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Is It Shingles or Something Else? Photos of Shingles (Herpes Zoster)

Electron micrograph of the Varicella-zoster virus

What is Shingles?

If you've ever had the chickenpox -- and almost all adults have -- there's a good chance the virus is still at large in your body. The varicella-zoster virus can lie dormant for decades without causing any symptoms. In some people, the virus wakes up and travels along nerve fibers to the skin. The result is a distinctive, painful rash called shingles.

shingles rash on male torso

What Does the Shingles Rash Look Like?

The shingles rash can be a distinctive cluster of fluid-filled blisters -- often in a band around one side of the waist. This explains the term "shingles," which comes from the Latin word for belt. The next most common location is on one side of the forehead or around one eye. But shingles blisters can occur anywhere on the body.

woman scratching

Shingles Symptoms: Before the Rash

The first symptoms of shingles appear one to five days before the rash. These early warning signs are usually felt in the location where the rash will develop:

  • Itching
  • Tingling
  • Burning
  • Pain
man with fever

Other Symptoms of Shingles

While the localized pain and rash are the tell-tale signs of shingles, other symptoms may include:

  • Fever
  • Chills
  • Headache
  • Upset stomach


cold sore blisters and poison ivy

Shingles or Something Else?

Small blisters that appear only on the lips or around the mouth may be cold sores, sometimes called fever blisters. They're not shingles, but are instead caused by the herpes simplex virus. Itchy blisters that appear after hiking, gardening, or spending time outdoors could be a reaction to poison ivy, oak, or sumac. If you aren't sure what's causing your rash, see your health care provider.

illustration of shingles virus

What Causes Shingles?

The varicella zoster virus is the culprit behind both chickenpox and shingles. The first time someone is exposed to the virus, it causes the widespread, itchy sores known as chickenpox. The virus never goes away. Instead, it settles in nerve cells and may reactivate years later, causing shingles.  It's also called herpes zoster, but it's not related to the virus that causes genital herpes.

Small blisters at the onset of shingles oubreak

Diagnosing Shingles

A doctor can usually diagnose shingles just by looking at the rash. If you have shingles symptoms, see your health care provider even if you think you've never had chickenpox. Many childhood cases of chickenpox are mild enough to go unnoticed, but the virus can still linger and reactivate.  To prevent complications, it's important to start treatment as soon as shingles appears.  

Small blisters from shingles crusted over

How Long Does Shingles Last?

Shingles blisters usually scab over in 7-10 days and disappear completely in two to four  weeks. In most healthy people, the blisters leave no scars, and the pain and itching go away after a few weeks or months. But people with weakened immune systems may develop shingles blisters that do not heal in a timely manner.

Senior woman holding baby boy

Who's at Risk for Shingles?

Anyone who has ever had chickenpox can get shingles, but the risk increases with age. People older than 60 are 10 times more likely to get shingles than children under 10. Other factors that increase your risk include:

  • Some cancer medicines
  • Steroid medicines
  • Long-term stress or trauma
  • A weak immune system from illnesses such as cancer or HIV

A quarter of adults will develop shingles at some point, and most are otherwise healthy.

child with chicken pox

Is Shingles Contagious?

Yes, but not in the way you may think.  Your shingles rash will not trigger an outbreak of shingles in another person, but it can sometimes cause chickenpox in a child.  People who've never had chickenpox, or the vaccine to prevent it, can pick up the virus by direct contact with the open sores of shingles. So keep a shingles rash covered and avoid contact with infants, as well as pregnant women who have never had chickenpox or the varicella vaccine.

illustration of nerve damage

Can Shingles Cause Chronic Pain?

In some older people, the pain of shingles may linger for months or even years after the rash has healed. This pain, due to damaged nerves in and beneath the skin, is known as postherpetic neuralgia. Others feel a chronic itch in the area where the rash once was. In severe cases, the pain or itching may be bad enough to cause insomnia, weight loss, or depression.

Shingles rash over a man

Other Complications of Shingles

If the shingles rash appears around the eye or forehead, it can cause eye infections and temporary or permanent loss of vision. If the shingles virus attacks the ear, people may develop hearing or balance problems. In rare cases, the shingles virus may attack the brain or spinal cord. These complications can usually be prevented by beginning treatment for shingles as soon as possible.

colored capules

Treatment: Antiviral Medication

While there is no cure for shingles, antiviral medications can put the brakes on an attack. Prompt treatment can make a case of shingles shorter and milder, while cutting in half the risk of developing postherpetic neuralgia.  Doctors recommend starting prescription antiviral drugs at the first sign of a shingles rash. Options include acyclovir, valacyclovir, or famcyclovir.

Woman applying cream to forearm

Treatment: Rash Relief

Over-the-counter pain relievers and anti-itch lotions, such as calamine, can relieve the pain and itching of the shingles rash. If the pain is severe or the rash is concentrated near an eye or ear, consult your doctor right away. Additional medications, such as corticosteroids, may be prescribed to reduce inflammation.

oat bath and calamine lotion

Home Care for Shingles

Colloidal or powerderized oatmeal baths are an old standby for relieving the itch of chickenpox and can help with shingles as well. To speed up the drying out of the blisters, try placing a cool, damp washcloth on the rash (but not when wearing calamine lotion or other creams.) If your doctor gives you the green light, stay active while recovering from shingles. Gentle exercise or a favorite activity may help keep your mind off the discomfort.

Clinic worker preparing shot for older patient

Shingles Vaccine

The CDC recommends people ages 60 and older get the shingles vaccine,  Zostavax. In a large trial, this vaccine cut the risk of developing shingles in half and reduced the risk of postherpetic neuralgia by 67%. The vaccine won't treat a current outbreak of shingles, but it can prevent future attacks if you have already had shingles. The FDA has approved Zostavax for people as young as 50, depending on a doctor's guidance.

three pregnant women

Who Should Not Get the Vaccine?

Do not get the shingles vaccine if:

  • You might be pregnant
  • You have HIV/AIDS or a weak immune system
  • You are undergoing chemotherapy or radiation
  • You take medications that suppress the immune system
  • You have a history of leukemia or lymphoma

You are allergic to gelatin, the antibiotic neomycin, or any ingredient in the vaccine.

Reviewed by Laura J. Martin, MD on February 10, 2012

Views: 2550


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