A bout of chickenpox used to be a rite of passage during childhood. Since the vaccine to protect against varicella zoster virus (VZV) became available, most kids can now avoid this itchy infection.

But anyone who has had chickenpox may later develop shingles — even children. The good news is that shingles is pretty rare in kids and teens with healthy immune systems.

Shingles Basics

Shingles, also called zoster or herpes zoster, is a skin rash caused by a viral infection of the nerves just below the skin. Shingles usually appears as a stripe of irritated skin and blisters on one side of the chest or back, but it can occur anywhere on the body, including on the face and near the eyes.

Many cases of shingles have mild symptoms, but more severe cases can be very painful. Luckily, kids and teens almost always have mild cases; the severe cases usually only happen in older people.

Shingles is caused by the same virus that causes chickenpox, so it's highly contagious, meaning it can be easy for a child to pass the virus to others who aren't immune to chickenpox. This includes anyone who hasn't already had chickenpox or gotten the chickenpox vaccine. However, if someone else gets infected, they won't get shingles. They'll get chickenpox instead.

An episode of shingles will generally run its course and disappear in less than a month. Although a shingles flare-up usually resolves on its own, treatments can reduce a child's risk of complications and help him or her heal more quickly.

Causes

Shingles and chickenpox are both caused by the varicella zoster virus. This virus is related to the herpes viruses that cause cold sores and genital herpes, which is why shingles is sometimes called herpes zoster.

After someone has had chickenpox, the virus stays in that person's nervous system for the rest of his or her life, even though the chickenpox goes away. The virus can stay there dormant, or sleeping, for years. In many people, it will never be heard from again. But in about 1 million Americans a year, it flares up and causes shingles. It is possible to get shingles more than once, although this is fairly uncommon.

Doctors aren't sure why the virus suddenly flares up again after months or years of inactivity. It could be because our immune systems become more vulnerable to infections as we age, which might explain why shingles is more common in older adults.

Children who've had chickenpox face a greater risk of developing shingles if their immune systems have been weakened by diseases such as AIDS or cancer, or by certain medications.

Symptoms

In many cases, the first symptom of shingles will be tingling, itching, and sometimes pain in the area where the rash is going to appear. This can be frustrating: Your child may feel itchy, but you'll have no idea what's causing it.

When the rash finally appears, it starts as groups of pimples on one side of the body or face. The pimples change to pus-filled blisters that break open and scab over in about 7 to 10 days. Once the blisters are scabbed over, they begin to heal. The scabs typically heal and fall off about 2 to 4 weeks after the rash appears.

Some kids with shingles also may experience a fever, headache, fatigue, or general achiness. In rare cases, a child can experience the pain of shingles without having a rash.

Some people will have more severe symptoms, but these usually happen in people over age 50.

Complications

Most cases of shingles will heal on their own, with or without treatment, and won't lead to any other problems. In rare cases, shingles can lead to complications, including:

• Ongoing pain (post-herpetic neuralgia): Damaged nerve fibers in the skin send confused messages to the brain, leading to pain that can go on for a long time after a shingles rash has disappeared.
• Vision problems: If shingles occurs near or in a child's eye, it can lead to vision loss.
• Skin infections: A shingles rash can become infected with bacteria, leading to impetigo or cellulitis.
• Nervous system problems: Shingles on the face can involve different nerves that connect to the brain. This in turn can lead to nerve-related problems such as facial paralysis, hearing problems, and problems with balance. In very rare cases, shingles can lead to encephalitis (inflammation of the brain).

Diagnosis

If you think your child might have shingles, call a doctor. If there's a chance your child might have shingles on the face, it's really important to get a doctor's help immediately to keep the infection from spreading to the eyes.

If your child has a weakened immune system, call a doctor right away to avoid complications.

Usually, a doctor can diagnose shingles just by examining a child's rash and blisters. In rare cases, the doctor may remove a small sample of the infected tissue to be examined in a laboratory.

Treatment

Not all kids who get shingles need treatment. But if the doctor decides a treatment may help, it should be started as soon as possible.

Antiviral drugs can't eliminate the virus from the body, but they can reduce the chances of complications and help speed the healing process. The earlier a treatment program is started, the more effective it will be, and the less risk there will be of complications. Talk with a doctor about whether medications might be helpful for your child.

To treat the pain associated with shingles, doctors may prescribe a cream, spray, or skin patch to numb the skin and make it hurt less. Some prescription and over-the-counter medications also can help treat the pain. Don't give your child or teen aspirin, though, as it can lead to a rare but serious illness called Reye syndrome.

If a case of shingles is accompanied by itching, the doctor may recommend medicated lotions or medications called antihistamines.

To help ease the symptoms at home, keep the affected area clean. Wash it with water and a mild soap, and apply cool, wet compresses to the blisters several times a day to lessen pain and itching. Oatmeal baths also can bring relief.

To prevent the virus from spreading to other people, keep your child's rash covered at all times.

Prevention

It's not possible to prevent shingles entirely. The chickenpox vaccine can make a case of shingles less serious. So if your child hasn't had chickenpox, it's not too late to ask your doctor about getting the chickenpox vaccine.

There is a vaccine against shingles, but doctors usually only give it to older adults. That's partly because the older someone is, the more severe shingles can be. Kids are unlikely to be seriously affected by shingles.

Children who get a shingles rash that can't be completely covered should be kept out of school and childcare until the blisters are scabbed over and dry.

Newborn babies, pregnant women, people with weakened immune systems, and anyone who is not immune to chickenpox should avoid close contact with anyone who has shingles until the rash is completely healed.

Reviewed by: Elana Pearl Ben Joseph, MD
Date reviewed: March 2012