Although shingles and hives may look alike, the appearance and location of your rash can give clues on the underlying cause.

Shingles usually causes a painful and itchy rash. Reactivation of the varicella-zoster virus causes shingles. This is the same virus that causes chickenpox.

Hives is another condition that can cause an itchy rash. It’s characterized by raised welts that can range from small to large. An immune response to a foreign substance triggers the condition.

Read on to learn more about the similarities and differences between these two conditions.

ShinglesHives
Typical locationone side of the body, most commonly on your torsoanywhere, including your face or tongue
Rash appearancea cluster of small blisters in a stripe that scabs over in 7–10 daysraised welts or bumps in one area or over your entire body
Causereactivation of varicella-zoster virusallergy or sensitivity to a foreign substance

Shingles and hives can cause similar rashes. Here are the typical symptoms of each.

Shingles symptoms

The most common symptom of shingles is a rash on one side, most commonly on your torso. It can occur anywhere, including your face.

A few days before the rash appears, you may experience:

  • pain
  • itching
  • tingling

When the rash appears, it usually appears as a strip of small blisters. The blisters usually scab over within 7–10 days and heal within 2–4 weeks.

Other symptoms may include:

Hives symptoms

Hives is characterized by raised bumps or patches that:

  • can be large or small
  • can appear anywhere
  • appear in one area or across your body
  • itch, sting, or burn
  • look red or pink on light skin or purplish on dark skin

Here are some examples of both shingles and hives.

These are the causes and triggers for shingles and hives.

Shingles causes and triggers

Shingles is caused by a reactivation of the varicella-zoster virus that also causes chickenpox. This virus remains dormant in your nervous system until your immune system can no longer suppress it. The virus is most commonly reactivated in adults over age 65 years.

Potential triggers for shingles include:

  • stress
  • immunosuppressant medications
  • development of other illnesses
  • cancer or cancer treatment

Hives causes and triggers

Hives results from an immune response to a particular trigger. Exposure to your triggers activates white blood cells called mast cells and basophils, which leads to the release of chemicals like histamine and prostaglandin that cause your symptoms.

Potential triggers include:

  • certain foods
  • contact with plants, animals, or latex
  • cold exposure
  • emotional stress
  • spicy food
  • hot, sweaty skin
  • medication side effects
  • insect bites and stings
  • infections
  • wearing itchy and tight clothing
  • immune system problems

The American Academy of Dermatology Association (AAD) recommends seeing a dermatologist within 3 days of developing shingles.

It’s important to get prompt medical attention if you develop shingles in a sensitive area like your genitals or face.

The National Health Service (NHS) recommends seeing a doctor about hives if:

  • your symptoms do not improve after 2 days
  • you’re worried about your child’s hives
  • the rash is spreading
  • you have recurrent hives
  • you have a high fever or feeling of unwellness
  • you have swelling under your skin that can indicate angioedema
Medical emergency

Call emergency medical services or go to the nearest emergency room if you or somebody you’re with develops signs of a severe allergic reaction called anaphylaxis. This includes:

  • swelling in your throat, tongue, or mouth
  • fast breathing or trouble breathing
  • throat tightness
  • difficulty swallowing
  • pale, blue, or gray lips, tongue, or skin, which may be easiest to see on your palms or soles if you have a darker skin tone

A doctor can diagnose hives by looking at your swelling and asking about your medical history. They may order additional tests like blood tests or allergy skin tests.

The doctor will likely be able to identify shingles based on the distinct shape of your rash. They may request a skin scraping for lab testing.

Here’s a look at the treatment for shingles and hives.

Shingles treatment

A mild shingles rash may not need treatment. According to the NHS, you may be offered antiviral tablets if you have:

  • a weak immune system
  • a moderate or severe rash
  • a rash affecting areas other than your abdomen, back, or chest

Learn more about shingles treatment.

Hives treatment

You may not need treatment if you have mild hives. For moderate or severe cases, your doctors may prescribe:

Learn more about home remedies for hives.

If you’ve already had chickenpox, minimizing stress and supporting your immune system can help prevent the reactivation of the virus.

The Centers for Disease Control and Prevention (CDC) recommends the vaccine Shingrix for people over age 50 years.

You can prevent hives by avoiding substances that you know trigger your symptoms.

Here are some frequently asked questions people have about shingles and hives.

What does shingles look like at the start?

Shingles often starts as a tingling or painful sensation on your skin. A rash on one side usually appears a few days later, most often on your torso.

What could be mistaken for shingles?

Other conditions that can cause similar symptoms as shingles include:

Can you get hives after shingles?

Since hives and shingles are two distinct skin conditions, you could develop both at the same time or one after the other. A common reason for hives being associated with shingles would be due to an immune reaction to a treatment for shingles, such as a reaction to a topical shingles treatment.

Shingles usually causes a stripe of small blisters on one side of your torso but can develop anywhere on your body. Hives can cause welts and discoloration over one body part or your entire body.

It’s recommended that you get treatment within 3 days of developing shingles since this is when antiviral medications are most effective.

Hives is a rash caused by an immune reaction, often due to an allergic reaction. It’s critical to get emergency medical attention for hives if you develop symptoms of anaphylaxis.