Prodromal symptoms of shingles usually start one to two days before the actual outbreak. As the outbreak nears, the skin sensations can worsen and cause moderate to severe aching, burning, or stinging pain.
Slideshow: A Visual Guide to Shingles
If you’ve ever had the chickenpox — and almost all adults have or have at least been exposed to it– there’s a good chance the virus is still at large in your body. The varicella zoster virus can lie dormant for decades without causing any symptoms. In some people, the virus wakes up and travels along nerve fibers to the skin. The result is a distinctive, painful rash called shingles.
What Does the Shingles Rash Look Like?
2/18
The shingles rash can be a distinctive cluster of fluid-filled blisters — often in a band around one side of the waist. This explains the term “shingles,” which comes from the Latin word for belt. The next most common location is on one side of the forehead or around one eye. But shingles blisters can occur anywhere on the body.
Shingles Symptoms: Before the Rash
3/18
The first symptoms of shingles appear one to five days before the rash. These early warning signs are usually felt in the location where the rash will develop:
Other Symptoms of Shingles
4/18
While the localized pain and rash are the tell-tale signs of shingles, other symptoms may include:
- Fever
- Chills
- Headache
- Upset stomach
Shingles or Something Else?
5/18
Small blisters that appear only on the lips or around the mouth may be cold sores, sometimes called fever blisters. They’re not shingles, but are instead caused by the herpes simplex virus. Itchy blisters that appear after hiking, gardening, or spending time outdoors could be a reaction to poison ivy, oak, or sumac. If you aren’t sure what’s causing your rash, see your healthcare provider.
What Causes Shingles?
6/18
The varicella zoster virus is the culprit behind both chickenpox and shingles. The first time someone is exposed to the virus, it causes the widespread, itchy sores known as chickenpox. The virus never goes away. Instead, it settles in nerve cells and may reactivate years later, causing shingles. It’s also called herpes zoster, but it’s not related to the virus that causes genital herpes.
Diagnosing Shingles
7/18
A doctor can usually diagnose shingles just by looking at the rash. If you have shingles symptoms, see your healthcare provider even if you think you’ve never had chickenpox. Many childhood cases of chickenpox are mild enough to go unnoticed, but the virus can still linger and reactivate. To help prevent complications, it’s important to start treatment as soon as possible after the shingles rash appears.
How Long Does Shingles Last?
8/18
Shingles blisters usually scab over in 7-10 days and disappear completely in two to four weeks. In most healthy people, the blisters leave no scars, and the pain and itching go away after a few weeks or months. But people with weakened immune systems may develop shingles blisters that do not heal in a timely manner.
Who’s at Risk for Shingles?
9/18
Anyone who has ever had chickenpox can get shingles, but the risk increases with age. People older than age 60 are up to 10 times more likely to get shingles than younger people. Other factors that increase your risk include:
- Some cancer medicines
- Steroid medicines
- Long-term stress or trauma
- A weak immune system from illnesses such as cancer or HIV
A quarter of adults will develop shingles at some point, and most are otherwise healthy.
Is Shingles Contagious?
10/18
Yes, but not in the way you may think. Your shingles rash will not trigger an outbreak of shingles in another person, but it can sometimes cause chickenpox in a child. People who’ve never had chickenpox, or the vaccine to prevent it, can pick up the virus by direct contact with the open sores of shingles. So keep a shingles rash covered and avoid contact with infants, as well as pregnant women who have never had chickenpox or the varicella vaccine and people who may have weak immune systems such as chemotherapy patients.
Can Shingles Cause Chronic Pain?
11/18
In some people, the pain of shingles may linger for months or even years after the rash has healed. This pain, due to damaged nerves in and beneath the skin, is known as postherpetic neuralgia. Others feel a chronic itch in the area where the rash once was. In severe cases, the pain or itching may be bad enough to cause insomnia, weight loss, or depression.
Other Complications of Shingles
12/18
If the shingles rash appears around the eye or forehead, it can cause eye infections and temporary or permanent loss of vision. If the shingles virus attacks the ear, people may develop hearing or balance problems. In rare cases, the shingles virus may attack the brain or spinal cord. These complications can often be prevented by beginning treatment for shingles as soon as possible.
