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The 3 stages of shingles: What to know

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Shingles stagesSymptomsTreatmentsSummary
Shingles is an infection that comes from the varicella-zoster virus, which also causes chickenpox. Typically, a shingles rash goes through two or three different stages before healing.
Medically reviewed by Darragh O'Carroll, MD
Written by D. M. Pollock
Updated on July 20, 2023

The varicella-zoster virus (VZV) causes shingles, a condition characterized by a painful rash. This is the same virus that causes chickenpox.

So if you’ve had chickenpox, it’s possible that you might develop shingles later in life. This is because the virus remains dormant in your body, then reactivates later on.

According to the National Foundation for Infectious Diseases, nearly half of all Americans who live until the age of 85 will experience shingles.

There are three key stages in a shingles infection: pre-rash, eruptive, and chronic. Learning how these stages appear can help you identify the condition and receive treatment earlier.

Stages of shingles

A person scratching their head, representing one stage of shingles which can affect the scalp.
Photography by AndreyPopov/Getty Images

Symptoms of shingles do not typically last longer than 3–5 weeks, according to the National Institute on Aging (NIA). But this can vary between individuals, and the pain you experience throughout a shingles infection changes as time goes on.

The stages below outline the typical timeline for shingles symptoms, including pain.

Pre-eruptive

The medical term for early-stage symptoms of shingles is pre-eruptive. You may notice pain or burning sensations around certain areas of the skin. A red rash may appear in these same areas.

The areas where you are most likely to feel these sensations are places where your nerves spread out across your body. For example, it might occur across your abdomen, where nerves spread outward from the spine in horizontal lines.

These pains typically start at least 2 days before you notice any blistering.

Acute eruptive

After these 2 days, a shingles rash may start to appear. This will turn from a red rash to fluid-filled blisters. After about 10 days, this blistering rash will dry out, crust over, and eventually disappear, according to the NIA.

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.

Chronic

Not everyone experiences the chronic stage, also called the postherpetic neuralgia (PHN) stage. This is long-term nerve pain that about 1 in 5 people experience after a shingle infection. This stage can last from weeks to years.

Yet it does not affect everyone. According to the NIH, the older you are, the more likely you are to develop postherpetic neuralgia.

This nerve pain typically occurs in the same place on your body where the rash appeared.

Symptoms

The most common symptom of shingles is a painful rash on one side of your body, typically in a single stripe around the body. This rash develops into 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.

Pre-eruptive

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
  • headache
  • upset stomach
  • photophobia, or sensitivity to light
  • itching skin
  • tingling skin
  • burning pains on your skin

As soon as you experience any of these symptoms, and suspect you have shingles you should seek advice from a healthcare professional. They will be able to diagnose shingles from these symptoms and your medical history.

This will allow you to receive treatment as soon as possible.

Acute eruptive

The acute eruptive stage, or 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.

Within around 10 days, the vesicles will begin to heal and form scabs.

Chronic

The chronic stage of shingles does not happen to everyone. Most people, particularly if they have no underlying conditions, will most likely recover as soon as their rash disappears.

However, in some people, the infection causes nerve damage that takes a while to heal. Damaged nerves cannot send messages to the brain properly, meaning the messages get confused. This is called postherpetic neuralgia.

It can feel like the following:

  • burning sensation on the skin
  • sensitivity to slight touch
  • severe pain in the same area of the skin, even after the rash is gone

It may lead to other complications, such as:

  • anxiety
  • difficulty sleeping
  • weight loss
  • depressive episodes

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Treatments

There is no cure for shingles, but receiving a diagnosis quickly can help you get the treatment you need to speed up recovery, manage pain, and prevent any complications.

Medications and home remedies may help soothe your symptoms while you recover.

Medications

Medications that a healthcare professional may prescribe typically aim to help your body fight off 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 the following:

  • Antivirals: Oral antiviral medications aim to prevent neuralgia and speed up skin healing. Examples include acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir).
  • Anticonvulsants: The Food and Drug Administration (FDA) approves the use of gabapentin (Neurontin) and pregabalin (Lyrica) to manage pain from neuralgia.  
  • Capsaicin: Capsaicin is available as skin patches and low dose oral medications. This natural compound that comes from chili peppers 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:

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 age 50.

According to the Centers for Disease Control and Prevention (CDC), the Shingrix vaccine protects you from long-term nerve pain and will work even if you have already had shingles before.

If you are age 50 years or above and at risk of developing shingles, speak with a doctor about receiving a vaccination.

Summary

When you have shingles, your symptoms typically follow two to three stages, starting with tingling pains and sometimes a fever, then a blistering rash in the same areas.

Sometimes you may have long-term nerve pain, which is called postherpetic neuralgia. This can last anywhere from days to months, but it’s a more uncommon stage of the condition.

Natural treatments like oatmeal baths can help manage itching and stop you from scratching. Antiviral medications may help speed up your recovery.

The shingles vaccination is the most effective way to prevent shingles symptoms.

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