What Do the First Signs of Shingles Look Like?

Shingles is a painful belt-like patterned rash caused by varicella-zoster virus (the same virus that causes chickenpox). It is more common in adults over 50 years of age and in people with conditions that weaken the immune system.

Shingles is a painful belt-like patterned rash caused by varicella-zoster virus (the same virus that causes chickenpox). It is more common in adults over 50 years of age and in people with conditions that weaken the immune system.

The varicella-zoster virus is a type of herpesvirus. Other herpesviruses include the herpes simplex virus, which causes cold sores and genital herpes.

The first signs of shingles include: 

• Unusual sensations such as tingling, itching, or burning in an area of skin on one side of the body
• Fever
• Headache
• Feeling unwell (malaise)

After one to two days, signs and symptoms of shingles include: 

• A rash that looks like a band-like pattern of blisters on one side of the body 
  • Commonly appears on the trunk (chest, abdomen, and back) but can appear on almost any part of the body
  • After three to four days, blisters become open sores (ulcers)
  • After 7 to 10 days, sores crust over and are no longer contagious (in people with healthy immune systems)
  • A rash near the eye that can permanently affect vision if not treated
• Pain
  • Often starts several days before the rash appears
  • May range from mild to severe
  • May have a sharp, stabbing, or burning quality
  • Only involves the parts of the skin affected by the rash, but it can be severe and interfere with daily activities and sleep
  • Is often worse in older adults than in younger people

Skin color changes and scarring may occur after shingles have gone away.

Shingles is caused by the varicella-zoster virus. Once a person has had chickenpox, the varicella-zoster virus remains dormant in the body. The virus may be reactivated later in life, resulting in the shingles rash. 

Risk factors for developing shingles include: 

• Age: more common in adults 50 years of age and older
• Being immune compromised:
  • Autoimmune conditions 
  • Immunosuppressant medications used to treat certain conditions (such as rheumatoid arthritis) or to prevent organ transplant rejection 
  • Human immunodeficiency virus (HIV)
  • Certain cancers
  • Chemotherapy 

Shingles itself is not transmitted from person-to-person, however, a person who never had chickenpox or the chickenpox vaccine can get chickenpox from a person who has shingles.

Shingles can usually be diagnosed with a physical examination and patient history. 

A polymerase chain reaction (PCR) test may be used to confirm a diagnosis.

Treatment of shingles usually involves a combination of antiviral and pain medications. 

• Antiviral medications
  • Acyclovir (Zovirax)
  • Famciclovir (Famvir)
  • Valacyclovir (Valtrex)
• Pain medications
  • Nonsteroidal anti-inflammatory drugs 
    • Ibuprofen (Advil, Motrin)
    • Naproxen (Aleve, Anaprox) 
  • Acetaminophen (Tylenol) 
  • Narcotic pain relievers for severe pain
• Antibiotics, if the rash becomes infected
• Home remedies to help relieve itching
  • Wet compresses
  • Calamine lotion
  • Colloidal oatmeal baths

The primary way to prevent shingles is vaccination. There are two shingles vaccines available for adults 50 years and older to reduce the chance of developing shingles.

One form of the shingles vaccine is available in a single dose, and the other requires two doses administered two to six months apart. The two-dose vaccine is preferred because it is more effective.