Treatment: Antiviral Medication
13/18
While there is no cure for shingles, antiviral medications can put the brakes on an attack. Prompt treatment can make a case of shingles shorter and milder. Doctors recommend starting prescription antiviral drugs at the first sign of a shingles rash. Options include acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex).
Treatment: Rash Relief
14/18
Over-the-counter pain relievers and anti-itch lotions, such as calamine, can help relieve the pain and itching of the shingles rash. If the pain is severe or the rash is concentrated near an eye or ear, consult your doctor right away. Additional medications, such as corticosteroids, may be prescribed to reduce inflammation.
Home Care for Shingles
15/18
Colloidal oatmeal baths are an old standby for relieving the itch of chickenpox and can help with shingles, as well. To speed up the drying out of the blisters, try placing a cool, damp washcloth on the rash (but not when wearing calamine lotion or other creams.) If your doctor gives you the green light, stay active while recovering from shingles. Gentle exercise or a favorite activity may help keep your mind off the discomfort.
Shingles Vaccine
16/18
The CDC recommends that healthy adults ages 50 and older get the shingles vaccine, Shingrix, which provides greater protection than Zostavax. The vaccine is given in two doses, 2 to 6 months apart. Zostavax is still in use for some people ages 60 and older.
Who Should Not Get the Vaccine?
17/18
Do not get the shingles vaccine if:
- You have a severe allergic reaction, such as anaphylaxis, to any ingredient of a vaccine or to a previous dose of Shingrix
- You have shingles now.
- You are sick with an illness and a fever of 101°F or higher.
- You should also consider delaying the vaccine if you are pregnant or breastfeeding. Not enough is known about its safety for expectant and lactating women.
- You have had a negative test for varicella; this would be uncommon for adults eligible for the vaccine, as most adults worldwide ages 50 and older have been exposed to the virus. You do not have to be tested before getting the vaccine.
Chickenpox Vaccine and Shingles
18/18
Since the late 1990s, most children in the U.S. have received the varicella vaccine to protect against chickenpox. This vaccine uses a weakened strain of the varicella zoster virus that is less likely to settle into the body for the long haul.
Show Sources
IMAGES PROVIDED BY:
(1) CNRI / Photo Researchers, Inc.
(2) Bart’s Medical Library / Phototake
(3) Steve Pomberg / WebMD
(4) Thinkstock
(5) Interactive Medical Media, LLC; Scott Camazine / Phototake; John Kaprielian / Photo Researchers
(6) Peggy Firth and Susan Gilbert for WebMD
(7) N. M. Hauprich / Photo Researchers, Inc
(8) N. M. Hauprich / Photo Researchers, Inc
(9) Hans Neleman / Stone
(10) Dr. P. Marazzi / Photo Researchers
(11) David Mack / Photo Researchers
(12) SPL / Photo Researchers, Inc.
(13) Steve Pomberg / WebMD
(14) Denis Felix / Stone
(15) Steve Pomberg / WebMD
(16) Getty Images
(17) Thinkstock
(18) Thinkstock
American Academy of Dermatology: “Lip and Mouth Care” and “Poison Ivy: Signs and Symptoms.”
Centers for Disease Control and Prevention: “Shingles: Signs & Symptoms;” “Shingles: Transmission;” “Shingles (Herpes Zoster): Prevention and Treatment;” “Shingles Vaccination: What You Need to Know;” “Shingrix Recommendations;” and “What Everybody Should Know about Zostavax.”
National Institute of Allergy and Infectious Diseases: “”Shingles Symptoms,” “Shingles Diagnosis,” “Shingles Treatment.”
National Institute of Neurological Disorders and Stroke: “Shingles: Hope Through Research.”
What Shingles Looks Like
Cory Martin is the author of seven books including “Love Sick” a memoir about dating, life in Hollywood and dealing with MS. Her essays have appeared online with CNN, HuffPost, Everyday Health, Psychology Today, Folks, The Mighty, and more.
Updated on April 14, 2023
Casey Gallagher, MD, is board-certified in dermatology and works as a practicing dermatologist and clinical professor.
Table of Contents
Table of Contents
A shingles rash looks like a cluster of tiny, fast-growing blisters that quickly merge, rupture, and crust over. A shingles outbreak almost always develops on side of the body and follows a string of nerves servicing a specific part of the body (called a dermatome ).
