What the research says

The herbal research we found is mostly from China and focuses on the nerve pain that can follow shingles. A 2024 review of 15 studies (1,362 people) looked at herbal patches applied to acupuncture points for postherpetic neuralgia. The authors reported improvements in pain, sleep, depression and quality of life compared with control groups and said only two studies reported adverse reactions, with no significant difference between groups (Pu et al., 2024). We could not judge the quality of the individual studies, so this is early evidence and not a reason to skip medical care.

Safety

  • NCCIH says “natural” does not always mean safe, that supplements can interact with medicines (for example, St. John’s wort makes many medicines less effective), and that supplement rules are less strict than for drugs. The FDA has found prescription drugs in products sold as supplements (NCCIH).
  • Tell your doctor and pharmacist about every herb and supplement you take, especially with antivirals, which carry kidney and nervous-system cautions (MedlinePlus, MedlinePlus).
  • MBHA suggests not putting herbs, oils or other products on broken or blistered skin without asking your doctor. The NHS advises keeping the rash clean and dry (NHS).

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

We found little research on massage for shingles. It is not a treatment for the virus, and the rash itself should be left alone.

What to know

  • Skip the rash. CDC advises covering the rash and not touching or scratching it, which lowers the chance of spreading the virus (CDC). The NHS advises against anything that sticks to or irritates the skin (NHS). MBHA suggests no massage on or near the area until the blisters have scabbed over and your doctor agrees, and afterward only very light pressure if the skin is still tender.
  • Protect the therapist. Fluid from the blisters can give chickenpox to someone who has never had it or the vaccine (CDC). Reschedule until the rash has scabbed over.
  • Relaxation elsewhere. Once the rash has healed, massage on other parts of the body may help with tension and stress. NCCIH says the risk from massage appears low, though rare serious problems such as blood clots, nerve injury and bone fracture have been reported, mostly with vigorous massage or in older people (NCCIH). Shingles is more common in older adults, so MBHA suggests asking for gentle pressure.

What it costs

One national chain, Massage Envy, lists memberships at about $70 to $90 a month with a 12-month initial term, and the price varies by franchise (The Pricer). Medicare.gov lists massage therapy among the services ordered by a chiropractor that Original Medicare does not cover (Medicare.gov).

Find a massage therapist in our directory

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MBHA Wellness Coach

An MBHA Wellness Coach can help with the everyday side of shingles — getting care early, planning the vaccine, managing pain and sleep, and protecting other people — alongside, never instead of, your doctor.

Know the early signs, and act fast

Because treatment works best in the first few days, a coach can help you remember the signs: pain, itching or tingling on one side of the body or face, sometimes with fever, before blisters appear (CDC). If a stripe-like rash appears, contact a doctor as soon as possible (CDC).

Plan your vaccine

A coach can help you ask your doctor or pharmacist about the vaccine and track the second dose. Medicare Part D covers it at no cost to you (Medicare.gov).

Keep a pain and sleep diary

Writing down where it hurts and how you slept helps your doctor see whether pain is settling or lingering. In a Cochrane review, meaningful pain relief was linked with better sleep, less fatigue and less depression (Cochrane review, 2017). See also our sleep problems guide.

Calm the body and mind

In a small 2015 pilot study, 27 older adults with postherpetic neuralgia were randomly assigned to daily meditation for six weeks or usual care alone; the meditation group reported improvement in several pain scores (at a lenient statistical threshold), and people were able to keep up the practice. The study was too small to be conclusive (Meize-Grochowski et al., 2015). Stress has been linked to a somewhat higher chance of getting shingles, but that does not mean stress causes it (Marra et al., 2020).

Comfort and protecting others

A coach can help you plan loose clothing, cool compresses, a covered rash and handwashing for at least 20 seconds (CDC, NHS), and time away from work with babies, pregnant people or people with weakened immune systems until the rash has scabbed over.

Another approach

The shingles vaccine

CDC calls vaccination the best way to protect yourself from shingles (CDC). Talk with your doctor or pharmacist about whether the recombinant zoster vaccine (Shingrix) is right for you.

Who should get it

  • Adults 50 and older: CDC recommends 2 doses, separated by 2 to 6 months, and says there is no maximum age (CDC).
  • Adults 19 and older with weakened immune systems due to disease or therapy: also 2 doses, and if needed the second dose can be given 1 to 2 months after the first (CDC). The FDA label lists adults 18 and older who are or will be at increased risk because of immunodeficiency or immunosuppression (FDA label (DailyMed)).
  • If you had shingles before: you can still get the vaccine, generally after the rash is gone, to help prevent future episodes (CDC). The NHS likewise says it is worth having after a past episode, since you can get shingles more than once (NHS).
  • If you had the chickenpox vaccine or the older Zostavax: CDC says you should still get Shingrix (CDC).

How well it works

CDC reports that Shingrix is 97% effective against shingles in healthy adults 50 to 69 and 91% effective at 70 and older; against postherpetic neuralgia it is 91% effective for adults 50 and older and 89% at 70 and older. In adults with weakened immune systems it is 68% to 91% effective depending on the condition, and in healthy people 70 and older protection stayed high for at least 7 years (CDC). A 2023 Cochrane review of 26 studies concluded the recombinant vaccine is probably effective for at least three years, and that there are no data yet to recommend revaccination; most trial participants were healthy adults aged 60 or older (Cochrane review, 2023). The label says Shingrix is not meant to prevent chickenpox (FDA label (DailyMed)).

