Shingle is a viral infection that causes a prototypical vesicular rash, and it’s often marked by intense pain during the active outbreak phase.
The Centers for Disease Control and Prevention (CDC) estimate that about one in three people in the US will develop shingles in their lifetime, and some people are affected by recurring shingles.¹
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People who have had chickenpox are at risk of developing shingles. This is because the chickenpox virus, the varicella-zoster virus (VZV), stays inactive in your body after your original outbreak. This virus may reactivate later in life. When this happens, shingles reoccur.
In healthy people, the virus reactivates because cellular immunity and levels of antibodies can decrease as time passes. People with a compromised immune system are also susceptible to having a shingles outbreak, as well as those over 50.
Many people who have had an outbreak wonder, can shingle come back? Shingles recurrence happens in a small percentage of people who have had an initial outbreak.
Research has shown that the same strain of the virus responsible for the first outbreak is responsible for the second outbreak. It has also shown that the same dormant virus is reactivated again, not a new infection with a different virus.²
While you can conceivably have shingles outbreaks an unlimited number of times, one long-term study conducted for more than a decade found that:
87 of the 1,669 participants had just one shingles recurrence,
3 participants had two shingles recurrences, and
2 participants had three shingles recurrences.
This research supports the CDC’s estimate that most people who experience the condition will only have one outbreak in their lifetime. Ultimately, research shows that approximately 1–6% of adults will have a second episode of shingles.³
More than three cases of shingles in a lifetime were an extreme rarity.
While most people in the multi-year study had a single occurrence of shingles, certain groups were more likely to experience multiple outbreaks.
Women (7.2%) were more likely to experience recurrent shingles than men (4.5%). People with weakened immunity (12%) were also more likely to experience recurrent shingles than those with normal immunity (5.7%).
The most significant finding from this multi-year study is that the length of shingles pain symptoms during the initial outbreak was the most predictive risk factor for recurring shingles.
According to the data, 4.9% of people experienced more than one outbreak when their pain lasted less than 30 days, while 12.1% of people experienced more than one outbreak when their pain lasted 30 days or more.
A shingles recurrence is marked by the same symptoms as the first outbreak, including:
A red-colored, flat rash that forms into fluid-filled blisters occurring typically in a single nerve area called a dermatome
Tingling or burning sensations right 1 to 3 days before the vesicular rash occurs
Pain that builds during the acute (outbreak) phase
Headaches, nausea, fever, chills, and itching
Temporary face paralysis as well as auditory issues (Ramsay Hunt syndrome) when an outbreak occurs in that region
For recurring shingles, outbreaks sometimes occur on the opposite side of the body from the first occurrence. They’ve also been shown to appear on a different location (such as an arm vs. the face) in 45% of recurrences.⁴
Like with the first occurrence of shingles, a compromised immune system is the most significant risk for triggering the chickenpox virus to reactivate in adulthood and create a shingles outbreak. This may be caused by several factors, like taking medications that suppress the immune system or having a chronic disease.
In addition, since cellular immunity decreases with age, the risk of developing the condition rises after age 50. Research shows that women aged 50–69 had the highest risk of having more than one outbreak among all age groups and genders studied.
If you continue to experience shingles outbreaks, you should talk to your doctor about testing for an underlying health issue weakening your immune system.
Some potential health issues that may lead to a shingles outbreak include certain cancers like lung, prostate, and breast cancer, and HIV and AIDS.
Your doctor can also order testing to rule out other etiologies, such as contact dermatitis or recurrent zosteriform herpes simplex (i.e., HSV).
Your doctor will perform an initial physical exam to check your signs and symptoms. Certain conditions like eczema and psoriasis can look like shingles, so a PCR test is often the test of choice to confirm the diagnosis. It’s considered the most accurate for determining if the varicella-zoster virus that causes shingles is present on your skin.
For people with shingles symptoms who are unsure if they’ve had chickenpox in the past, an antibody test may be given first to determine if your body has encountered VZV before.