There are a total of 30 dermatomes in the body that individually service parts of the face, scalp, arms, chest, abdomen, back, buttocks, groin, tailbone, genitals, and feet. Shingles is typically constrained to one of these areas, causing a rash that looks similar to chickenpox.
Despite these tell-tale signs, shingles is often confused with other skin conditions. This can result in delayed treatment which, in turn, can lead to a longer or more severe outbreak.
This article describes what a shingle rash looks like at different stages of the infection. It also lists other conditions that look like shingles and explains what to expect after a shingles rash has cleared.
Symptoms Before Rash
Shingles is caused by the reactivation of the chickenpox virus, called the varicella-zoster virus (VZV). After someone gets chickenpox, VZV embeds itself in the nerve roots of the spine where it can lie dormant for decades.
In later years, VZV can reactivate and quickly multiply, moving from the spinal nerve root to the branches of nerves in the skin.
When VZV first reactivates, a person can experience so-called prodromal symptoms as the body reacts to the emergent virus. Prodromal symptoms are those that are non-specific and occur before the main symptoms appear.
With shingles, the prodromal symptoms include:
- Headache
- Mild fever
- A burning, tingling, numbness, or itchiness on a specific part of the body
- Malaise (a general feeling of unwellness)
Prodromal symptoms of shingles usually start one to two days before the actual outbreak. As the outbreak nears, the skin sensations can worsen and cause moderate to severe aching, burning, or stinging pain.
Initial Rash
Soon after the onset of prodromal symptoms, slightly reddish patches of skin with small bumps ( papules ) will develop in a cluster in the areas of pain. These often look like pimples or an allergic rash but are differentiated by sharp, needle-like pain, particularly if you scratch or pick at them.
Joel Carillet / Getty Images
The pain is caused by both the inflammation and the overstimulation of nerves by the fast-multiplying virus. This differs from rashes that originate in skin cells in which nerves are affected collaterally rather than directly.
Moreover, the nerves that VZV inhabits are sensory ganglia whose function is to send sensory information from the skin to the brain.
As the infection progresses, more bumpy patches can develop, often following a visible pathway along the nerve string.
Vesicles Rash
As VVZ migrates to the skin, the virus will multiply rapidly between the outermost (epidermal) layer of skin and the underlying (dermal) layer of skin.
Following the appearance of bumpy patches, tiny blisters ( vesicles ) will appear within 12 to 24 hours. These vesicles form when inflammation causes fluid to leak from swollen tissues into the tiny papules.
pinglabel / Getty Images
Blisters
The rapid development of blister clusters will reveal one of the hallmarks of a shingles infection, namely the so-called “shingle belt.” This manifests as a single stripe that runs along one side of the body (such as one side of the trunk, one side of the face, or down one thigh).
Only one side is affected because there are two separate nerve roots on each side of the spine, each of which services the same body part on the opposite side.
Though rare, shingles can affect more than multiple dermatomes. This can lead to widespread shingles across the body.
Over the course of the next 48 hours, the blisters will start to turn cloudy and increase in number and size. Many will converge into larger blisters and/or rupture, leaving behind a raw, indented, oozing ulcer.
At this stage, the pain can be extreme, making movement or even the lightest touch excruciating.
Scabs and Crusting
Once a herpes blister ruptures, the secreted fluid will crystalize and form a honey-colored crust. A scab will form underneath, stemming the oozing fluid and allowing the ulcer to heal. The healing of the sore and shedding of the scab takes a week to 10 days.
A lesion is no longer considered contagious 72 to 96 hours after a scab has naturally fallen away.
franciscodiazpagador / Getty Images
But even as sores begin to heal, new clusters of blisters can continue to form. Depending on the severity of an outbreak, shingles can three to five weeks to progress through all of its stages.
Can You Shorten an Outbreak?
There is no cure for shingles. However, antiviral drugs can shorten the duration and severity of an outbreak, especially when taken within the first three days of the appearance of a rash.
Eye Shingles
Ophthalmic shingles, also known as herpes zoster ophthalmicus (HZO), occur when the shingles develops in or around the eye. It is a severe variant that affects 20% of people with shingles. People with compromised immune symptoms, such as those with advanced HIV, are at the highest risk.
