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. 

IMAGES PROVIDED BY:

(1) CNRI / Photo Researchers, Inc.
(2) Bart’s Medical Library / Phototake
(3) Steve Pomberg / WebMD
(4) Thinkstock
(5) Interactive Medical Media, LLC; Scott Camazine / Phototake; John Kaprielian / Photo Researchers
(6) Peggy Firth and Susan Gilbert for WebMD
(7) N. M. Hauprich / Photo Researchers, Inc
(8) N. M. Hauprich / Photo Researchers, Inc
(9) Hans Neleman / Stone
(10) Dr. P. Marazzi / Photo Researchers
(11) David Mack / Photo Researchers
(12) SPL / Photo Researchers, Inc.
(13) Steve Pomberg / WebMD
(14) Denis Felix / Stone
(15) Steve Pomberg / WebMD
(16) Getty Images
(17) Thinkstock
(18) Thinkstock
 

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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Shingles: Symptoms with Pictures

Early signs of shingles can include tingling and localized pain. You may also develop a blistering rash that can itch, burn, or hurt.

Shingles, also known as herpes zoster, occur when the dormant chickenpox virus, varicella zoster, is reactivated in your nerve tissue.

Typically, the shingles rash lasts 2 to 4 weeks, and most people make a complete recovery.

Doctors are often able to quickly diagnose shingles from the appearance of the skin rash.

Share on PinterestShingles rash, shown here on a darker skin tone, appears as tiny red blisters in a group or cluster.
Anukool Manoton/ShutterstockShare on PinterestA viral infection causes shingles and a painful rash (shown on a lighter skin tone).
Photography by DermNet New Zealand

Prior to the rash starting, you may develop a burning sensation, itchiness, or tingling on one side of the body, often on the trunk. You may also develop:

• a headache
• sensitivity to light
• general fatigue

When the rash starts, you may notice pink or red blotchy patches on one side of your body. These patches cluster along nerve pathways. Some people report feeling shooting pain in the area of the rash.

During this initial stage, shingles is not contagious.

The rash quickly develops fluid-filled blisters like chickenpox. They may be accompanied by itching. New blisters continue to develop for several days. In most cases, according to the Centers for Disease Control and Prevention (CDC), blisters appear over a localized area, but widespread blistering is possible.

Blisters are most common on the torso and face, but they can occur elsewhere. In rare cases, the rash appears on the lower body. Some possibly may not develop a rash at all.

It’s not possible to transmit the shingles virus to someone. However, if you’ve never had chickenpox or the chickenpox (varicella) vaccine, it’s possible to get chickenpox from someone with shingles through direct contact with active blisters since the same virus causes both shingles and chickenpox.

Once a rash starts, it’s important to consult with your doctor within 3 days, according to the American Academy of Dermatology (AAD). In the first 3 days, they can prescribe an antiviral, which can help speed up recovery and reduce symptom severity.

Share on PinterestAs shingles heals, the rash will start to scab over (shown on a darker skin tone).
abdmalekmd/Getty Images

Share on PinterestIn most cases, shingles rash leaves no scars and fully heals (shown on a lighter skin tone).
helovi/Getty Images

Blisters sometimes erupt and ooze. They may then turn slightly yellow and begin to flatten. As they dry out, scabs form. Each blister can take 7 to 10 days to crust over, per the National Institute on Aging.

During this stage, your pain may ease a little, but it can continue for months, or in some cases, years.

Once all blisters have completely crusted over, there is a low risk of transmitting the virus.

Shingles often appears around the rib cage or waist, and may look like a “belt” or “half belt. ” You might also hear this formation referred to as a “shingles band” or a “shingles girdle.”

This classic presentation is easily recognizable as shingles. The belt can cover a wide area on one side of your midsection. Its location can make tight clothing particularly uncomfortable.

Share on PinterestIn some cases, shingles rash can present near the eye. This is known as ophthalmic shingles.
VideoBCN/Shutterstock

Ophthalmic shingles, also known as herpes zoster ophthalmicus, occurs around the eye. Often, it starts out as a burning or tingling sensation on the scalp, cheeks, or forehead.

Like when shingles appears on other areas of the body, the tingling sensation can turn into an itchy, painful rash on the scalp, forehead, or cheeks.

