The type of shingles you have depends on which nerve roots the virus affects. While it most commonly affects the torso, it can also affect your eyes, face, or mouth, be widespread, or not cause a rash at all.

The virus that causes chickenpox, varicella-zoster virus (VZV), remains dormant in your nerve roots after you’ve recovered. Years later, it can reactivate, causing shingles.

Shingles is a painful rash that most often appears on your trunk. But VZV can reactivate in any nerve root, causing different types of shingles.

Although shingles can be quite painful, it’s not usually dangerous. But some shingles types warrant early, aggressive medical treatment.

Herpes zoster (HZ), or typical shingles, is most common in adults ages 50 years and older, though it can occur at any age.

If VZV reactivates in your nerves, your first symptoms might be:

After a few days, the shingles rash appears on that patch of skin. This dermatomal rash pattern resembles a band or cluster on one side of your body.

Initially, the rash looks like flat pink or discolored spots. These progress into small blisters, then eventually scab over. This process usually takes about 10 days.

A doctor can diagnose shingles by talking with you and examining your rash. Sometimes, skin swabs are needed to confirm a diagnosis.

Oral antiviral medications are especially helpful if started within 72 hours of symptom onset. These medications include:

A doctor may also recommend oral or topical pain medications.

Shingles symptoms typically last 2–4 weeks. However, some people experience chronic symptoms lasting months to years after their rash resolves.

Postherpetic neuralgia (PHN) is long-term nerve pain in the affected area. PHN can affect up to 20% of people after shingles, especially older adults.

In herpes zoster ophthalmicus (HZO), VZV affects the ophthalmic branch of your fifth cranial nerve.

Symptoms include burning or tingling followed by an eruption of shingles rash on your forehead, upper eyelid, and nose.

In about half of cases, the eye itself is involved, leading to:

  • pain
  • redness
  • light sensitivity
  • vision changes

A doctor may recommend antivirals, pain medication, and an evaluation with an eye doctor called an ophthalmologist. Topical antibiotics, steroids, or even surgical procedures may be necessary.

Although HZO is serious, most adults recover fully within about 4 weeks. Still, long-term complications, like PHN and chronic degeneration or scarring of the cornea, are possible.

HZO is a medical emergency

Shingles in your eye is a medical emergency due to the risk of serious complications like vision loss. Contact a doctor right away if you think you have shingles on or near your eye.

Less than 1% of shingles cases involve the seventh cranial nerve, causing herpes zoster oticus, or Ramsay Hunt syndrome.

Symptoms include:

It may also affect the nearby eighth cranial nerve, causing:

  • vertigo
  • hearing loss or tinnitus in the affected ear
  • decreased sense of taste
  • slurred speech

About 85% of people with Ramsay Hunt syndrome recover from facial paralysis partially within 4 weeks and fully within 6 months.

Some people experience long-term issues, such as synkinesis. This is when moving one part of your face causes another to move involuntarily. PHN is also possible.

Prompt treatment with oral antivirals and high dose corticosteroids, such as prednisone, can help reduce your risk of complications.

When VZV reactivates in other branches of your fifth cranial nerve, symptoms primarily affect your oral cavity (mouth).

As in other types of shingles, you may first develop fever, fatigue, and tingling or burning pain on one side of your mouth. Pain can also involve the face or teeth.

Shingles lesions then appear inside your mouth. Oral shingles won’t cross the midline of your mouth, which helps differentiate it from other oral infections.

A doctor can prescribe treatment with antivirals and recommend oral or topical pain relievers. Common shingles complications like PHN may occur.

Doctors diagnose disseminated zoster when more than 20 shingles lesions appear outside the primary dermatomal area. It’s much more common in people with a weakened immune system.

Disseminated zoster can also affect other areas, including your:

  • lungs
  • gastrointestinal tract
  • blood vessels
  • brain
  • spinal cord

This can cause severe complications, such as:

People with disseminated zoster may require hospitalization to receive intravenous antiviral medication and other treatments, depending on their circumstances.

The outlook for people after disseminated zoster varies. It depends on any underlying health conditions and the particulars of the illness.

Zoster sine herpete (ZSH) is an unusual condition in which you develop classic pre-rash shingles symptoms, but the rash never erupts.

ZSH can occur anywhere, including your skin, internal organs, or cranial nerves, mimicking many of the other shingles types.

ZSH can be difficult to diagnose given the absence of rash. A doctor might order viral PCR testing to confirm ZSH.

Treatment includes antiviral medications, pain management, and sometimes corticosteroids.

PHN is always a risk after shingles, but other long-term outcomes after ZSH depend on underlying health conditions and the body systems affected.

What usually triggers shingles?

Shingles triggers include stress, illness, immunosuppression, medications like steroids and chemotherapy, and cancer. Although some triggers are known, doctors aren’t sure exactly how the virus reactivates or what causes it to reawaken in some people but not in others.

What can shingles be mistaken for?

A typical shingles rash might be mistaken for herpes simplex, folliculitis, or contact dermatitis, such as poison ivy.

HZO might be mistaken for other forms of infectious, irritant, or allergic conjunctivitis or keratitis.

The facial paralysis associated with Ramsay Hunt syndrome could be mistaken for stroke or Bell’s palsy.

Can shingles spread to other parts of the body?

Because shingles isn’t a new infection, you don’t usually need to worry about it spreading to other parts of your body.

But rarely, disseminated or widespread shingles can occur. There have also been case reports of people accidentally spreading their shingles lesions through procedures like microneedling.

You can also transmit the infection to people who have never had (or been vaccinated against) chickenpox if they come into contact with your shingles blisters.

Shingles typically causes a localized, blistering skin rash along with nerve pain. But shingles can present in different ways.

Shingles may involve your eye (HZ ophthalmicus), inner ear or facial nerve (HZ oticus or Ramsay Hunt syndrome), or become widespread (disseminated shingles). In such cases, prompt recognition and treatment adjustments are very important to prevent serious long-term complications.

Contact a doctor immediately if your shingles rash is widespread or if you suspect you have shingles affecting your eye, ear, or mouth.