HZO usually appears within two to four weeks of a shingles outbreak, causing a blistering rash around the eyes and eyelids. The infection can extend to the cornea (the transparent layer in front of the eye), causing scarring and potentially severe vision loss.
lauraag / Getty Images
Eye damage can also occur due to inflammation of the blood vessels servicing the eye. The rupture of these vessels can deprive these nerves (including the optic nerve) of the oxygen and nutrients they need to survive. Damage to these nerves can also affect vision.
If you develop a shingles rash near the eye, contact your healthcare provider without delay.
Is It Shingles or Something Else?
A shingles rash may seem pretty self-evident, but there are other conditions that can also cause a blistering, painful rash.
While your healthcare provider may prescribe treatment based on the presumption of shingles, it is important to undergo a complete evaluation to ensure some other condition (requiring a whole different course of treatment) is not involved.
These include conditions like:
- Genital herpes
- Contact dermatitis
- Poison ivy
- Dermatitis herpetiformis (celiac disease rash)
- Allergic drug reactions
- Autoimmune blistering diseases like pemphigus and pemphigoid
Other Symptoms
Scratching shingles blisters—or scabs as the rash heals—increases your risk of a secondary bacterial infection. Secondary infections are relatively easy to establish when bacteria beneath the fingernails are introduced into exposed tissue within a sore. This can slow healing times and even lead to permanent scarring.
Phadungsakphoto / Getty Images
Never scratch a shingles rash. Instead, tap the skin or apply a cool, moist cloth to help ease the itch. Over-the-counter remedies like calamine lotion and colloidal oatmeal baths may also help.
Call a healthcare provider immediately if you experience signs of a secondary skin infection, including fever, a pus-like discharge, or increasing redness, swelling, or heat.
Symptoms After the Rash Disappears
Even after a shingles outbreak resolves, you may experience long-lasting nerve pain due to the inflammatory damage caused to nerves.
This condition, known as postherpetic neuralgia , is the most common complication of shingles. It causes burning pain that can last for months and years after the infection has cleared.
People over 60s are at the greatest risk, which is why shingles vaccination is recommended for adults 50s and over. There is no cure for postherpetic neuralgia, but different medications can help ease the pain.
There is also some evidence that the early use of antiviral drugs during the early stages of the infection can reduce the risk or severity of postherpetic neuralgia compared to people who have not received treatment.
For most people, postherpetic neuralgia gets better over time.
Shingles Doctor Discussion Guide
Get our printable guide for your next appointment with a healthcare provider to help you ask the right questions.
About Us
Family Medicine
In 2024 our team of doctors and nurses provide a comprehensive range of family planning services. Our doctors have expertise in antenatal care, preconception planning, and STD checks. Contraceptive advice including Mirena and Implanon insertion is available.
- Early detection of illness;
- Family planning;
- Promotion of healthy lifestyle;
- Skin cancer checks;
- Sports injuries;
- Weight reduction;
- Workers compensation and third party.
Children's Health
Baby Weighing Service. Babies can be booked with our Nurse for weighing, a doctors appointment is not required to use this service. Contact reception for a appointment to have your baby weighed.
Immunisations. At Tuggeranong Square children's immunisation is regarded an important part of your childs health care. Our doctors take immunising children very seriously. and to ensure all children are immunised Tuggeranong Square Medical Practice doctors BULK BILL for all childhood immunisations. Tuggeranong Square Medical Practice also ensures the Practice Nursing Staff are highly trained in childhood immunisations.
Women's Health
Our practice is dedicated to treating a wide spectrum of women’s health concerns. We offer pre-natal, antenatal and postnatal care, contraceptive options, pap screening, and preventative health care advice. We provide assistance, advice and support through all stages of life, recognising the many issues many women may face from adolescence through to the peri and post-menopausal period.
- Cervical Screening tests;
- Reproductive health. Including Mirena and Implanon insertion;
- Shared antenatal care.
Men's Health
We encourage men to present routinely to their GP to discuss all aspects of their health. We provide comprehensive advice and support for men to address the prevention and management of various health conditions. This may include assessments for cardiovascular risk, diabetes, cancer prevention, mental health assessments, STD screening, sports injuries and the importance of sleep as it relates to other areas of health.
- Preventative Healthcare. Including cardiovascular screening, mental health and cancer checks;
- Prostate examination.
