Pediatric Herpes Zoster (Shingles)

Shingles (herpes zoster) is a painful skin rash. It’s caused by the varicella-zoster virus (VZV). This is the same virus that causes chickenpox.

After a person has chickenpox, the virus stays in the body’s nerve cells but is inactive. Months or years later, the varicella-zoster virus can become active again. The virus can then cause a red rash or small blisters, usually on one side of the body. The rash or blisters spread along a nerve pathway where the virus was living.

Shingles in children is not common. A child is more at risk for shingles if either of these are true:

• They had chickenpox before age 1.
• The child’s mother had chickenpox very late in pregnancy.
• The child has a weak immune system from a health condition or certain treatments such as cancer therapy.

Children who get the chickenpox vaccine still have a small risk for shingles. But it may be a lower risk than after a chickenpox infection. And the symptoms may be less severe.

The symptoms start with pain, burning, tingling or itching on one part of the face or body. The rash can appear up to five days after these symptoms.

The shingles rash most often occurs on the torso and buttocks. It may also appear on the arms, legs, or face. The rash starts as small, red spots that turn into blisters. The blisters turn yellow and dry. The rash is usually only on one side or part of the body. It goes away in two to four weeks.

Your child may also have symptoms such as:

• Fever and chills
• Headache
• Nausea

The symptoms of shingles can be like other health conditions. Make sure your child sees a provider for a diagnosis.

The health care provider will ask about your child’s symptoms and health history. Your child will have a physical exam. Shingles can generally be diagnosed by the exam alone. Your child may also have tests, such as:

• Skin scrapings. The blisters are gently scraped to remove tiny samples. The samples are tested to check for the virus.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

Treatment right away with antiviral medicine may help lessen how long the symptoms last and how serious they are. These antiviral medicines work better the sooner they are started. Your child may be given acyclovir, famciclovir or valacyclovir. Talk with your child’s health care providers about the risks, benefits and possible side effects of all medicines.

Ask the health care provider about over-the-counter pain medicine. You may be able to give acetaminophen or ibuprofen for fever and discomfort. Don't give ibuprofen to a child younger than 6 months old, unless your health care provider tells you to. Don't give aspirin to children. Aspirin can cause a serious health condition called Reye syndrome.

If your child’s pain is severe, the health care provider may prescribe stronger pain medicine.

A shingles rash can get infected with bacteria, causing a skin infection (cellulitis). After the shingles rash is gone, the pain may continue for a long time. This is a complication called postherpetic neuralgia (PHN). Talk with the health care provider if your child’s pain stays after the rash goes away.

There is a shingles vaccine for older adults, but not for children. This is because shingles is more severe in older adults. But a child who has had the chickenpox vaccine may have milder symptoms of shingles. If your child has not had chickenpox, talk with the health care provider about the chickenpox vaccine.

Call the health care provider if your child has:

• Symptoms that don’t get better, or get worse
• New symptoms