Most cases of shingles don’t last longer than two to five weeks. When complications such as post-herpetic neuralgia occur, the pain may linger for months after other symptoms have cleared up.9
Summary
Shingles proceeds through several different stages. In the early or prodromal stage, you may have mild symptoms such as a headache or low-grade fever. As the infection progresses, you will develop patches of small, reddish bumps that produce a sharp, needle-like pain.
Twelve to 24 hours after the rash appears, tiny blisters called vesicles form, which will rapidly develop into a belt of blister clusters that run along one side of the body. These blisters will eventually rupture, scab, and crust over. Some people continue to experience pain for weeks or months after a shingles infection.
A shingles rash looks like a cluster of tiny, fast-growing blisters on a red base of skin. The blisters quickly merge, rupture, and crust over. A shingles outbreak almost always develops on one side of the body and follows a string of nerves servicing a specific part of the body (called a dermatome).
There are a total of 30 dermatomes in the body that individually service parts of the face, scalp, arms, chest, abdomen, back, buttocks, groin, tailbone, genitals, and feet. Shingles is typically constrained to one of these areas, causing a rash that looks similar to chickenpox.
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Initial Symptoms of Shingles Before Rash
Shingles is caused by the reactivation of the chickenpox virus, called the varicella-zoster virus (VZV). After someone gets chickenpox, VZV embeds itself in the nerve roots of the spine where it can lie dormant for decades.
Can I get shingles if I’ve already had chickenpox?
A past chickenpox infection doesn’t protect you from shingles, in fact, a past chickenpox infection is the reason why you get shingles. Shingles occurs when the VZV virus is reactivated, which most often happens in adulthood.1 Once reactivated, it can quickly multiply, moving from the spinal nerve root to the branches of nerves in the skin, causing shingles.
When VZV first reactivates, a person can experience so-called prodromal symptoms as the body reacts to the emergent virus. Prodromal symptoms are non-specific and occur before the main symptoms appear.
With shingles, the prodromal symptoms include:
Headache
Mild fever
A burning, tingling, numbness, or itchiness on a specific part of the body
Malaise (a general feeling of unwellness)
Prodromal symptoms of shingles usually start one to two days before the outbreak. During this time, the skin sensations worsen and may cause moderate to severe aching, burning, or stinging pain.
Initial Rash
Soon after the onset of prodromal symptoms, slightly reddish patches of skin with small bumps (papules) will develop in a cluster in the areas of pain. Though the rash may look like pimples or an allergic rash, it produces a sharp, needle-like pain, particularly if you scratch or pick at it.
The pain is caused by both the inflammation and the overstimulation of nerves by the virus. This differs from rashes that originate in skin cells in which nerves are not affected directly. Moreover, the nerves that VZV inhabits are sensory ganglia. Their function is to send sensory information from the skin to the brain.
As the infection progresses, more bumpy patches can develop, often following a visible pathway along the nerve string.
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Vesicles Rash
As VZV migrates to the skin the virus will multiply rapidly in the outermost (epidermal) layer.2 Tiny blisters (vesicles) will appear within 12 to 24 hours after the first bumps. These vesicles form when the swelling is significant enough to cause blister formation.
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Blisters
The rapid development of blister clusters is one of the hallmarks of a shingles infection, namely the so-called “shingles belt.” This manifests as a single stripe that runs along one side of the body (such as one side of the trunk, one side of the face, or down one thigh).
Only one side is affected because there are two separate nerve roots on each side of the spine, each of which services the same body part on the opposite side.
Though rare, shingles can affect more than multiple dermatomes. This can lead to widespread shingles across the body.3 When shingles occurs in more than one dermatome, it may be an indication of immunosuppression.
Over the course of the next 48 hours, the blisters will start to turn cloudy and increase in number and size. Many will converge into larger blisters and/or rupture, leaving behind a raw, indented, oozing ulcer.
At this stage, the pain can be intense, making movement or even the lightest touch extremely painful.
