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Are you wondering whether a bumpy or painful rash is shingles? Shingles is a very common infection – about a third of Americans who’ve had chickenpox will get shingles, with the chance increasing after age 50. Fortunately, shingles can often be managed without too much trouble, especially if you start treatment early.
But it’s not always easy to tell the difference between a shingles rash and other rashes, especially in the beginning. Below, we’ll cover early shingles symptoms, how the virus progresses and when to see a primary care doctor or clinician.
The early symptoms and progression of shingles
Shingles goes through three stages with a recognizable beginning, middle and end. You may notice different symptoms at each stage, and the intensity of your symptoms may change over time.
During the first stage of shingles, you’ll feel rather than see symptoms
The beginning stage of shingles is the pre-eruptive (prodromal) stage. You won’t see any visible skin changes or signs of a rash, but you might feel tingling, itching or pain at the site where the rash will develop. Flu-like symptoms are also a common early symptom of shingles, including headaches, chills, light sensitivity, dizziness, brain fog and fatigue.
Known as the active phase or eruptive phase, the second stage of shingles is when the rash becomes visible. Blisters typically appear on one side of the body, usually around the neck, torso or face. However, people with a weakened immune system may have a more widespread rash.
When shingles blisters appear, the pain often becomes much stronger. It can be a burning or sharp pain, which may feel like an electric shock for some people. Even a light touch or the feel of clothing against your body can be uncomfortable.
The good news is that this stage won’t last forever, and the shingles are usually gone in 10 days. In the meantime, gentle self-care can go a long way toward easing discomfort. Cool compresses, loose clothing and over-the-counter pain relief can make a big difference. Plus, the pain and other symptoms usually get better as the blisters scab over.
If you have active, blistering shingles, it’s usually best to stay home. It’s especially important to avoid contact with people who haven’t had chickenpox or are more likely to get sick, like pregnant women and infants.
What a shingles rash looks like
When first developing, a shingles rash might look like a collection of small bumps. Eventually this rash will turn into a cluster of fluid-filled blisters under the skin called vesicles. On lighter skin, inflamed vesicles are often very red or pink, and on darker skin, they can appear purple or dark brown. The fluid-filled spot in each blister can sometimes appear white or gray.
Shingles can become chronic in the third stage
In some cases, shingles pain, tingling or numbness can last for months or years after the rash heals. This is called postherpetic neuralgia, a condition caused by changes in nerve function after the shingles virus. When nerves are affected, they may send mixed or exaggerated pain signals to the brain. Postherpetic neuralgia is more common in people over 60, and it often gets better over time.
Symptom improvement and feeling better
Shingles symptoms will begin to fade as you heal. Blisters will rupture, start to drain, scab over and fall off, which can be painful, but it’s all a part of the healing process. Once that happens, blister sites may look like a dry rash, becoming slightly itchy and uncomfortable. In rare instances, scabs from collections of blisters can merge, looking like plaque psoriasis. However, that tingling, painful feeling should start to go away.
What causes shingles?
Shingles is caused by the varicella-zoster virus, which is the same virus that causes chickenpox. When you recover from chickenpox, the virus doesn’t go away. Instead, it “sleeps” in your nerve roots. In some people, the virus stays dormant. But in others, the virus “wakes up” when disease, stress or aging weakens your immune system. The virus travels up your nerve roots, which supply feeling to your skin along a pathway on each side of your body. Once the virus is active again, it can only cause shingles, not chickenpox.
Anyone who’s had chickenpox can get shingles. It’s most common in adults over 50 years old and people with weakened immune systems, but kids can get shingles too.
Is shingles contagious?
You can’t catch shingles from someone else. However, there’s a small chance that the varicella-zoster virus can spread from someone with active shingles to someone who’s never had chickenpox or the chickenpox vaccine. If you haven’t had either and you’re exposed to the virus, you’ll get chickenpox, not shingles.
The virus spreads through direct contact with fluid from the blisters, so covering the rash and practicing good hygiene helps prevent transmission. Once the blisters have crusted over, the risk of spreading the virus is gone.
How shingles is different from other rashes
How shingles progresses and the types of symptoms you’ll have are quite different than most other rashes. With shingles, you often experience additional symptoms prior to the outbreak, and your rash will typically form on one side of the body. If you have a rash that appears without warning, it’s more likely that it’s being caused by something else, though it still could be shingles.
Additionally, the rash and the healing process tend to be much more painful than with other skin conditions, and those symptoms can linger even after the rash goes away.
Is there a vaccine that prevents shingles?
Yes. To help prevent shingles, HealthPartners recommends that healthy adults 50 years and older get two doses of the Shingrix vaccine (separated by 2 to 6 months). Shingrix is more than 90% effective in preventing shingles. But if you do get shingles after receiving the vaccine, the rash is likely to be less painful and clear up more quickly.
How shingles is treated to help manage pain and other symptoms
Antiviral and pain medicine are used to treat shingles. Starting antiviral treatment within the first 72 hours can help your rash heal faster and be less painful. Early treatment can also help prevent long-term issues. In addition to medicine, there are at-home therapies you can do to help skin lesions dry up quicker.
1. Clean the blisters daily
Unfortunately, it’s possible for shingles blisters to become infected, usually because of scratching and itching. To prevent infection, it’s important to clean the blisters every day. Use gentle, fragrance-free soap and water, making sure not to scratch or scrub. Once you pat dry, keep the blisters covered with sterile, nonstick bandages.
2. Apply calamine lotion
Calamine lotion can help dry up blisters and decrease itching. However, don’t use lotion on open, active blisters. Calamine lotion is helpful during the stage of shingles when the blisters have scabbed over.
3. Try using a cold compress
A cold compress (such as a wet, cold rag or an icepack) can help calm the nerve irritation causing shingles pain. It can also decrease inflammation and offer relief from itching. Use your cold compress for 10-20 minutes at a time, making sure to wrap ice packs so they don’t touch the skin directly.
Get to the doctor early if you think you have shingles
If you think you have shingles, it’s best to see a doctor within two or three days. Simply make an in-person or video visit appointment to meet with your preferred primary care doctor or a clinician.
Shingles, like many other viruses, will naturally run its course. But getting care can help manage symptoms and make you feel better, sooner.
