Table of ContentsView AllTable of ContentsEarly SymptomsInitial RashShingles Blisters"Shingles Belt"Scabs and CrustingEye ShinglesSimilar ConditionsRisk of InfectionChronic Nerve Pain
Table of ContentsView All
View All
Table of Contents
Early Symptoms
Initial Rash
Shingles Blisters
“Shingles Belt”
Scabs and Crusting
Eye Shingles
Similar Conditions
Risk of Infection
Chronic Nerve Pain
A shingles rash looks like a cluster of tiny, fast-growing blisters on a red base of skin. The blisters quickly merge, rupture, and crust over. A shingles outbreak almost always develops on one side of the body and follows a string of nerves servicing a specific part of the body (called adermatome).
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.
Initial Symptoms of Shingles Before Rash
Can I get shingles if I’ve already had chickenpox?A past chickenpox infection doesn’t protect you from shingles, in fact, a past chickenpox infection is the reason why you get shingles. Shingles occurs when the VZV virus is reactivated, which most often happens in adulthood.Once reactivated, it can quickly multiply, moving from the spinal nerve root to the branches of nerves in the skin, causing shingles.
Can I get shingles if I’ve already had chickenpox?
A past chickenpox infection doesn’t protect you from shingles, in fact, a past chickenpox infection is the reason why you get shingles. Shingles occurs when the VZV virus is reactivated, which most often happens in adulthood.Once reactivated, it can quickly multiply, moving from the spinal nerve root to the branches of nerves in the skin, causing shingles.
When VZV first reactivates, a person can experience so-calledprodromal symptomsas the body reacts to the emergent virus. Prodromal symptoms are non-specific and occur before the main symptoms appear.
With shingles, the prodromal symptoms include:
Prodromal symptoms of shingles usually start one to two days before the outbreak. During this time, the skin sensations worsen and may cause moderate to severe aching, burning, or stinging pain.
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. Though the rash may look like pimples or an allergic rash, it produces a sharp, needle-like pain, particularly if you scratch or pick at it.
Joel Carillet / Getty Images
As the infection progresses, more bumpy patches can develop, often following a visible pathway along the nerve string.
Vesicles Rash
As VZV migrates to the skin the virus will multiply rapidly in the outermost (epidermal) layer.Tiny blisters (vesicles) will appear within 12 to 24 hours after the first bumps. These vesicles form when the swelling is significant enough to cause blister formation.
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Blisters
The rapid development of blister clusters is one of the hallmarks of a shingles infection, namely the so-called “shingles 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 multipledermatomes. This can lead to widespread shingles across the body.When shingles occurs in more than one dermatome, it may be an indication of immunosuppression.
Fisle /Wikimedia Commons
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 intense, making movement or even the lightest touch extremely painful.
Is Shingles Contagious?You can’t give someone shingles, but it is possible to pass the varicella-zoster virus to people who are not immune to chickenpox. In that case, the person would develop chickenpox, not shingles.
Is Shingles Contagious?
You can’t give someone shingles, but it is possible to pass the varicella-zoster virus to people who are not immune to chickenpox. In that case, the person would develop chickenpox, not shingles.
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 once the rash has crusted over.
franciscodiazpagador / Getty Images
Even as sores begin to heal, new clusters of blisters can continue to form. Depending on the severity of an outbreak, shingles can take three to five weeks to progress through all stages.
Can You Shorten an Outbreak?There is no cure for shingles. However,antiviral drugscan shorten the duration and severity of an outbreak, especially when taken within the first three days of the appearance of a rash.
Can You Shorten an Outbreak?
There is no cure for shingles. However,antiviral drugscan shorten the duration and severity of an outbreak, especially when taken within the first three days of the appearance of a rash.
Ophthalmic shingles, also known asherpes zoster ophthalmicus(HZO), occur when 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 advancedHIV, are at highest risk.
HZO causes 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. If you develop a shingles rash near the eye, contact your healthcare provider right away.
lauraag / Getty Images
Eye damage can also occur when shingles involves the retina or optic nerve in the back of the eye without causing a skin rash or other symptoms at the surface of the eye. This is called viralretinitis.
Damage in viral retinitis is due to inflammation of the blood vessels servicing the eye. The rupture of these vessels can deprive these nerves (including theoptic nerve) of the oxygen and nutrients they need to survive. Damage to these nerves can also affect vision.
How to Tell if My Rash Is 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:
Other Symptoms
Scratching shingles blisters—or scabs as the rash heals—increases your risk of asecondary 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 inflammatory damage to your nerves.
This condition, known aspostherpetic 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 60 are at the greatest risk, which is why ashingles vaccinationis recommended for adults aged 50 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 antiviral treatment.
For most people, postherpetic neuralgia gets better over time.
How Long Does Shingles Last:?Most cases of shingles don’t last longer than two to five weeks. When complications such as post-herpetic neuralgia occur, the pain may linger for months after other symptoms have cleared up.
How Long Does Shingles Last:?
Most cases of shingles don’t last longer than two to five weeks. When complications such as post-herpetic neuralgia occur, the pain may linger for months after other symptoms have cleared up.
Summary
Shingles proceeds through several different stages. In the early or prodromal stage, you may have mild symptoms such as a headache or low-grade fever. As the infection progresses, you will develop patches of small, reddish bumps that produce a sharp, needle-like pain.
