What the Shingles Rash Looks Like

Medically Reviewed by Carol DerSarkissian, MD on September 05, 2021

If you’ve ever had the chickenpox — and almost all adults have or have at least been exposed to it– 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.

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.

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

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

• Fever
• Chills
• Headache
• Upset stomach

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 healthcare provider.

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.

A doctor can usually diagnose shingles just by looking at the rash. If you have shingles symptoms, see your healthcare 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 help prevent complications, it’s important to start treatment as soon as possible after the shingles rash appears.   

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.

Anyone who has ever had chickenpox can get shingles, but the risk increases with age. People older than age 60 are up to 10 times more likely to get shingles than younger people. 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.

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 and people who may have weak immune systems such as chemotherapy patients.

In some 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.

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 often be prevented by beginning treatment for shingles as soon as possible.

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.  Doctors recommend starting prescription antiviral drugs at the first sign of a shingles rash. Options include acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex).

Over-the-counter pain relievers and anti-itch lotions, such as calamine, can help 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.

Colloidal 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.

The CDC recommends that healthy adults ages 50 and older get the shingles vaccine, Shingrix, which provides greater protection than Zostavax. The vaccine is given in two doses, 2 to 6 months apart. Zostavax is still in use for some people ages 60 and older.

Do not get the shingles vaccine if:

Since the late 1990s, most children in the U.S. have received the varicella vaccine to protect against chickenpox. This vaccine uses a weakened strain of the varicella zoster virus that is less likely to settle into the body for the long haul. 

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REFERENCES:

American Academy of Dermatology: “Lip and Mouth Care” and “Poison Ivy: Signs and Symptoms.”
Centers for Disease Control and Prevention: “Shingles: Signs & Symptoms;” “Shingles: Transmission;” “Shingles (Herpes Zoster): Prevention and Treatment;” “Shingles Vaccination: What You Need to Know;” “Shingrix Recommendations;” and “What Everybody Should Know about Zostavax.”
National Institute of Allergy and Infectious Diseases: “”Shingles Symptoms,” “Shingles Diagnosis,” “Shingles Treatment.”
National Institute of Neurological Disorders and Stroke: “Shingles: Hope Through Research. “
 

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Is it shingles? Symptoms vs. other conditions and causes

Shingles, also called herpes zoster, is an infection that causes a painful, blistering rash, often on one side of the body or face. There may also be ongoing neurologic pain.

Shingles happens when the chickenpox virus reactivates, often many years later. It affects about 1 million people each year in the United States. There may also be a fever, chills, headache, gastrointestinal disturbances, and headache.

In most cases, shingles is not a life threatening condition, but it can cause severe pain, and the effects can linger for months or years as postherpetic neuralgia.

Vaccinations against the chickenpox virus and the shingles virus can help prevent shingles.

The first symptoms of shingles are usually:

• pain
• itching
• tingling

Next, the following may start to appear:

• a painful rash of blistering sores, which appears as a single stripe around one side of the trunk
• a rash around the eye
• fever and chills
• headache
• gastrointestinal symptoms
• a rash or ulcers in the mouth, known as oral shingles

The rash from shingles tends to develop in a hallmark pattern, usually on the trunk. People sometimes call it a “shingles band” due to the striped pattern. They appear over 3–5 days.

Pain occurs because the virus causes inflammation in the nerves.

Over the next 7–10 days, the blisters often rupture, form sores, and then crust over and heal. The rash usually disappears in 2–4 weeks.

Disseminated shingles involves a widespread rash. It can affect people with a weakened immune system.

In some people, the rash heals, but the pain continues for 4 weeks or longer. In some cases, there may be severe pain lasting 90 days or more, known as postherpetic neuralgia (PHN).

According to the Centers for Disease Control and Prevention (CDC), PHN affects 10–18% of people who have had shingles. It rarely affects those under 40 years, but 13% of individuals aged 50 years or over will develop PHN after shingles. By the age of 70, this figure rises to around 75%.

In some cases, shingles can lead to:

• vision loss
• pneumonia
• hearing loss
• encephalitis, an inflammation of the brain
• partial facial paralysis
• polyneuritis, where multiple peripheral nerves become damaged

In some cases, the virus affects the internal organs, such as the lungs, liver, brain, spinal cord, or blood vessels. In this case, it can become life threatening. Having a weakened immune system may increase the risk of internal involvement.

What is internal shingles?

The symptoms of shingles can sometimes resemble those of other conditions, such as:

• cellulitis
• chickenpox
• herpes simplex
• impetigo
• folliculitis
• irritant contact dermatitis
• insect bites
• mucosal candidiasis, or oral thrush

The best way to work out if a rash is shingles is to speak with a doctor. In most cases, a doctor can make a diagnosis according to a person’s medical history, a physical exam, and symptoms. However, they may take a sample of skin, mucus, or blood for testing to confirm the diagnosis.

