Early signs of shingles can include tingling and localized pain. You may also develop a blistering rash that can itch, burn, or hurt.

Shingles, also known as herpes zoster, occur when the dormant chickenpox virus, varicella zoster, is reactivated in your nerve tissue.

Typically, the shingles rash lasts 2 to 4 weeks, and most people make a complete recovery.

Doctors are often able to quickly diagnose shingles from the appearance of the skin rash.

Shingles rash shown on a darker skin tone. Share on Pinterest
Shingles rash, shown here on a darker skin tone, appears as tiny red blisters in a group or cluster.
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Picture of shingles on lighter skinShare on Pinterest
A viral infection causes shingles and a painful rash (shown on a lighter skin tone).
Photography by DermNet New Zealand

Prior to the rash starting, you may develop a burning sensation, itchiness, or tingling on one side of the body, often on the trunk. You may also develop:

  • a headache
  • sensitivity to light
  • general fatigue

When the rash starts, you may notice pink or red blotchy patches on one side of your body. These patches cluster along nerve pathways. Some people report feeling shooting pain in the area of the rash.

During this initial stage, shingles is not contagious.

The rash quickly develops fluid-filled blisters like chickenpox. They may be accompanied by itching. New blisters continue to develop for several days. In most cases, according to the Centers for Disease Control and Prevention (CDC), blisters appear over a localized area, but widespread blistering is possible.

Blisters are most common on the torso and face, but they can occur elsewhere. In rare cases, the rash appears on the lower body. Some possibly may not develop a rash at all.

It’s not possible to transmit the shingles virus to someone. However, if you’ve never had chickenpox or the chickenpox (varicella) vaccine, it’s possible to get chickenpox from someone with shingles through direct contact with active blisters since the same virus causes both shingles and chickenpox.

Once a rash starts, it’s important to consult with your doctor within 3 days, according to the American Academy of Dermatology (AAD). In the first 3 days, they can prescribe an antiviral, which can help speed up recovery and reduce symptom severity.

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As shingles heals, the rash will start to scab over (shown on a darker skin tone).
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In most cases, shingles rash leaves no scars and fully heals (shown on a lighter skin tone).
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Blisters sometimes erupt and ooze. They may then turn slightly yellow and begin to flatten. As they dry out, scabs form. Each blister can take 7 to 10 days to crust over, per the National Institute on Aging.

During this stage, your pain may ease a little, but it can continue for months, or in some cases, years.

Once all blisters have completely crusted over, there is a low risk of transmitting the virus.

Shingles often appears around the rib cage or waist, and may look like a “belt” or “half belt.” You might also hear this formation referred to as a “shingles band” or a “shingles girdle.”

This classic presentation is easily recognizable as shingles. The belt can cover a wide area on one side of your midsection. Its location can make tight clothing particularly uncomfortable.

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In some cases, shingles rash can present near the eye. This is known as ophthalmic shingles.

Ophthalmic shingles, also known as herpes zoster ophthalmicus, occurs around the eye. Often, it starts out as a burning or tingling sensation on the scalp, cheeks, or forehead.

Like when shingles appears on other areas of the body, the tingling sensation can turn into an itchy, painful rash on the scalp, forehead, or cheeks.

If shingles affects the eyes, it can cause symptoms such as redness and swelling of the eye, inflammation of your cornea or iris, and drooping eyelid. Ophthalmic shingles can also cause:

  • mild to severe vision loss
  • discharge from the eye
  • feeling that a foreign body is in the eye
  • light sensitivity

According to the CDC, though less common, people who develop shingles may develop a rash that crosses multiple dermatomes. Dermatomes are separate skin areas that are supplied by separate spinal nerves.

When the rash affects three or more dermatomes, it is called “disseminated or widespread zoster.” In these cases, the rash may look more like chickenpox than shingles. You are more likely to develop widespread shingles if you have a weakened immune system.

A secondary bacterial infection is a possible complication of shingles.

Open sores of any kind are always susceptible to bacterial infection. To lower the possibility of a secondary infection, keep the area clean and avoid scratching.

Severe infection can lead to permanent scarring of the skin. Report any sign of infection to your doctor immediately. Early treatment can help prevent it from spreading. People with weakened immune systems have a higher chance of developing infections or other complications.

Most people can expect the rash to heal within 2 to 4 weeks. Although some people may be left with minor scars, most will make a complete recovery with no visible scarring.

In some cases, pain along the site of the rash can continue for several months or longer. This is known as postherpetic neuralgia.

You may have heard that once you get shingles, you can’t get it again. However, the CDC cautions that shingles can return multiple times in some people.

The varicella-zoster virus causes shingles to occur. If you had chickenpox as a child or got the chickenpox vaccine, you can develop shingles at some point within your life. However, you have a lower risk of developing shingles if you had the vaccine.

The exact reason why the virus resurfaces is still not fully understood. However, as you age and your defense against the virus decreases, you may become more susceptible. The risk of developing shingles and complications increases drastically at 50 years old.

According to the CDC, about 1 in 3 adults will develop shingles at least once in their lifetime. Several factors, including age, can increase your risk of developing shingles at least once in your lifetime.

Possible risk factors include:

  • being age 50 years or older
  • living with human immunodeficiency virus (HIV)
  • being a bone marrow or solid organ transplant recipient
  • taking immunosuppressive medications, such as chemotherapy, steroids, or those related to transplants
  • living with cancer, particularly leukemia and lymphoma

The CDC notes that other factors may play a part in who develops shingles, but more research is needed to further explain, better understand, and confirm these factors. According to research:

  • There’s a higher prevalence of shingles diagnoses in white people compared with Black people.
  • People who are assigned female at birth may be more likely to develop shingles than people who are assigned male at birth.

Most doctors can visually examine and diagnose shingles based on the rash and other symptoms. In most cases, the rash:

  • appears a few days after other symptoms, such as tingling sensation, start
  • develops only on one side of the body
  • often occurs around the trunk
  • appears only in one or two areas
  • develops a blistering effect that lasts about 2 to 4 weeks

Shingles rash vs. herpes

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Cold sores are caused by HSV-1 (shown on a darker skin tone).
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HSV-1 spreads by close contact, commonly through kissing (shown on a lighter skin tone).
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Shingles, also known as herpes zoster, is in the same viral family as herpes simplex. At first, it may be difficult to tell the two conditions apart because they both cause blistering rashes.

However, shingles, unlike herpes, typically does not cross the body’s midline and often appears on the trunk. Herpes often appears around the genitals or in the mouth. In both cases, a person may not develop a rash at all or may develop other symptoms that can help a doctor distinguish between the two conditions.

A person should talk with their doctor if they’re not sure which virus may be causing the rash.

For more information on herpes versus shingles rash, click here.

Shingles rash vs. poison ivy

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Poison ivy rash will appear red and inflamed and can be painful (shown on a darker skin tone).
Photo by DermNet New Zealand
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Poison ivy exposure can cause a quick-forming rash on the exposed areas (shown on a lighter skin tone).
Abm6868, CC BY-SA 4.0, via Wikimedia Commons

Poison ivy, oak, or sumac can cause an allergic reaction that results in a painful, itchy rash. When the rash appears, it often appears as a straight line.

One way to distinguish between the two conditions is that poison ivy often appears on exposed areas of skin and on both sides of the body.

You can learn more about the difference between shingles and poison ivy rash here.