Shingles rash: how to identify, treat, and prevent it

Shingles is synonymous with a painful, blistery rash. If you develop a rash, you may wonder if shingles is to blame.

There are ways to tell. The shingles rash has some standout characteristics. But in some cases, it may be hard to determine whether shingles is the cause of your skin symptoms—or if you’re dealing with something else.

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According to the Centers for Disease Control and Prevention, the most common shingles rash is a single strip or band, made up of clusters of painful blisters that appear on one side of the body or face. The rash often appears near your waistline, like a belt, which also explains the term "shingles," which comes from the Latin word for belt: "cingulum" (NINDS, 2019).

During the shingles rash early stages, the first sign can be a burning pain, itching, or tingling on the area of the skin where the blisters will show up. Other symptoms of shingles include headaches, chills, fatigue, an upset stomach, and other fever-like symptoms (CDC-a, 2019).

Once the rash starts to appear, it often takes the form of two or three crops of blisters—again, arranged in a kind of strip or band—that are fully formed within three to five days. Those blisters can be very painful. They will usually break open, leak fluid, and then crust over. This phase usually lasts two-to-four weeks.

In rare cases, shingles rashes may appear in many places all over your body (Nair, 2021).

The shingles rash and blisters typically heal and disappear—along with all their other symptoms—within three to five weeks (NINDS, 2019).

Shingles is a viral syndrome. It’s caused by the varicella-zoster virus, which is the same virus that causes chickenpox (Nair, 2021).

If you’ve ever had chickenpox, you’ve been infected by varicella-zoster. And even though you recovered from chickenpox, that virus still lives inside your body.

After years or decades of inactivity, that virus can reactivate and give you a painful rash and other symptoms known collectively as shingles. The formal medical name for shingles is herpes zoster (CDC-b, 2019).

Shingles is super common. Roughly one out of every three Americans will get shingles at some point (Harpaz, 2008).

While shingles can happen at any age, older adults are at greater risk. By some estimates, your risk of shingles roughly triples if you’re older than age 65 (Nair, 2021).

Compared to healthy adults, people who have weakened immune systems are also at increased risk for shingles. This includes people with HIV, people who have had an organ transplant, or those undergoing cancer treatments that weaken the immune system (NINDS, 2019). 

Experts aren’t 100% sure what causes the long-dormant varicella-zoster virus to flare. But many believe that a weakened immune system—either due to old age, illness, or one of the other factors mentioned above—allows the reactivation of the virus.

Once that happens, the virus replicates (make copies of itself) inside of your nerve cells. Some of these copies make their way down the nerves to the skin, where they cause inflammation, blistering, severe pain, and other common shingles symptoms (Nair, 2021).

About 10% of people who have shingles develop a chronic pain condition called postherpetic neuralgia. The older you are, the greater your risk for this complication (CDC-c, 2019).

For people with postherpetic neuralgia, the pain usually lingers around the site of the skin rash. That pain tends to be cutting or burning, and it continues for three months or longer after the initial outbreak has gone away.

Experts aren’t exactly sure why some people (but not others) develop postherpetic neuralgia. But there’s some evidence that out-of-control inflammation may be to blame (Gruver, 2020).

Some other shingles complications include (Nair, 2021) (CDC-d, 2019):

• Scarring at the site of the blisters

• A secondary bacterial infection

• Nerve problems or numbness

• Brain inflammation caused by infection (encephalitis)

• Pneumonia

• Hearing problems or vision loss 

The main treatments for shingles are prescription antiviral medications. These include acyclovir, valacyclovir (see Important Safety Information), and famciclovir. These antivirals can speed up the disappearance of your blisters, lower your shingles pain, and reduce the risk of complications like postherpetic neuralgia (Nair, 2021).

A healthcare provider may also prescribe you a topical antibiotic cream to prevent bacterial infections. If your pain is severe, prescription and over-the-counter drugs can also be helpful. Wet compresses, calamine lotion, and colloidal oatmeal baths can help with itching or discomfort (CDC-e, 2019).

If you have shingles blisters, you could spread the varicella-zoster virus to anyone who comes into direct contact with the fluid from your blisters. But if that happens, the person you infect would develop chickenpox, not shingles. That person could then develop shingles later in life.  

You can't spread the virus to someone who has already had it. You also can't spread the virus to someone vaccinated against varicella-zoster (CDC-b, 2019).

If you have shingles, antiviral medications can reduce your risk for complications like postherpetic neuralgia. For this reason, it’s a good idea to see a medical professional right away if you think you have shingles.

A medical professional can also perform tests to confirm that what you have is shingles and that you're getting the appropriate treatment (Nair, 2021).

Shingles is a preventable illness.

Since the late 1990s, a chickenpox vaccine has been available to Americans. If you’ve had that vaccination, you’re protected against both chickenpox and shingles (Gruver, 2020).

If you’ve already had chickenpox, there is also a vaccine that offers 90% protection against shingles. It’s called Shingrix, and it involves two separate shots in your upper arm. A medical professional will give you these shots two-to-six months apart.

The CDC recommends that all adults aged 50 and older get the shingles vaccines. Even if you’ve already had shingles, the CDC recommends the vaccine because it protects you from repeat cases of shingles (CDC-f, 2018).

The bottom line on shingles is that, in most cases, it’s treatable or preventable. If you develop a rash that you think may be shingles, the most important step you can take is to talk with a medical professional.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

July 21, 2021

Written by

Health Guide Team

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.