Twelve to 24 hours after the rash appears, tiny blisters called vesicles form, which will rapidly develop into a belt of blister clusters that run along one side of the body. These blisters will eventually rupture, scab, and crust over. Some people continue to experience pain for weeks or months after a shingles infection.
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9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Johnson RW, Alvarez-Pasquin MJ, Bijl M, et al.Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective.Ther Adv Vaccines. 2015;3(4):109-120. doi:10.1177/2051013615599151 [Published correction appears inTher Adv Vaccines. 2016;4(1-2):32.]Tommasi C, Breuer J.The biology of varicella-zoster virus replication in the skin.Viruses. 2022;14(5):982. doi:10.3390/v14050982Kantaria SM.Bilateral asymmetrical herpes zoster.Indian Dermatol Online J. 2015;6(3):236. doi:10.4103/2229-5178.156448MedlinePlus.Shingles | herpes zoster.Tuft S.How to manage herpes zoster ophthalmicus.Community Eye Health. 2020;33(108):71-72.Harvard Health Publishing.Shingles of the eye can cause lasting vision impairment.Institute for Quality and Efficiency in Health Care.Shingles: overview.Texakalidis P, Tora MS, Boulis NM.Neurosurgeons' armamentarium for the management of refractory postherpetic neuralgia: a systematic literature review.Stereotact Funct Neurosurg.2019;97(1):55-65. doi: 10.1159/000499476. PMID: 30995653National Library of Medicine.Shingles: Learn more – Lasting pain after shingles.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Johnson RW, Alvarez-Pasquin MJ, Bijl M, et al.Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective.Ther Adv Vaccines. 2015;3(4):109-120. doi:10.1177/2051013615599151 [Published correction appears inTher Adv Vaccines. 2016;4(1-2):32.]Tommasi C, Breuer J.The biology of varicella-zoster virus replication in the skin.Viruses. 2022;14(5):982. doi:10.3390/v14050982Kantaria SM.Bilateral asymmetrical herpes zoster.Indian Dermatol Online J. 2015;6(3):236. doi:10.4103/2229-5178.156448MedlinePlus.Shingles | herpes zoster.Tuft S.How to manage herpes zoster ophthalmicus.Community Eye Health. 2020;33(108):71-72.Harvard Health Publishing.Shingles of the eye can cause lasting vision impairment.Institute for Quality and Efficiency in Health Care.Shingles: overview.Texakalidis P, Tora MS, Boulis NM.Neurosurgeons' armamentarium for the management of refractory postherpetic neuralgia: a systematic literature review.Stereotact Funct Neurosurg.2019;97(1):55-65. doi: 10.1159/000499476. PMID: 30995653National Library of Medicine.Shingles: Learn more – Lasting pain after shingles.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Johnson RW, Alvarez-Pasquin MJ, Bijl M, et al.Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective.Ther Adv Vaccines. 2015;3(4):109-120. doi:10.1177/2051013615599151 [Published correction appears inTher Adv Vaccines. 2016;4(1-2):32.]Tommasi C, Breuer J.The biology of varicella-zoster virus replication in the skin.Viruses. 2022;14(5):982. doi:10.3390/v14050982Kantaria SM.Bilateral asymmetrical herpes zoster.Indian Dermatol Online J. 2015;6(3):236. doi:10.4103/2229-5178.156448MedlinePlus.Shingles | herpes zoster.Tuft S.How to manage herpes zoster ophthalmicus.Community Eye Health. 2020;33(108):71-72.Harvard Health Publishing.Shingles of the eye can cause lasting vision impairment.Institute for Quality and Efficiency in Health Care.Shingles: overview.Texakalidis P, Tora MS, Boulis NM.Neurosurgeons' armamentarium for the management of refractory postherpetic neuralgia: a systematic literature review.Stereotact Funct Neurosurg.2019;97(1):55-65. doi: 10.1159/000499476. PMID: 30995653National Library of Medicine.Shingles: Learn more – Lasting pain after shingles.
Johnson RW, Alvarez-Pasquin MJ, Bijl M, et al.Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective.Ther Adv Vaccines. 2015;3(4):109-120. doi:10.1177/2051013615599151 [Published correction appears inTher Adv Vaccines. 2016;4(1-2):32.]
Tommasi C, Breuer J.The biology of varicella-zoster virus replication in the skin.Viruses. 2022;14(5):982. doi:10.3390/v14050982
Kantaria SM.Bilateral asymmetrical herpes zoster.Indian Dermatol Online J. 2015;6(3):236. doi:10.4103/2229-5178.156448
MedlinePlus.Shingles | herpes zoster.
Tuft S.How to manage herpes zoster ophthalmicus.Community Eye Health. 2020;33(108):71-72.
Harvard Health Publishing.Shingles of the eye can cause lasting vision impairment.
Institute for Quality and Efficiency in Health Care.Shingles: overview.
Texakalidis P, Tora MS, Boulis NM.Neurosurgeons' armamentarium for the management of refractory postherpetic neuralgia: a systematic literature review.Stereotact Funct Neurosurg.2019;97(1):55-65. doi: 10.1159/000499476. PMID: 30995653
National Library of Medicine.Shingles: Learn more – Lasting pain after shingles.
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