Key takeaways
- Shingles is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox, and it progresses through 4 stages: pre-eruptive (tingling and pain before the rash), eruptive (painful blistering rash), healing (crusting over), and sometimes chronic (long-term nerve pain called postherpetic neuralgia).
- Early symptoms include tingling, burning, fever, and headaches, followed by a painful rash with fluid-filled blisters that typically appears on one side of the body in areas like the abdomen, shoulders, neck, or face.
- Antiviral medications like acyclovir (Zovirax) or valacyclovir (Valtrex) can speed recovery and reduce complications if started within 3 days of the rash appearing. The Shingrix vaccine is also effective against shingles and long-term nerve pain for adults over 50 and other high risk adults.
Overview
The varicella-zoster virus (VZV) causes shingles, a condition characterized by a painful rash. This is the same virus that causes chickenpox.
If you’ve had chickenpox, you might develop shingles at a later date. This is because the virus remains dormant in your body and can reactivate.
According to the National Foundation for Infectious Diseases, nearly half of all people in the United States who live until 85 years old will experience shingles.
A shingles infection goes through four key stages:
- pre-eruptive, also known as prodromal
- eruptive, also known as active
- healing stage
- chronic, also known as the postherpetic neuralgia (PHN) stage, though this doesn’t occur for everyone
Learning how these stages appear can help you identify the condition and receive treatment earlier.
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1. Pre-eruptive
The medical term for the early stage symptoms of shingles is pre-eruptive. It’s also known as the prodromal stage. You may notice pain or burning sensations around certain areas of the skin. A rash may appear in these same areas.
You’re most likely to feel these sensations where your nerves spread out across your body. For example, it might occur across your abdomen, where nerves spread from the spine in horizontal lines.
These pains typically start at least 2 days before you notice any blistering.
Symptoms of the pre-eruptive stage
Once the shingles virus reactivates inside your body, you may notice certain symptoms a few days before anything is obvious. Some of these symptoms can include:
- tiredness
- fever
- headaches
- upset stomach
- photophobia (sensitivity to light)
- itching skin
- tingling skin
- burning pains on your skin
As soon as you experience any of these symptoms and suspect shingles, seek advice from a healthcare professional. A doctor will be able to confirm you have shingles from these symptoms and your medical history.
This will allow you to receive treatment as soon as possible.
2. Eruptive
After these 2 days, a shingles rash may start to appear. This will turn from a rash to a cluster of fluid-filled blisters. After about 10 days, this blistering rash will dry out, crust over, and eventually disappear.
These blisters are painful, and this stage is most contagious. So, it may be a good idea to avoid people who have never gotten the shingles or chickenpox vaccines or had either infection. It’s also important to avoid contact with babies or people with weakened immune systems.
Eruptive stage symptoms
The eruptive (active) stage of shingles is when you start to see rashes and groups of small blisters appear on the skin. These blisters are called vesicles, and they occur alongside the symptoms of the early stage, like fever, headaches, and an upset stomach.
This rash can be very painful and affect your daily activities. If you have a weakened immune system — for example, if you are undergoing chemotherapy — you may be more likely to develop this rash on your face or eyes.
3. Healing
In the healing stage, your blisters will start to ooze and crust over. You will likely still have what looks like a dry rash. During this stage, your condition is no longer contagious. However, the rash may take a couple of weeks to clear completely.
In the healing stage, true to the name, your symptoms are getting better. After around 7 to 10 days of the eruptive stage, the vesicles will dry up and start to crust over. After a few weeks, the remaining scabs should clear up.
4. Chronic
Not everyone experiences the final chronic stage, also called the PHN stage. This is long-term nerve pain that around 10% to 18% of people experience after a shingles infection. This stage can last from weeks to years.
This nerve pain typically occurs in the same place on your body where the rash appeared.
How long does shingles last?
Shingles will usually take 3 to 5 weeks to run its course, according to the National Institute on Aging (NIA). However, this can vary between individuals and treatments, and the pain you experience during a shingles infection changes as time goes on.
The most common symptom of shingles is a painful rash on one side of your body, typically in a single stripe. This rash develops into a cluster of blisters.
Some areas where you are most likely to see rashes include:
- upper and lower abdomen
- shoulders
- neck
- forehead
- scalp
Symptoms progress as the virus goes through different stages.
Treatments for shingles
There is no cure for shingles, but receiving a quick diagnosis can help you get the treatment to speed up recovery, manage pain, and prevent any complications.
Medications and home remedies may help soothe your symptoms while you recover.
Medications
Prescription medications aim to help your body fight the virus and soothe any discomfort. Most medications for shingles are effective only if you take them in the early stages of the condition.
They can include:
- Antivirals: Oral antiviral medications aim to prevent neuralgia and speed up skin healing. Examples include acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir). Antivirals are incredibly important if the rash is on your face, and you must start them as soon as possible.
- Anticonvulsants: The drugs gabapentin (Neurontin) and pregabalin (Lyrica) can be used to manage pain from neuralgia.
- Capsaicin: Capsaicin is available as a topical cream, skin patches, and low dose oral medications. This natural compound comes from chili peppers and can help manage pain from shingles.
- Antidepressants: Tricyclic antidepressants can help manage nerve pain from shingles by preventing the reuptake of certain neurotransmitters. They can be oral tablets or liquid solutions.
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Home remedies
Some natural remedies that you can try at home to soothe symptoms include:
- placing cool compresses on the rash during the blistering stage to stop itching
- taking colloidal oatmeal baths in lukewarm water, which can reduce itching and inflammation and help prevent scarring
- supporting your immune system by upping your antioxidant intake, such as including plenty of fresh vegetables in your diet
Prevention
The best way to avoid shingles symptoms is to avoid developing the condition in the first place. The shingles vaccine, Shingrix, is available to healthy adults over 50 years old and immunocompromised adults of any age. Talk with your doctor if you have any problems with your immune system.
According to the Centers for Disease Control and Prevention (CDC), the Shingrix vaccine is over 90% protective against long-term nerve pain and will work even if you have already had shingles.
If you are 50 years or above and at risk of developing shingles, speak with a doctor about getting a vaccination.
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Even if your case of shingles is mild, you should still seek treatment straight away. It’s important to speak with a doctor within 3 days of noticing the rash. If the rash is on your face, it’s even more essential to start antivirals quickly.
Getting treatment as soon as possible can help clear up your symptoms faster, reduce the severity of your pain, and reduce the risk of long-term complications like PHN.
Online care services, including Optum Perks Online Care, may make getting treatment easier. With these services, you can submit an online form answering a few questions about your symptoms, and a US-licensed healthcare professional will respond soon after to prescribe a treatment plan.
Summary
When you have shingles, your symptoms typically follow three to four stages, starting with tingling pains and sometimes a fever, then a blistering rash in the same areas.
Sometimes, long-term nerve pain can occur, called postherpetic neuralgia. This stage is less common and can last days to years.
Natural treatments like oatmeal baths can help manage itching. Antiviral medications may help speed your recovery.
The shingles vaccination is the most effective way to prevent shingles symptoms.
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