Wondering if a painful or bumpy rash is shingles? Shingles is a very common infection: About a third of Americans who have had chickenpox will get shingles, and the chance increases after age 50. Fortunately, shingles can often be controlled without too many problems, especially if treatment is started early.
But it’s not always easy to distinguish between a shingles rash and other rashes, especially at first. Below, we’ll cover the early symptoms of shingles, how the virus progresses, and when to see a doctor or primary care physician.
The first 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 will feel rather than see the symptoms
The initial stage of shingles is the preeruptive (prodromal) stage. You won’t see any visible skin changes or signs of a rash, but you may feel tingling, itching, or pain where the rash will develop. Flu-like symptoms are also a common early symptom of shingles, including headaches, chills, sensitivity to light, dizziness, mental confusion, and fatigue.
Known as the active phase or eruptive phase, the second stage of shingles is when the rash becomes visible. Blisters usually 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 usually becomes much stronger. It may be a burning or sharp pain, which some people may feel like an electric shock. Even a light touch or the feel of clothing against the body can be uncomfortable.
The good news is that this stage won’t last forever, and shingles usually goes away within 10 days. In the meantime, gentle self-care can go a long way toward easing discomfort. Cold compresses, loose clothing, and over-the-counter pain relievers can make a big difference. Additionally, pain and other symptoms usually improve as the blisters scab over.
If you have active, blistering shingles, it is usually best to stay home. It is especially important to avoid contact with people who have not had chickenpox or who are more likely to get sick, such as pregnant women and babies.
What a shingles rash looks like
When it first develops, a shingles rash may look like a collection of small bumps. Over time, this rash will become a group of fluid-filled blisters under the skin called vesicles. On lighter skin, inflamed vesicles are usually very red or pink, and on darker skin, they may appear purple or dark brown. The fluid-filled spot in each blister may sometimes appear white or gray.
Shingles can become chronic in the third stage.
In some cases, the pain, tingling, or numbness of shingles can last 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 can send mixed or exaggerated pain signals to the brain. Postherpetic neuralgia is most common in people over 60 and often improves over time.
Improvement of symptoms and feeling better.
Shingles symptoms will begin to go away as you recover. The blisters break, begin to drain, scab over, and fall off, which can be painful, but it’s all part of the healing process. Once that happens, the blister sites may look like a dry rash, with slight itching and discomfort. In rare cases, scabs of blister accumulations may fuse together and resemble plaque psoriasis. However, that tingling and sore 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 does not go away. Instead, it “sleeps” in the nerve roots. In some people, the virus remains latent. But in others, the virus “wakes up” when illness, stress or aging weakens the immune system. The virus travels up nerve roots, which provide sensation to the skin along a path on each side of the body. Once the virus is active again, it can only cause shingles, not chickenpox.
Anyone who has had chickenpox can get shingles. It is most common in adults over 50 and in people with weakened immune systems, but children can also get shingles.
Is shingles contagious?
You can’t get shingles from someone else. However, there is a small chance that the varicella-zoster virus can be transmitted from someone with active shingles to someone who has never had chickenpox or has not received the chickenpox vaccine. If you haven’t had either and are exposed to the virus, you will get chickenpox, not shingles.
The virus is transmitted by direct contact with the fluid in 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 disappears.
How Shingles Is Different From Other Rashes
The way shingles progresses and the types of symptoms you will have are quite different than most other rashes. With shingles, you often experience additional symptoms before the outbreak and the rash usually forms on one side of the body. If you have a rash that appears without warning, it is more likely to be caused by something else, although it could still be shingles.
Additionally, the rash and healing process tends to be much more painful than with other skin conditions, and those symptoms can persist even after the rash goes away.
Is there a vaccine that prevents shingles?
Yes. To help prevent shingles, HealthPartners recommends that healthy adults age 50 and older receive two doses of the Shingrix vaccine (2 to 6 months apart). Shingrix is more than 90% effective in preventing shingles. But if you get shingles after getting the vaccine, the rash will likely be less painful and go away more quickly.
How Shingles is Treated to Help Control Pain and Other Symptoms
Pain relievers and antivirals are used to treat shingles. Starting antiviral treatment within the first 72 hours may help the rash heal faster and be less painful. Early treatment can also help prevent long-term problems. In addition to medications, there are home therapies you can do to help skin lesions dry faster.
1. Clean the blisters daily
Unfortunately, it is possible for shingles blisters to become infected, usually due to scratching and itching. To prevent infection, it is important to clean the blisters every day. Use mild, unscented soap and water, making sure not to scratch or scrub. Once it dries, keep the blisters covered with sterile non-stick bandages.
2. Apply calamine lotion
Calamine lotion can help dry out blisters and decrease itching. However, do not use lotion on open, active blisters. Calamine lotion is useful during the shingles stage, when the blisters have crusted over.
3. Try using a cold compress.
A cold compress (such as a cold, damp cloth or ice pack) can help soothe the nerve irritation that causes shingles pain. It can also decrease inflammation and offer relief from itching. Use your cold compress for 10 to 20 minutes at a time, making sure to wrap ice packs so they don’t touch the skin directly.
Go to the doctor early if you think you have shingles
If you think you have shingles, it is best to see a doctor within two to three days. Simply schedule an in-person or video visit appointment to meet with your primary care physician or a preferred clinician.
Shingles, like many other viruses, will run its course naturally. But getting care can help control symptoms and make you feel better sooner.
