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
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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