If shingles affects the eyes, it can cause symptoms such as redness and swelling of the eye, inflammation of your cornea or iris, and drooping eyelid. Ophthalmic shingles can also cause:

• mild to severe vision loss
• discharge from the eye
• feeling that a foreign body is in the eye
• light sensitivity

According to the CDC, though less common, people who develop shingles may develop a rash that crosses multiple dermatomes. Dermatomes are separate skin areas that are supplied by separate spinal nerves.

When the rash affects three or more dermatomes, it is called “disseminated or widespread zoster.” In these cases, the rash may look more like chickenpox than shingles. You are more likely to develop widespread shingles if you have a weakened immune system.

A secondary bacterial infection is a possible complication of shingles.

Open sores of any kind are always susceptible to bacterial infection. To lower the possibility of a secondary infection, keep the area clean and avoid scratching.

Severe infection can lead to permanent scarring of the skin. Report any sign of infection to your doctor immediately. Early treatment can help prevent it from spreading. People with weakened immune systems have a higher chance of developing infections or other complications.

Most people can expect the rash to heal within 2 to 4 weeks. Although some people may be left with minor scars, most will make a complete recovery with no visible scarring.

In some cases, pain along the site of the rash can continue for several months or longer. This is known as postherpetic neuralgia.

You may have heard that once you get shingles, you can’t get it again. However, the CDC cautions that shingles can return multiple times in some people.

The varicella-zoster virus causes shingles to occur. If you had chickenpox as a child or got the chickenpox vaccine, you can develop shingles at some point within your life. However, you have a lower risk of developing shingles if you had the vaccine.

The exact reason why the virus resurfaces is still not fully understood. However, as you age and your defense against the virus decreases, you may become more susceptible. The risk of developing shingles and complications increases drastically at 50 years old.

According to the CDC, about 1 in 3 adults will develop shingles at least once in their lifetime. Several factors, including age, can increase your risk of developing shingles at least once in your lifetime.

Possible risk factors include:

• being age 50 years or older
• living with human immunodeficiency virus (HIV)
• being a bone marrow or solid organ transplant recipient
• taking immunosuppressive medications, such as chemotherapy, steroids, or those related to transplants
• living with cancer, particularly leukemia and lymphoma

The CDC notes that other factors may play a part in who develops shingles, but more research is needed to further explain, better understand, and confirm these factors. According to research:

• There’s a higher prevalence of shingles diagnoses in white people compared with Black people.
• People who are assigned female at birth may be more likely to develop shingles than people who are assigned male at birth.

Most doctors can visually examine and diagnose shingles based on the rash and other symptoms. In most cases, the rash:

• appears a few days after other symptoms, such as tingling sensation, start
• develops only on one side of the body
• often occurs around the trunk
• appears only in one or two areas
• develops a blistering effect that lasts about 2 to 4 weeks

Shingles rash vs.

herpes

Share on PinterestCold sores are caused by HSV-1 (shown on a darker skin tone).
BonNontawat/Shutterstock

Share on PinterestHSV-1 spreads by close contact, commonly through kissing (shown on a lighter skin tone).
simarik/Getty Images

Shingles, also known as herpes zoster, is in the same viral family as herpes simplex. At first, it may be difficult to tell the two conditions apart because they both cause blistering rashes.

However, shingles, unlike herpes, typically does not cross the body’s midline and often appears on the trunk. Herpes often appears around the genitals or in the mouth. In both cases, a person may not develop a rash at all or may develop other symptoms that can help a doctor distinguish between the two conditions.

A person should talk with their doctor if they’re not sure which virus may be causing the rash.

For more information on herpes versus shingles rash, click here.

Shingles rash vs. poison ivy

Share on PinterestPoison ivy rash will appear red and inflamed and can be painful (shown on a darker skin tone).
Photo by DermNet New Zealand

Share on PinterestPoison ivy exposure can cause a quick-forming rash on the exposed areas (shown on a lighter skin tone).
Abm6868, CC BY-SA 4.0, via Wikimedia Commons

Poison ivy, oak, or sumac can cause an allergic reaction that results in a painful, itchy rash. When the rash appears, it often appears as a straight line.

One way to distinguish between the two conditions is that poison ivy often appears on exposed areas of skin and on both sides of the body.

You can learn more about the difference between shingles and poison ivy rash here.

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