According to the National Institutes of Health (NIH), your risk for stroke increases after a shingles outbreak, especially with shingles of the eye. In fact, in one study of more than half a million people, the risk of stroke increased by 35% for those who contracted shingles, and the risk of heart attack increased by 59%.⁵ ⁶
Other potential complications of shingles include:
Vision loss for those with ophthalmic (eye) shingles
Hearing loss for those with Ramsay Hunt syndrome (herpes zoster oticus)
Postherpetic neuralgia (or PHN, the pain after an outbreak clears up) that may last for a lifetime
Bacterial infections in the skin lesions
Temporary paralysis of facial nerves
Between 1–4% of people with shingles are hospitalized due to these or other complications.
Like with an initial shingles outbreak, antiviral medications are prescribed to help clear up a recurring shingles outbreak. Taking antiviral medications prescribed by your doctor as soon as you notice symptoms of shingles can reduce your risk of developing PHN pain by almost half.
New treatments are also being researched to understand how the shingles virus influences the body to allow for reactivation, and clinical trials are ongoing.
In addition, one antiviral medication, valacyclovir, is being tested as part of a multi-year study to determine its success in treating recurring complications from ophthalmic (eye) shingles.⁷
Keeping your immune system healthy is key to helping reduce your risk of shingles. This may include:
Eating a healthy diet
Cutting out (or decreasing) smoking and alcohol consumption
Maintaining a regular schedule of physical activity
Getting enough sleep for your body to rest and repair
Your doctor may also prescribe certain pain medications like Neurontin (commonly called gabapentin) to help you better manage shingles pain after the acute illness.
Likewise, a group of drugs called tricyclic antidepressants is considered part of the first line of management of PHN pain. Many people also use over-the-counter pain and numbing creams and capsaicin 8% patches.
In addition to focusing on your immune health, the Shingrix vaccine is recommended by NIH and CDC for adults aged 50 and older who have had shingles. It is 90% effective overall in preventing shingles outbreaks and 89–91% effective in preventing PHN pain.⁸
Yes, the NIH recommends getting a shingles vaccine even if you’ve already had shingles to help prevent a recurrence of the condition.
Recurring shingles is most common in people with a compromised immune system. Also at risk are women aged 50–69 and people who have experienced pain for 30 days or more during the first outbreak.
Since the shingles virus has been shown to increase your risk for heart attack, stroke, bacterial infections, vision loss, and hearing loss, treatments such as antiviral and pain medications and a healthy diet, as well as appropriate exercise and sleep are all used to help clear up symptoms and reduce your risk for experiencing multiple outbreaks.
The Shingrix vaccine has also been shown to be 90% effective in preventing the condition, and it’s recommended even if you’ve already had an outbreak to help stop shingles from coming back.
Yes. Research has shown that about 6.2% of people who have had shingles once get it again.
A lowered immune response is linked to shingles reactivation. Cellular immunity tends to decrease over time, which is why people 50 and older are particularly susceptible to shingles outbreaks. Chronic health conditions or taking immunosuppressant medications can also increase your risk.
The best ways to avoid recurring shingles are to keep your immune system healthy and strong and get the Shingrix vaccine, which is 90% effective in preventing outbreaks.
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Shingles: Hope through research | National Institute of Neurological Disorders and Strokes
Zoster eye disease study (ZEDS) | Clinical Trials.gov
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Transmission | Centers for Disease Control and Prevention
Ramsay hunt syndrome (2022)
CDC seeks to protect older adults with shingles vaccine message | Chronic Disease
Shingles | NHS Inform
Shingles more likely to develop in people with cancer | Cancer Health
Diagnosis & testing | Centers for Disease Control and Prevention
Clinical overview | Centers for Disease Control and Prevention
Herpes zoster ophthalmicus (2008)
Shingles | National Institute of Neurological Disorders and Strokes
New developments in herpes zoster infections | American Academy of Opthalmology
Six tips to enhance immunity | Centers for Disease Control and Prevention
How sleep affects immunity | Sleep Foundation