Anyone who suspects they have shingles needs to seek medical advice. Treatment can help speed recovery and reduce the risk of complications.

What do skin infections look like?

A virus called varicella zoster causes shingles. It also causes chickenpox, which used to be a common childhood illness before health experts developed a vaccine for it.

Once a person has a chickenpox infection, the virus remains in their nervous system, even after they recover. Although the virus stays in the body, doctors consider it latent, meaning it is inactive and does not cause any symptoms.

At some point, the virus can reactivate and cause shingles. The reason the virus reactivates is not entirely clear — it may become active again if a person’s immune system becomes weakened or stressed.

What treatment options are there for shingles?

A person cannot get shingles from another individual, but they can get chickenpox from someone who has shingles if they do not have immunity to chickenpox.

Transmission can occur through contact with the fluid that comes from the blisters.

When is shingles contagious?

Vaccination

According to the CDC, the shingles vaccine (Shingrix) is safe and can provide up to 97% protection against shingles, depending on the person’s age and the status of their immune system.

The Department of Health and Human Services advises everyone to have the shingles vaccine if they are:

• are aged 50 years or older
• are aged 19 or older and have a weakened immune system due to a health condition or treatment, such as chemotherapy
• are aged 19 or older and are at risk of a weakened immune system because of upcoming treatments

People should have the vaccine even if they:

• have already had shingles
• have previously been vaccinated with Zostavax, a vaccine that is no longer in use
• are not sure if they have had chickenpox

The vaccine comes in two doses, the second being 2–6 months after the first.

Here are some questions people often ask about shingles symptoms.

What are the first signs of shingles?

Early symptoms include a feeling of pain, burning, and itching in one area of the skin. After this, a rash appears, and fluid-filled blisters form. The rash is painful because the virus causes infection in the nerve cells.

What are the triggers for shingles?

Possible triggers for shingles include:

• emotional stress
• the use of immunosuppressant medications
• having a health condition that affects immunity

Will shingles go away without treatment?

There is currently no cure for shingles, but the rash usually clears up in 2–4 weeks. However, treatment can help manage it. If a person takes antiviral medication soon after the rash appears, it may shorten the duration of the infection and reduce the severity of symptoms.

Over-the-counter pain relief, wet compresses, calamine lotion, and lukewarm baths with colloidal oatmeal may help manage discomfort.

What are some natural treatments for shingles?

How long does shingles last?

The first symptoms of shingles are often pain, tingling, itching, and then a rash. The rash often forms a band around one side of the trunk. In time, blisters can form. These usually heal within 2–4 weeks, but some people have ongoing pain known as postherpetic neuralgia.

The rash can also affect the eyes and mouth, with a risk of vision loss.

Vaccination can help prevent shingles. Health experts recommend it for people aged 50 years and above and those aged 19 and over who have or are at risk of having a weakened immune system.

Pink lichen (Pityriasis Gibert): symptoms, treatment, causes

Rosacea has many names in medicine. It is called roseola flaky, Gibert’s disease, pityriasis rosea. The disease belongs to the infectious-allergic category of dermatoses, is of an acute inflammatory nature with the appearance of spotty, papular, erythematous-squamous foci. They are located mainly on the trunk and on the surface of the limbs. Most often, pink lichen Zhibera is diagnosed in women aged 20 to 40 years, as well as in adolescents. In other age groups of people, the disease is extremely rare. The peak of complaints falls in spring and autumn during the spread of acute respiratory diseases.

Information about pityriasis rosea: causes, symptoms, manifestations

Medicine does not know the exact causes of the development of Zhiber’s lichen in men and women. Research is being carried out in the field of influence of herpes viruses of types 6 and 7, but an unambiguous etiological agent has not yet been determined. The causes of pink lichen continue to be studied. It is only known that at any moment a weakened immune system can become a trigger. The causes of pink lichen lie precisely in the reduction of the body’s defenses due to bacterial and infectious diseases.

Symptoms and clinical picture of the disease

Due to colds, hypothermia, severe emotional state, stress, a rash may appear on the skin. Symptoms of pink lichen begin to appear from it. The classic clinical picture is the formation of the main focus in the form of a medallion with a diameter of 2 to 10 cm. Within 7-14 days after its appearance, the rash spreads in the form of plaques and papules of pink and yellow-brown color. They are smaller than the main focus – their diameter can be from 0.5 to 2 cm. In appearance, the rash can be confused with ringworm due to the scaly edge of the rash. A few days after the rash, the spots turn pale, wrinkle and the stratum corneum cracks. The central part of the plaques remains smooth. Symptoms of pink lichen may be accompanied by itching, fatigue, fever, general intoxication, enlarged lymph nodes in the neck and chin.

