Shingles: Symptoms, Stages, and What the Rash Looks Like

The rash of shingles lies in a band on one side of the body — like the mark left by a belt. Behind this bodily image is the varicella-zoster virus, which after a previous infection lies dormant in nerve ganglia for decades and then returns in a different guise.

How shingles begins: the first signs

The onset of shingles almost never looks like a rash. A few days before the rash appears, tingling, burning, or pain occurs in some area of the skin — as a rule, on one side of the body. A person may feel run-down without realizing that a rash will soon appear. The virus becomes active when immunity weakens: due to stress, severe illnesses, immunosuppressive drugs, or tumor treatment. Before the rash, the following signs may appear:

• tingling, burning, or pain in a limited area of skin on one side;
• headache and general malaise;
• fever and chills;
• joint aches;
• enlarged lymph nodes.

What the rash looks like: stages of the eruption

The rash goes through several recognizable stages. First, pink swollen patches appear on the skin; against this background, groups of papules form over 3–4 days and quickly turn into vesicles with clear contents. The vesicles itch, burst, and leak fluid, and after 6–8 days they dry out and become covered with yellow-brown crusts. The crusts fall off after 2–3 weeks, leaving slight pigmentation; scars rarely form. On dark skin, redness is harder to notice, but the one-sidedness and clustering of vesicles remain. The skin heals completely in about 4 weeks.

Where the rash appears: back, neck, head, face, leg

Most often the rash appears on the trunk — the chest, abdomen, and back — along the intercostal nerves, in a narrow band from the spine to the anterior abdominal wall. The rash may occur on the neck, on the face and around the eye, in the mouth and ear area, on the arms and legs — anywhere the branches of the affected nerve run. It is distinguished by strict one-sidedness: rash on both halves of the body is uncharacteristic. Involvement of the ophthalmic branch of the trigeminal nerve is dangerous for the cornea, so a rash near the eye and on the nose requires prompt evaluation by a doctor.

Pain in shingles

Pain is not merely a companion of the rash but its harbinger. It ranges from mild to very severe and often appears before the rash. When nerves are damaged, pain can persist for months and even years — this condition is called postherpetic neuralgia. If the virus affects motor nerves, muscle weakness is added to the pain, up to temporary or persistent paresis. Uncomplicated shingles usually lasts 3–4 weeks.

Features in older adults and children

The disease occurs at any age, but its frequency increases after 55–60 years: in people aged 60–75, 12–15 cases per 100,000 people are recorded. Postherpetic neuralgia occurs more often in people aged 60 and older. Recurrent episodes occur in 2% of people with normal immunity and in 10% with immunodeficiency. If a person with a weeping rash is near an unvaccinated child who has not had chickenpox, the child may develop chickenpox rather than shingles. The virus can be transmitted as chickenpox to those who have not had it, and this is dangerous for pregnant women, infants, and people with weakened immunity.

Complications and when an urgent doctor's consultation is needed

Most people recover without consequences, but complications are possible: prolonged neuralgia, secondary bacterial infection of the rash, skin discoloration and scars, muscle weakness, vision problems up to vision loss, and Ramsay Hunt syndrome with one-sided weakness of the facial muscles and hearing impairment. With weakened immunity, the disease is more severe: in some patients with lymphoma the rash spreads over the entire skin, and in 5–10% of people with widespread rash, pneumonia, meningoencephalitis, or hepatitis develops. The diagnosis is usually made by skin examination and history-taking.

Shingles by itself is not a reason to call an ambulance; 103/112 — if a rash has appeared around the eye or on the nose and is accompanied by changes in vision: eye involvement without emergency care can lead to blindness.

This material is for reference: only a doctor can distinguish shingles and choose a management approach after an examination, so at the first suspicious rash, a conversation with a doctor matters more than any article.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer