Why Is Shingles So Concerning? (2023)

The most well-known symptom of shingles (herpes zoster) is a severe skin rash. However, before any signs of blisters, you mayfeel as if you're only coming down with the flu.

You may experience chills and fever, as well as intense pain. It's not until a few days later that a rash finally joins these shingles symptoms, with clusters of tiny, pimple-like blisters progressing quickly once they appear.

Why Is Shingles So Concerning? (1)

If you're familiar with the signs and symptoms of shingles,you'll be able to recognize what's going on, get a diagnosis quickly, and dealwith it without delay. Doing so makes you less likely to develop complications, such as nerve issues or bacterial skin infections.

This article reviews the symptoms of shingles and what you need to know about potential complications.

Shingles Symptoms Before Rash

Shingles develops in two stages. The first is called the prodromal period.

Shingles is a reactivation of the varicella virus, which is what causes chickenpox. After an initial infection, the virus lays dormant in the body. Once reactivated, which can happen years down the line, shingles results.

Often, the earliest signs this is occurring are similar to what you'd expect at the start of any infection. These symptoms sometimes occur at times when you're feeling stressed or run down. They are also systemic, meaning they affect the whole body.

You may assume you're just overtired or coming down with a cold when you actually have shingles.

First Signs and Symptoms of Shingles

Among the systemic symptoms that may appear in the first few days of the prodromal stage of shingles are:

  • Pain in a specific, localized area of the body
  • Fever
  • Chills
  • Upset stomach
  • A headache
  • Sensitivity to light

The most telling first symptom of shingles typically isthe pain. Often excruciating, the discomfort has been described as burning, stinging, tingly, prickly, itchy, numbing, achy, or shooting. It can be persistent or intermittent, but will always be limited to one side of the body.

Because the pain from shingles is localized, it can be mistaken for other conditions depending on where it's focused.

For example, a stabbing or persistent pain on one side of the lower back may mistakenly be attributed tosciaticaor a kidney problem. Shingles pain around the lips could suggest a cold sore coming on, while pain focusedonthe eye or ear might seem like the start of amigraine.

Appearance of the Shingles Rash

The eruptive stage of shingles begins a few days later. This is when arash appears.

The skin in the area of the prodromal pain caused by shingles will oftenbe sensitive to the touch and reddish in appearance. As these symptoms getworse, it may begin to feel like a sunburn.

(Video) Shingles: Pathophysiology, Symptoms, 3 stages of Infection, Complications, Management, Animation.

Within three to five days of the initial pain, a few tiny pimple-like spots appear and quickly multiply into clusters, forming a rash that feels prickly to the touch.

From there, sometimes within hours, the pimples develop into water-filled blisters, orvesicles, that then consolidate into larger blisters. Often,redness and swelling accompany the rash.

The shingles rash looks very much like the chickenpox rash, with a key difference: Chickenpox blisters are widely scattered over the entire body. With shingles, the rash almost always occupies a finite strip of skin.

Ultimately, the pain of shingles may get so excruciating that simply grazing the skin with clothing can set off what feels like an electric shock.

Where a Shingles Rash Forms

A shingles rash typically occurs on the face, neck, or chest, on just one side of the body.

The affected area of skin is called adermatome, a region supplied by the sensory fibers of a specific spinal nerve.Outbreaks can involve two adjacent dermatomes, but rarely two non-adjacent dermatomes.

The exception may be in people whose immune systems are severely comprised, such as those withadvanced HIVinfection. They're oftenat risk of disseminated shingles (occurring in three or more dermatomes), shingles of the eyes or internal organs, and a recurrence of shingles within six months.

How Long It Takes for Shingles to Go Away

The shingles rash forms over a period of three to five days and then gradually crusts over. Although it will heal within two to four weeks, the pain that accompanies it can sometimes last for weeks, months, and occasionally years.

Shingles Pictures

Common Complications

Aside from the discomfort that can come along with shingles, it is particularly concerning because of its potential complications.

Postherpetic Neuralgia

The most common complication of shingles is a potentially debilitating condition calledpostherpetic neuralgia(PHN)that develops when nerve fibers become damaged. It's characterized by persistent pain in the area where a shingles rash has been. For instance, when shingles affect nerves in the head, tenacious facial pain may continue for long after the rash clears up.

Symptoms of PHN can be severe enough to interfere with daily life and include:

  • Burning, sharp, or deep, achy pain that lasts for three months or longerafter the shingles rash has healed
  • Allodynia(sensitivity to light touch): Even the sensation of clothing onthe skincan be excruciating.
  • Itching and numbness
  • Difficulty sensing temperature and vibration

Age increases susceptibility to PHN. TheCenters for Disease Control and Prevention(CDC) reports that as many as 13%of folks over 60 who have shingles will have PHN.

Other risk factors include experiencing a particularly severe and painful shingles rash. Having the rash on the face or torso also increases the risk of the condition.

Treating PHN can be complicated, but it's important, as the condition can lead to further complications such as depression, fatigue, trouble concentrating, sleep issues, andappetite loss. There's no one-size-fits-allapproach, however, and it often takes several medications to relieve the pain and other symptoms. Among the drugs used most often to treat PHN are:

(Video) Shingles: What you need to know about causes, symptoms, and prevention.

  • Lidocaine patches (sold under the brand name Lidoderm)
  • Capsaicin, a natural derivative of chili peppers, in the form of acreamor patch
  • Anticonvulsantmedications such as Neurontin(gabapentin) and Lyrica (pregabalin)
  • Antidepressants, including Aventyl (nortriptyline) and Cymbalta (duloxetine)
  • Opioids likeOxycontin(oxycodone) and morphine
  • Steroidinjections

Bacterial Skin Infections

The blisters caused byshinglescan leave open sores, making skin vulnerable to microbes that can cause what the CDC describes as "bacterial superinfection of the lesions." The bugs most often responsible for such infections are Staphylococcus aureus and group Abeta hemolyticstreptococcus.

One bacterial skin infection sometimes associated with shingles isimpetigo, which most often affects children. It starts with itchy sores that burst and then form honey-colored crusts. Impetigo is extremely contagiousbut can be treated effectively with antibiotics.

Cellulitis is another skin infection known to result from shingles. Unlike impetigo, which affects the outermost layer of skin, cellulitis is an infection of the deeper layers and even the tissue beneath the skin, according to theAmerican Academy of Dermatology.

It starts with an area that's red, swollen, and feels warm and tender to the touch. If it's not treated, cellulitis can spread quickly and even affect the lymph nodes, eventuallyleading to a blood infection. As long as it's treated right away with oral antibiotics and good care of the affected skin, cellulitis ishighly curable and unlikely to leave permanent damage.

What Is Cellulitis?

Facial Pain and Eye Damage

Between 10% and 15% of the time,shinglesaffects the trigeminal ganglion—a triple-branched nerve that provides sensation to structures in the face. The medical term for head or facial pain due to shingles is "painful trigeminal neuropathy attributed to herpes zoster."

Specifically, the trigeminal ganglioninvolves the eye (the ophthalmic branch); the cheek (the maxillary branch); and the mandibularbranch (the jaw). Of these, the ophthalmicbranch is the one most commonly affected by herpes zoster.

According to the American Academy of Ophthalmology (AAO), 25% of the 300,000 to 500,000 cases of shingles that occur each year areherpes zosterophthalmicus(HZO).

HZO can affect any part of the eye, from the optic nerve to the conjunctiva (the membrane that covers the front of the eye and lines the eyelid). Withoutantiviral treatment, almost half of people who have shingles near the eye will experience eye damage or even lose an eye, so it's vital to see an ophthalmologist immediately.

Uncommon Complications

Another potential, though uncommon,health problems caused by shingles include:

Ramsay Hunt Syndrome

Otherwise known asherpes zosteroticus,thisis inflammation of a facial nerve near one of the ears. The symptoms include facial paralysis,ear pain, and small, fluid-filled blisters (calledvesicles) inside the ear canal. People with Ramsay Hunt often experience dizziness or lack of balance. The condition also can cause permanent hearing loss if not treated promptly.


This is an infection of the meninges. Symptoms include fever, severe headache, sensitivity to light, and achy muscles. Because this type of meningitis is caused by a virus, it is treated with antiviral medications.


Like meningitis, this is a secondary viral infection. It affects the brain and can cause symptoms such asa headache, memory loss, fever, and changes in personality.

Motor Neuropathy

Normally the varicella virus affectsonlysensation in the skin, but, in rare cases, it can go deeper into muscle tissue, causing weakness or atrophy. Most patients experiencing motor neuropathy will regain motor function.

When to See a Doctor

If you suspect you have shingles, you should see a doctor right away. You can then begin appropriate treatment that will help relieve your symptoms, speed your recovery, andlower your risk of complications.This is especially important if you:

  • Are over age60
  • Have a condition that has caused you to have a weakened immune system, such as HIV
  • Take medication that may diminish your body's immune response (e.g.chemotherapy drugs, steroids, or immunosuppressants after an organ transplant)
  • You share a home with someone who has a weakened immune system
  • The rash is on your face: Blisters near your eye could lead to serious eye damage or even cause you to lose sight in that eye.

Shingles Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Why Is Shingles So Concerning? (2)

Download PDF
(Video) Shingles: What You Should Know | Johns Hopkins Medicine

If while you're dealing with shingles you experience any of the following, let the doctor who's treating you know right away:

  • You aren't getting relief from the pain with treatment.
  • The pain doesn't go away after three to four weeks.
  • The rash spreads beyond the initial area.
  • You begin to have symptoms of a secondary infection, such as a very high fever, chills, and severe headache.​

Your healthcare provider will help you determine the right treatment for you. This may include antiviral drugs, antidepressant medications, and pain medications.

How Shingles Is Treated

Frequently Asked Questions

  • Where does shingles usually start?

    The rash usually appears in a band around the left or right side of your torso (back or chest). It can also occur on the side of your face.

  • What does mild shingles look like?

    When the rash starts, it can look like little pimples in the shape of a band or belt. These pimples will change to fluid-filled blisters.

    Learn More:What Shingles Looks Like

    (Video) What You Should Know About Shingles Vaccines | Johns Hopkins Medicine
  • What does nerve pain from shingles feel like?

    The skin will be sensitive to any pressure, even a light touch, around the damaged nerves. Pain is often described as sharp, stabbing, or burning. It can be constant or come and go, and it may feel worse with movement.

  • What triggers a shingles outbreak?

    While researchers aren't sure, one theory is that a weakened immune system can allow the virus to reemerge. This can happen as you get older and your immune system becomes less robust.

  • Will shingles go away if left untreated?

    It can, but there's a risk of developing severe pain without treatment. It's important to see your healthcare provider within three days of developing a rash. Early treatment with antiviral medicine can help the rash heal faster and prevent severe pain.

  • What is the most common early treatment for shingles?

    Antiviral medications can help prevent severe pain and shorten the length of the illness. These include acyclovir, valacyclovir, and famciclovir.

Shingles Causes and Risk Factors

(Video) Why Is Everyone Getting Shingles?


Why is shingles so common now? ›

Summary. The rates of shingles are increasing in younger adults. The exact reason for this increase is unknown, but studies suggest that it could be caused by decreased exposure to the shingles virus, known as the varicella zoster virus (VSZ), due to childhood varicella vaccinations.

Is shingles something to worry about? ›

Shingles is not usually dangerous to healthy individuals although it can cause great misery during an attack. Anyone with shingles on the upper half of their face, no matter how mild, should seek medical care at once because of the risk of damage to the eye.

Why is shingles a problem? ›

Shingles may cause inflammation of the brain (encephalitis), facial paralysis, or problems with hearing or balance. Skin infections. If shingles blisters aren't properly treated, bacterial skin infections may develop.

Is shingles a warning about your immune system? ›

The primary risk factor associated with getting shingles is a weakened immune system. When your immune system isn't functioning properly, VZV can reactivate. As you age, your immune system doesn't fight off invaders as well.

How painful is shingles on a scale of 1 to 10? ›

“Shingles is extremely painful," Wigand-Bolling said. “On a scale from one to 10, most patients will say the pain ranges from six to 10.” Between 1 and 5 days after the first symptoms occur, a rash will develop in the affected area.

What medications can trigger shingles? ›

Steroids and DMARD/biologic combination raised shingles risk

A large study that surveyed Medicare data found that patients with rheumatoid arthritis had significantly increased risk for shingles if they took steroid medications such as prednisone.


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