Shingles - Symptoms

Introduction Causes Symptoms Treatments

Shingles is caused by the same virus that causes chickenpox. After an attack of chickenpox, the virus remains in the tissues in your nerves. As you get older, or if you have an illness or stress that weakens your immune system, the virus may reappear in the form of shingles

Early symptoms of shingles include headache, sensitivity to light, and flu-like symptoms without a fever. You may then feel itching, tingling, or pain where a band, strip, or small area of rash may appear several days or weeks later. A rash can appear anywhere on the body but will be on only one side of the body, the left or right. The rash will first form blisters, then scab over, and finally clear up over a few weeks. This band of pain and rash is the clearest sign of shingles.

The rash  caused by shingles is more painful than itchy. The nerve roots that supply sensation to your skin run in pathways on each side of your body. When the virus becomes reactivated, it travels up the nerve roots to the area of skin supplied by those specific nerve roots. This is why the rash can wrap around either the left or right side of your body, usually from the middle of your back toward your chest. It can also appear on your face around one eye. It is possible to have more than one area of rash on your body. A few people won't get a rash, or the rash will be mild. Most people who get shingles will not get the disease again.

    Stages of Shingles

    Shingles symptoms happen in stages.

    • At first you may have a headache or be sensitive to light. You may also feel like you have the flu but not have a fever.
    • Later, you may feel itching, tingling, or pain in a certain area. That’s where a band, strip, or small area of rash may occur a few days later. The rash turns into clusters of blisters. The blisters fill with fluid and then crust over. It takes 2 to 4 weeks for the blisters to heal, and they may leave scars. Some people only get a mild rash, and some do not get a rash at all.
    • It’s possible that you could also feel dizzy or weak, or you could have long-term pain or a rash on your face, changes in your vision, changes in how well you can think, or a rash that spreads. If you have any of these problems from shingles, call your doctor right away.

    Prodromal stage (before the rash appears)

    • Pain, burning, tickling, tingling, and/or numbness occurs in the area around the affected nerves several days or weeks before a rash appears. The discomfort usually occurs on the chest or back, but it may occur on the belly, head, face, neck, or one arm or leg.
    • Flu-like symptoms (usually without a fever), such as chills, stomachache, or diarrhea, may develop just before or along with the start of the rash.
    • Swelling and tenderness of the lymph nodes may occur.
    • Active stage (rash and blisters appear)
    • A band, strip, or small area of rash appears. It can appear anywhere on the body but will be on only one side of the body, the left or right. Blisters will form. Fluid inside the blister is clear at first but may become cloudy after 3 to 4 days. A few people won't get a rash, or the rash will be mild.
    • A rash may occur on the forehead, cheek, nose, and around one eye ( herpes zoster ophthalmicus ), which may threaten your sight unless you get prompt treatment. 2
    • Pain, described as "piercing needles in the skin," may occur along with the skin rash.
    • Blisters may break open, ooze, and crust over in about 5 days. The rash heals in about 2 to 4 weeks, although some scars may remain.

    Postherpetic neuralgia (chronic pain stage)

    • Postherpetic neuralgia is the most common complication of shingles. It lasts for at least 30 days and may continue for months to years. Symptoms are: 4
    • Aching, burning, stabbing pain in the area of the earlier shingles rash.
    • Persistent pain that may linger for years.
    • Extreme sensitivity to touch.
    • The pain associated with postherpetic neuralgia most commonly affects the forehead or chest. This pain may make it difficult for the person to eat, sleep, and perform daily activities. It may also lead to depression.
    • Shingles may be confused with other conditions that cause similar symptoms of rash or pain, such as herpes simplex infection or appendicitis.


    Complications of shingles include:

    • Postherpetic neuralgia, which is pain that does not go away within 1 month. It may last for months or even years after shingles heals. Postherpetic neuralgia affects up to 10% to 15% of those who experience shingles. 5 It is more common in people age 50 and older and in people who have a weakened immune system due to another disease, such as diabetes or HIV infection. People who have severe pain and rash during shingles have an increased risk for postherpetic neuralgia. 6
    • Disseminated zoster, which is a blistery rash that spreads over a large portion of the body and can affect the heart, lungs, liver, pancreas, joints, and intestinal tract. Infection may spread to nerves that control movement, which may cause temporary weakness.
    • Cranial nerve complications. If shingles affects the nerves originating in the brain (cranial nerves), complications may include:
    • Inflammation, pain, and loss of feeling in one or both eyes. The infection may threaten your vision. A rash may appear on the side and tip of the nose (Hutchinson's sign).
    • Intense ear pain, a rash around the ear, mouth, face, neck, and scalp, and loss of movement in facial nerves ( Ramsay Hunt syndrome). Other symptoms may include hearing loss, dizziness, and ringing in the ears. Loss of taste and dry mouth and eyes may also occur.
    • Inflammation, and possibly blockage, of blood vessels, which may lead to stroke.
    • Scarring and skin discoloration.
    • Bacterial infection of the blisters.
    • Muscle weakness in the area of the infected skin before, during, or after the episode of shingles.


    Call your doctor immediately if

    • Any sign of shingles develops (such as pain or changes in vision) on or in the area of your forehead, nose, eye, or eyelid.
    • Any symptoms of shingles develop (such as headache, stiff neck, dizziness, weakness, hearing loss, or changes in your thinking and reasoning abilities) that affect your central nervous system.
    • Skin sores spread to parts of your body beyond the original area of the rash .
    • You think you have a bacterial skin infection in the same area as the shingles rash, or your rash has not healed in 2 to 4 weeks.
    • You develop pain in your face or are unable to move muscles in your face.

    Call your doctor today if:

    • You suspect you might have shingles. There are medicines that can limit your pain and rash. The earlier you start treatment for shingles, the better the results.

    Watchful Waiting

    • If you think you have shingles, see a doctor as soon as possible. Early treatment with antiviral medicines may help reduce pain and prevent complications of shingles, such as disseminated zoster or postherpetic neuralgia.
    • If intense pain persists for more than 1 month after the skin heals, see your doctor to find out whether you have postherpetic neuralgia.