What can be mistaken for shingles?

Key takeaways

• Shingles is a viral infection caused by the reactivation of the varicella-zoster virus (VZV), which also causes chickenpox. It typically produces a painful, blistering rash on one side of your body.
• Several skin conditions can resemble shingles, including eczema, psoriasis, hives, chickenpox, and fungal infections like ringworm. A healthcare professional can distinguish shingles by its one-sided rash, pre-rash nerve pain, and fluid-filled blisters.
• Oral antiviral medications like acyclovir, famciclovir, or valacyclovir can speed recovery and reduce pain when started within 3 days of symptoms. Anti-inflammatory medications and topical numbing creams may also help manage discomfort.

Overview

Shingles causes a blistering rash that can be painful. It can resemble other conditions that cause rashes, like eczema, psoriasis, or chickenpox. If you have had a case of chickenpox, you are at risk of developing shingles at some point.

While some symptoms of shingles are easy to identify, others can resemble other conditions that affect your skin. These symptoms can include:

• itching
• tender skin
• discolored patches of skin
• fluid-filled blisters

Knowing what condition is affecting you is essential to ensure you’re getting the right treatment.

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What looks like shingles?

According to the Centers for Disease Control and Prevention (CDC), shingles affects about 1 in 3 people in the United States at some point. 

Shingles is preventable for the majority of people who have previously had chickenpox. The CDC recommends that adults ages 50 years and above receive the recombinant zoster vaccine (Shingrix) to greatly reduce the risk of developing shingles and its complications.

The safest way to work out whether a rash is shingles is to speak with a healthcare professional. They will likely perform a physical exam to assess your symptoms and will consider your medical history. This physical exam is important when correctly diagnosing shingles.

Some shingles symptoms can resemble other skin conditions. For example, a doctor will need to determine whether your rash is not one of the following conditions:

• eczema
• herpes simplex
• impetigo
• insect bites, like from a mosquito
• reactions to medications

Some common conditions that can resemble shingles include:

Eczema

Eczema is a group of skin conditions that causes patches of discolored, itchy, and dry skin. These patches can resemble the rash you see with shingles.

However, the cause of eczema is different from shingles. While shingles is the result of an infection, there is no clear cause of eczema.

Researchers think that genetic factors relating to the production of a protein called filaggrin may be the cause. An overactive immune system, which causes inflammation, may also be a factor.

What differentiates eczema from shingles is the following distinct symptoms that only appear with shingles:

• Pre-rash symptoms: Burning sensations or tingling nerve pain before any visible rash develops. If you have eczema, you may experience itching before a rash develops, but you will not notice any pain.
• Rash location: A shingles rash usually only occurs on one side of your body. Eczema, on the other hand, causes rashes across your body.
• Skin soreness: Shingles typically causes tingling, numbness, and pain that is sensitive to touch. You may notice itching at first with shingles, but it will usually become painful. Pain does not typically occur with eczema unless symptoms are more severe.
• Frequency of rashes: Shingles rashes usually happen only once. Eczema is a chronic condition that flares up and will continue to come and go without treatment.
• Other symptoms: Symptoms such as fever, headaches, and an upset stomach can occur with shingles. Eczema typically only affects your skin.

Psoriasis

Psoriasis is a chronic autoimmune disorder. It results in fast skin cell turnover, producing thickening skin, or plaques, that are often itchy, discolored, and inflamed. While psoriasis and shingles both cause patches of itchy and painful skin, there are some key differences in their symptoms to look out for.

These include:

• Rash distribution: Shingles usually develops on only one side of your back, abdomen, limbs, face, or chest. Psoriasis lesions are multiple, appearing on both sides of your body, and usually along your scalp, knees, and elbows.
• Rash color: While both conditions cause patches of thickening skin, psoriasis can appear as silvery scales where the dead skin cells collect. In shingles, the rash appears redder on lighter skin or purple or dark brown in people with darker skin tones.
• Other symptoms: Shingles can cause fatigue, fever, and headaches. Psoriasis may cause your joints to stiffen, which can also lead to fatigue if your condition is severe. This condition is called psoriatic arthritis.

Chickenpox

Varicella-zoster virus causes chickenpox, and shingles is an illness that can develop years later if the virus reactivates. The symptoms of both conditions are very similar.

However, shingles rashes only develop on one side of the body. This is not the case with chickenpox. You’re also more likely to catch chickenpox earlier in life, while shingles mostly develops after the age of 50 years.

Chickenpox can pass from one person to another through physical contact. On the other hand, you can develop shingles only if you are carrying the dormant chickenpox virus. About 1 in 3 people in the United States go on to develop shingles years after chickenpox.

Hives

While hives and shingles both produce itchy rashes, they are two very different health conditions. Hives, or urticaria, are typically your skin’s reaction to an allergen.

The most common symptoms of hives are patches of raised skin that turn white when you press on them. These are called welts, and they can develop anywhere from the back to the arms and chest. 

The key differences between hives and shingles rashes include:

• hives cause welts to develop, while shingles do not
• hives are not painful to the touch, unlike shingles
• shingles rashes cause fluid-filled bumps, while hives do not

Fungal infections

Certain fungal infections can resemble a shingles rash, particularly in their early stages. One example of this is ringworm. The fungi that cause this infection can live on household surfaces like bedding and clothes.

Early ringworm infection may occur initially in your groin. These rashes can resemble shingles or eczema and may have the following features:

• red or brown raised rashes
• itchy skin
• scaly patches

However, ringworm rashes are typically circular, with a small patch of healthy skin in the center. They are also painless to the touch but are itchy and swollen. They can occur on either side of the body but usually start at the groin, scalp, or foot.

Shingles rashes are painful to the touch and only occur on one side of the body.

Shingles symptoms

Shingles can affect anyone who has had a chickenpox infection, but not everyone who has had chickenpox will go on to develop shingles.

The following factors place you at an increased risk of developing shingles:

• being more than 50 years of age
• having a weakened immune system, like from medication or a health condition
• previously having shingles

The following are common symptoms people experience with shingles:

• painful, blistering rash on one side of your body
• skin numbness
• tingling
• itching
• a fever
• headaches
• stomach upset
• shooting or burning pain

Treatments

There are medications available that a doctor can prescribe to you to help treat shingles.

These include:

You can also try natural remedies to ease your symptoms, including oatmeal baths to help soothe itching.

If you need help covering the cost of medications, the free Optum Perks Discount Card could help you save up to 80% on prescription drugs. Plus, you can now get them delivered to your home in as little as 3 days. Search for your medication here.

Online care for shingles

It’s important to seek treatment for shingles within 3 days of noticing symptoms. Getting the right treatment quickly can help reduce the peak of your pain and prevent long-term complications. It may also reduce the length of your illness.

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

Shingles is a viral infection that can develop several years after a chickenpox infection, caused by the reactivation of the chickenpox virus. It usually causes a painful rash with fluid-filled blisters that cluster only on one side of your body. The blisters can sometimes develop in a line across the abdomen.

Because the condition causes a rash, it can sometimes resemble other skin conditions like eczema, psoriasis, or fungal infections. However, several clinical features help doctors distinguish between shingles and lookalike conditions.

If you suspect you have shingles, it is important to seek advice from a healthcare professional. They will be able to accurately diagnose the cause of your rash, whether it’s shingles or something else, and help find the best treatment for you.

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