You can’t give someone shingles, but it is possible to pass the varicella-zoster virus to people who are not immune to chickenpox. In that case, the person would develop chickenpox, not shingles.
Scabs and Crusting
Once a herpes blister ruptures, the secreted fluid will crystalize and form a honey-colored crust. A scab will form underneath, stemming the oozing fluid and allowing the ulcer to heal. The healing of the sore and shedding of the scab takes a week to 10 days.
A lesion is no longer considered contagious once the rash has crusted over.4
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Even as sores begin to heal, new clusters of blisters can continue to form. Depending on the severity of an outbreak, shingles can take three to five weeks to progress through all stages.
Can You Shorten an Outbreak?
There is no cure for shingles. However, antiviral drugs can shorten the duration and severity of an outbreak, especially when taken within the first three days of the appearance of a rash.4
Eye Shingles
Ophthalmic shingles, also known as herpes zoster ophthalmicus (HZO), occur when shingles develops in or around the eye. It is a severe variant that affects 20% of people with shingles. People with compromised immune symptoms, such as those with advanced HIV, are at highest risk.5
HZO causes a blistering rash around the eyes and eyelids. The infection can extend to the cornea (the transparent layer in front of the eye), causing scarring and potentially severe vision loss. If you develop a shingles rash near the eye, contact your healthcare provider right away.
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Eye damage can also occur when shingles involves the retina or optic nerve in the back of the eye without causing a skin rash or other symptoms at the surface of the eye. This is called viral retinitis.6
Damage in viral retinitis is due to inflammation of the blood vessels servicing the eye. The rupture of these vessels can deprive these nerves (including the optic nerve) of the oxygen and nutrients they need to survive. Damage to these nerves can also affect vision.
How to Tell if My Rash Is Shingles or Something Else
A shingles rash may seem pretty self-evident, but there are other conditions that can also cause a blistering, painful rash.
While your healthcare provider may prescribe treatment based on the presumption of shingles, it is important to undergo a complete evaluation to ensure some other condition (requiring a whole different course of treatment) is not involved.
Scratching shingles blisters—or scabs as the rash heals—increases your risk of a secondary bacterial infection. Secondary infections are relatively easy to establish when bacteria beneath the fingernails are introduced into exposed tissue within a sore. This can slow healing times and even lead to permanent scarring.
Never scratch a shingles rash. Instead, tap the skin or apply a cool, moist cloth to help ease the itch. Over-the-counter remedies like calamine lotion and colloidal oatmeal baths may also help.
Call a healthcare provider immediately if you experience signs of a secondary skin infection, including fever, a pus-like discharge, or increasing redness, swelling, or heat.7
Symptoms After the Rash Disappears
Even after a shingles outbreak resolves, you may experience long-lasting nerve pain due to inflammatory damage to your nerves.
This condition, known as postherpetic neuralgia, is the most common complication of shingles. It causes burning pain that can last for months and years after the infection has cleared.8
People over 60 are at the greatest risk, which is why a shingles vaccination is recommended for adults aged 50 and over. There is no cure for postherpetic neuralgia, but different medications can help ease the pain.
There is also some evidence that the early use of antiviral drugs during the early stages of the infection can reduce the risk or severity of postherpetic neuralgia compared to people who have not received antiviral treatment.
For most people, postherpetic neuralgia gets better over time.
How Long Does Shingles Last:?
Most cases of shingles don’t last longer than two to five weeks. When complications such as post-herpetic neuralgia occur, the pain may linger for months after other symptoms have cleared up.9
Summary
Shingles proceeds through several different stages. In the early or prodromal stage, you may have mild symptoms such as a headache or low-grade fever. As the infection progresses, you will develop patches of small, reddish bumps that produce a sharp, needle-like pain.
Twelve to 24 hours after the rash appears, tiny blisters called vesicles form, which will rapidly develop into a belt of blister clusters that run along one side of the body. These blisters will eventually rupture, scab, and crust over. Some people continue to experience pain for weeks or months after a shingles infection.