COVID-19 has been linked with a slew of unusual side effects, like COVID toes and loss of taste and smell, but new research has found having the virus can also increase your risk of developing another illness: shingles.

That’s the main takeaway from a new study published in the journal Open Forum Infectious Diseases. For the study, researchers analyzed data from nearly 2 million people ages 50 and up and compared the rate of shingles (aka herpes zoster) in people who had COVID-19 to those who never had the virus.

The researchers found that people who had COVID-19 had a 15% higher risk of shingles than those who didn’t have the virus. The risk was even higher—21%—in people who had been hospitalized with COVID-19.

This, the researchers concluded, highlights “the relevance of maintaining herpes zoster vaccination.”

It seems weird that you might get shingles after having COVID, but experts say it’s not shocking. Here’s what you need to know about the link.

What is shingles, again?

Shingles is a condition caused by the varicella zoster virus, the same virus that causes chickenpox, according to the Centers for Disease Control and Prevention (CDC). After you recover from the chickenpox, the virus stays inactive in your body. However, it can reactivate years later, causing shingles.

Shingles causes a painful rash that develops on one side of the face or body. It can cause pain, itching, or tingling in the area, along with fever, headache, chills, and an upset stomach. “It can be very painful when you have shingles and can be problematic in some people afterwards as well,” says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York. Shingles can even cause something known as post-herpetic neuralgia, he says, which is essentially lingering pain from the virus.

How can COVID-19 raise your risk of shingles?

The study didn’t look into this, but there are some theories. SARS-CoV-2, the virus that causes COVID-19, “is known to cause immune dysfunction and physiologic stress,” says infectious disease expert Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security. This, he says, may lead to a reawakening of the varicella zoster virus.

In general, people are at a higher risk of developing shingles as they get older and their immune system starts to weaken, the American Academy of Dermatology (AAD) says. However, other people with a weakened immune system, like those who have certain cancers, HIV, take medication to suppress their immune system, or are undergoing chemotherapy are also at a greater risk, the AAD says.

“But we don’t always know exactly why people develop shingles in the first place,” says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. “Many people develop shingles and they cannot identify any precipitating event.” Dr. Russo agrees. “When people develop shingles, sometimes it’s quite mysterious why it’s happened,” he says.

Still, Dr. Schaffner says, there have been anecdotal reports of people developing shingles after they’ve had an infection. “It’s not entirely clear why this is the case—you’d think an infection would rev up the immune system and shingles is supposed to occur when the immune system is suppressed,” Dr. Schaffner says.

Are rashes symptoms of coronavirus?

Currently, the CDC does not mention a rash as one of the main symptoms of COVID-19. That list of symptoms includes:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

    However, Dr. Schaffner says, “rashes have been described but are not a prominent feature of COVID-19.”

    What are the common skin manifestations of COVID-19?

    There have been reports of other skin issues that develop from COVID-19. A big one, Dr. Schaffner says, is COVID toes, which are unusual blisters and skin discolorations that can develop on the toes when someone has the virus.

    The AAD also says that COVID-19 can cause the following skin manifestations:

    • Itchy bumps
    • Blisters that look like chickenpox
    • Round, pinpoint spots on the skin
    • Large patches with several smaller ones
    • A lace-like pattern on the skin
    • Flat spots and raised bumps that join together

      How can you lower your risk of developing shingles from COVID?

      To lower your risk of developing shingles from COVID, Dr. Russo recommends getting both your COVID-19 vaccine and herpes zoster vaccine (if you’re eligible). The CDC currently recommends that people ages 60 and up get the herpes zoster vaccine, whether or not they had shingles in the past.

      If you’ve had the chickenpox vaccine (which is recommended for children, teens, and adults who have never had chickenpox and were never vaccinated), it should also lower your risk, Dr. Russo says, although there’s no data on this just yet.

      Overall, though, Dr. Schaffner points out that reducing the odds you'll get COVID-19 should tamp down on the risk you'll develop shingles as a complication of the virus.

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