Side effects

  • CDC says side effects are usually temporary, lasting 2 to 3 days: a sore arm, redness and swelling at the injection site, tiredness, muscle pain, headache, shivering, fever, stomach pain and nausea. They were more common in younger people, and CDC says to get the second dose even if you reacted to the first (CDC). The Cochrane review found these reactions were common but mostly mild to moderate (Cochrane review, 2023).
  • Guillain-Barré syndrome (GBS) has been reported very rarely after Shingrix, and CDC notes a very small increased risk of GBS after shingles itself (CDC). The label says postmarketing observational studies saw an increased risk of GBS in the 42 days after vaccination, and that fainting can occur with injected vaccines (FDA label (DailyMed)).

Who should not, or should wait

Do not get Shingrix if you have had a severe allergic reaction to any part of the vaccine or to a previous dose, or if you currently have shingles. CDC says pregnant people should wait, and people with a moderate or severe illness should wait until they recover; a minor illness such as a cold should not stop you (CDC, FDA label (DailyMed)). If you have a weakened immune system and no record of chickenpox, ask your doctor (CDC).

What it costs

Medicare says you pay nothing for the shingles vaccine if you have Part D, because plans do not charge a copayment or deductible for vaccines ACIP recommends (Medicare.gov). Cost for other insurance and no insurance: being researched.

Another approach

Postherpetic neuralgia and pain control

Postherpetic neuralgia (PHN) is nerve pain that remains where the shingles rash was, after the rash has healed. CDC calls it extremely painful and says it can last months or years and interfere with daily life (CDC). MedlinePlus says it usually improves over weeks or months but lasts years for some people (MedlinePlus). The NHS defines it as pain lasting several months after the rash has gone (NHS). It is a form of nerve pain; see our Nerve Damage & Peripheral Neuropathy guide.

Can it be prevented?

The vaccine is the strongest tool: CDC reports 91% effectiveness against PHN in adults 50 and older (CDC). Early antivirals help the acute illness, but a Cochrane review found that oral acyclovir did not significantly reduce PHN (Cochrane review, 2014), and another found the effect of oral steroids during the rash on PHN very uncertain (Cochrane review, 2023).

Conventional treatments

These are prescription choices, decided with your doctor or a pain specialist:

  • Gabapentin-type medicine. MedlinePlus says gabapentin is prescribed to relieve the pain of PHN, may cause drowsiness and dizziness, and should not be stopped suddenly (MedlinePlus). In a Cochrane review, about 32% of people with PHN taking gabapentin had at least 50% pain relief versus 17% on placebo, and about 46% versus 25% had at least 30% relief; the authors note that over half of treated people will not have worthwhile pain relief (Cochrane review, 2017). One brand-name gabapentin tablet (Gralise) carries an FDA label specifically for managing PHN, and the label says it is not interchangeable with other gabapentin products (Gralise label (DailyMed)).
  • Lidocaine patch. The Lidoderm label says it is indicated for relief of pain associated with PHN and should be applied only to intact skin (Lidoderm label (DailyMed)).
  • Capsaicin skin patch. The Qutenza label lists it for neuropathic pain associated with PHN; it is applied by a health care professional and not on broken skin (Qutenza label (DailyMed)). A 2016 review of six placebo-controlled trials of topical capsaicin for PHN found results in favor of capsaicin, with side effects consistently more frequent (Yong et al., 2016).

Acupuncture and mindfulness are covered in the sections above. If pain is not improving or is wearing you down, tell your doctor.

Another approach

Shingles near the eye, ear and face

Shingles that involves the face needs extra attention because of what lies beneath: the eye, the ear and the facial nerve.

The eye

CDC says shingles on the face can affect the eye and cause vision loss (CDC). Its clinical overview says treatment within 72 hours helps prevent progressive corneal involvement and potential vision loss (CDC). The NHS says a rash on the eye or nose, or any change in vision, needs urgent advice (NHS). Do not wait to see whether it improves. See our Eyes guide for general eye care.

The ear and the facial nerve (Ramsay Hunt syndrome)

When the virus spreads to the facial nerves, the condition is called herpes zoster oticus, or Ramsay Hunt syndrome. NINDS lists intense ear pain, a rash around the ear, mouth, face, neck and scalp, and paralysis of the facial nerves, with possible hearing loss, vertigo, ringing in the ears, loss of taste and dry mouth and eyes. Doctors may prescribe antivirals or corticosteroids when treatment is needed (NINDS).

A 2008 Cochrane review found only one small, low-quality trial of antivirals for Ramsay Hunt syndrome (15 people), with no statistically significant difference, and the authors cautioned that this does not prove antivirals are ineffective (Cochrane review, 2008). That is an older review, so ask your doctor what is recommended now. See also our Bell’s Palsy guide and the Ear guide.

Another approach

Protecting other people

You cannot catch shingles from someone who has it. What you can catch is chickenpox, if you have never had chickenpox or the chickenpox vaccine: the virus spreads through direct contact with fluid from shingles blisters, or by breathing in virus particles from the blisters (CDC). People with chickenpox are more likely to spread the virus than people with shingles, and people with shingles cannot spread it before the blisters appear or after the rash scabs over (CDC). MedlinePlus says the risk is low if the rash stays covered (MedlinePlus).

What to do

  • Cover the rash, avoid touching or scratching it, and wash your hands often for at least 20 seconds (CDC).
  • Until the rash has scabbed over, avoid contact with pregnant women who have never had chickenpox or the vaccine, premature or low-birth-weight infants, and people with weakened immune systems (CDC). The NHS also lists babies under 1 month, and says to stay off work or school while the rash is oozing and cannot be covered (NHS).

If you have been around someone with shingles and are pregnant, have a weakened immune system or have never had chickenpox, call your doctor to ask what to do.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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