Shingles, medically known as herpes zoster, happens when the chickenpox virus (varicella zoster) that has been inactive in your nerves becomes reactivated.
The Centers for Disease Control and Prevention (CDC) report that in the United States, a significant portion of people will experience shingles at least once during their lifetime.
The rash associated with shingles typically persists for a few weeks, and most individuals make a full recovery. Clinicians can usually identify shingles quickly by examining the characteristic skin eruption.
Continue reading to find out more about early signs of shingles and to view images showing how shingles can appear.
What are the early signs of shingles?
Prior to the rash emerging, you might feel a burning sensation, itching, or tingling confined to one side of the body, commonly across the trunk. Other early symptoms can include:
- headache
- light sensitivity
- general tiredness
Blisters
When the shingles rash begins, you may see pink, red, or purplish patchy areas on one side of the body following nerve distributions.
These initial patches aren’t infectious, but soon after, fluid-filled blisters similar to chickenpox form and may be itchy. Within a few days, the blisters cluster over a limited region, though in some instances they can be more widespread.
Blisters most often show up on the face and torso but can occur in other places. Rarely, a person may have shingles without a visible rash.
After a rash starts, it’s advisable to see a physician within 3 days. Antiviral medication prescribed in that early window can shorten recovery time and lessen symptom intensity.
Scabbing and crusting
Shingles blisters may break open and ooze. They often take on a yellowish tint and begin to flatten. As they dry, crusts and scabs form.
According to the National Institute on Aging, each blister can require several days to crust over.
During this phase, pain may reduce somewhat, but it can persist for months or, occasionally, years.
When all blisters are fully crusted, the likelihood of spreading the virus is low.
The shingles “belt”
Shingles frequently emerges around the ribcage or waist, resembling a “belt” or “half-belt.” You may also hear this pattern referred to as a “shingles band” or “shingles girdle.”
This typical presentation is readily identified as shingles. The belt-like rash can span a broad area on one side of the midsection, and its placement often makes tight clothing uncomfortable.
Shingles on the face (ophthalmic shingles)
Ophthalmic shingles, sometimes called zoster ophthalmicus, affects the region around the eye. It often begins with a burning or tingling feeling on the scalp, cheek, or forehead.
This sensation can progress to an itchy, painful rash.
Seek urgent medical care if you notice these symptoms to reduce the risk of complications such as vision impairment.
Widespread shingles
Less commonly, shingles can present as a rash that spans multiple dermatomes. Dermatomes are distinct skin regions served by specific spinal nerves.
When three or more dermatomes are involved, the condition is termed “disseminated” or “widespread zoster.” In these situations, the rash may resemble chickenpox more than the typical localized shingles rash.
If your immune system is weakened, you’re more likely to develop widespread shingles.
How do I know if my rash is shingles?
Most healthcare providers can diagnose shingles by eye, based on the rash and accompanying symptoms. Common features include:
- rashes appearing a few days after symptoms like tingling
- occurrence on only one side of the body
- frequent appearance around the trunk
- limited to one or two distinct areas
- progression to blistering that lasts roughly 2 to 4 weeks
Shingles rash vs. herpes
Shingles belongs to the same viral family as herpes simplex. Initially, it can be hard to distinguish between them because both cause blistering eruptions.
However, shingles typically does not cross the body’s midline and often affects the trunk. Herpes simplex more commonly involves areas around the genitals or mouth.
In both conditions, a rash may not appear at all, or additional symptoms may help a clinician tell them apart.
If you’re uncertain which virus is responsible for your symptoms, consult a healthcare professional.
Learn more about herpes versus shingles.
Shingles rash vs. poison ivy
Contact with poison ivy, oak, or sumac can cause an allergic reaction that leads to a painful, itchy rash. This rash often appears in a linear pattern.
One distinguishing point is that poison ivy typically shows up on exposed skin and can affect both sides of the body.
Learn more about how to tell shingles apart from a poison ivy rash.
Frequently asked questions
How do I know if I’ve got shingles?
Before the rash shows, you may experience itching, tingling, or burning on one side of your body. A hallmark sign is a band-like rash that wraps around one side of your torso, as described here.
What does a very mild case of shingles look like?
In mild cases, you might only feel tingling or itching without painful blisters. This presentation is more typical in younger people with strong immune systems. Learn more about mild shingles.
How long are you contagious with shingles?
You cannot pass shingles itself to another person. However, someone who has never had chickenpox or the vaccine can develop chickenpox from contact with active shingles blisters because the same virus causes both illnesses. Blisters are no longer infectious once they have dried and formed scabs.
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The bottom line
Shingles, or herpes zoster, is caused when the dormant chickenpox virus (varicella zoster) becomes active again within nerve tissue, producing tingling and localized pain.
Over time, a rash featuring blisters can develop, which may be itchy, uncomfortable, or painful.
You cannot directly spread shingles to another person, but contact with active shingles blisters can transmit the virus and cause chickenpox in someone who has never had it or hasn’t been vaccinated.
Most people recover from shingles within a few weeks.
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