Types of disease

Pink lichen can have a classic appearance, when the clinical picture develops in stages in accordance with the generally accepted system – from the appearance of a “maternal” plaque to smaller rashes in the chest, back, abdomen, thighs, and on the flexor surfaces of the limbs. In the medical classification, several more forms of the disease are distinguished. Deprive Zhibera happens:

• urticarial – characterized by the presence of not plaques, but a blistering rash. There is severe itching. In appearance it resembles a urticaria;
• vesicular – manifested by generalized rashes of vesicles with severe itching. The diameter of the blisters with a clear or cloudy liquid is from 2 to 6 mm. Often they form “rosettes”;
• papular – rare. It is characterized by the appearance of cavityless formations above the surface of the skin. Small papules 1-2 mm in diameter;
• hemorrhagic – dotted hemorrhages (hemorrhages) occur, so the color of the plaques is darker than usual;
• follicular – rashes are grouped into rounded plaques of follicular papules, which can occur in parallel with classic plaques;
• single-sided;
• hypopigmented – more common in people with swarthy or dark skin. Lichen inverse is characterized by rashes in the axillary and inguinal regions and in the popliteal fossae;
• asbestos-like – extremely rare, and manifests itself in the scalp in the form of gray plaques;
• giant lichen pink Darya – the formation of large plaques in diameter from 5-7 cm. In severe cases, they reach the size of the patient’s palm;
• Vidal’s rosacea annulare has an atypical location, predominantly in the groin or axilla. The rashes look ring-shaped.

Gender and age characteristics

Pink lichen affects women, teenagers and children. Different forms of the disease affect certain groups of people. For example, the vesicular form is diagnosed more often in children and adolescents. The papular form is diagnosed in most cases in pregnant women and young children. Unilateral – equally occurs in both adults and children.

How disease is transmitted

Studies have not given a clear answer to the question of infection. Theoretically, pink lichen is transmitted by tactile contact, but this happens extremely rarely. There must be triggers for infection to occur. We are talking about low immunity, past viral and infectious diseases, colds. Relapse is possible in people with HIV, oncology and blood diseases.

What you need to know about diagnosis and treatment

Diagnosis of pink lichen is based on the collection of the patient’s history. To confirm or refute, analyze complex cases, a number of laboratory tests are prescribed. They include a clinical study of blood and urine. It is necessary to exclude syphilis and mycosis, therefore, serological and microscopic studies are additionally carried out. If these methods do not provide enough information to verify the diagnosis, the patient is referred for a biopsy (biopsy histology).

Treatment for rosacea is not always required. The disease is prone to arbitrary self-healing within 5 weeks. However, dermatosis should not be considered harmless. First of all, antipruritic therapy is required. For this, topical glucocorticosteroid drugs, antihistamines are used externally. Ointments, gels, pastes can not be used without the appointment of a dermatologist. Otherwise, the rash can increase the scale of the skin lesion, capturing new areas. Of the drugs, antibiotics and antiviral agents can be prescribed, depending on the definition of indications. Ultraviolet therapy gives a good effect.

Dermatologist’s help in Moscow

Diagnosis of pink lichen and treatment is the field of activity of a dermatologist. Depending on the form of the disease, the scale of the skin lesion, the patient is provided with recommendations. With lichen, the emotional and psychological background of a person is important, therefore, promptly making the correct diagnosis allows you to quickly overcome the disease.

You can make an appointment with the dermatologist of JSC “Medicina” (clinic of Academician Roitberg) by phone +7 (495) 775-73-60. Self-medication is not worth it. The reason – according to external signs, skin rashes can turn out to be differential diseases, for example, toxidermia, psoriasis, mycosis, secondary syphilis. In these cases, the appointment of another therapy is required, taking into account the specific clinical picture and the patient’s history.

Frequently asked questions from patients

What causes pink lichen?

There is no single answer to this question. Research is ongoing. Presumably, the cause may be the herpes virus type 6 or 7. With a decrease in immunity, it is activated, which triggers the process of rashes of various types (plaques, vesicles, blisters). Stress, poor ecology, hormonal surges, chronic diseases can provoke the disease.

Is rosacea contagious?

Pink lichen in humans is considered non-contagious, but rare cases of the disease of entire families are known. Much depends on the state of immunity and the body’s defenses that can resist viruses, bacteria and infections.

Is it possible to sunbathe with pink lichen?

One of the types of therapy for this dermatological disease is light therapy. Moderate exposure to ultraviolet radiation has a positive effect on the condition of the skin, stimulating its regeneration. Combustion must not be allowed. This will lead to increased itching in the area of ​​the spots.

Didn’t find the answer to your question?

Our experts are ready to advise you by phone:

+7 (495) 775-73-60

Pink lichen in a child: symptoms, diagnosis, treatment

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