What are the Signs and Symptoms of Shingles?

Shingles, also known as Herpes Zoster, is a painful and contagious rash that can appear on one side of the body or face. This condition typically affects people who have had chickenpox in the past. It is caused by the varicella-zoster virus, which has lain dormant for many years in the nerve cells before becoming active again.

What are the signs and symptoms of shingles?

The signs and symptoms of shingles are described below:

Prodromal sensory phenomena (i.e., the first signs that indicate you may have shingles) include tingling, prickling, burning, and itching in a localized area along one or more dermatomes (which is an area of the skin that is connected to nerves from a single spinal root) on the body. There may also be other symptoms present which are more systemic, such as headaches, sensitivity to light and touch, fatigue, chills, stomach upset, and fever.

Around 48 hours after onset of these symptoms, the rash can appear reddish with small and flat discolored skin lesions (also known as macules) or in the form of raised bumps (also known as papules), which are blisters that contain fluid. The redness of the rash presents differs slightly on people with darker pigmentation as the redness can be less pronounced. These rashes typically appear on one side of the body that is dependent on the location of the affected dermatome. The back of the chest (58%), the neck (20%), and the facial/eye area (10–20%) are the most common areas where these rashes can be found (Bond & Panesar, 2021). There are several complications that can result depending on the area affected. When the seventh cranial nerve is concerned, it can result in weakness of the facial muscles and go on to affect the inner, middle, and external ear area (zoster oticus). This goes on to produce ringing in the ears, hearing loss, nausea and vomiting, vertigo, and involuntary eye movements (Cohen et al., 2013).

These open lesions, which are fluid-filled and virus shedding, increase the risk of transmission. Scabs typically start to form at day 7–10 of the disease and heal (with some scarring) in 3 to 5 weeks. However, immunocompromised shingles sufferers such as those with AIDS and cancer may need a more extended period to recover as their immune system is less capable of fighting against the virus. There are various reasons why scarring and pigmentation might remain. Still, the two most common reasons are when the shingles patient scratches the rashes often, leading to an incomplete healing process in the skin, or if the rashes encounter secondary bacterial infection.

What can be mistaken for shingles?

It is easy to mistake shingles’ early signs and symptoms for other common skin afflictions, including hives and psoriasis. However, some characteristics are slightly different from that of shingles.

Hives is an allergic reaction to medications, foods, latex, or a viral infection. It typically presents itself as red, itchy bumps of different sizes that can appear anywhere on the body.

Psoriasis is an autoimmune disease that can form rash-like patches, which can then go on to develop blisters. Psoriasis can persist for quite a long period of time, and the skin keeps turning more red and scaly and can even crack and bleed.

One way to tell if the rashes are indeed caused by shingles is via the pattern of the rashes. Unlike hives and psoriasis, shingles often only affects one side of the body, very commonly along the nerves of the chest and belly. Shingles can also cause someone to suffer much more pain as compared to other milder skin conditions.

Shingles can also be mistaken for chickenpox, which is caused by the same virus. However, chickenpox rashes are often spread across the body, while shingles will typically be on one side of the body. However, there are also cases in which shingles spreads throughout the entire body, and this is known as disseminated herpes zoster. In such cases, the best way to correctly diagnose the condition is to seek medical attention. A doctor can diagnose shingles via the clinical presentation of the disease, as well as lab tests such as polymerase chain reaction (PCR) tests or direct fluorescent antibody (DFA) smears.


In conclusion, shingles is caused by the reactivation of the varicella-zoster virus in the nerve cells. This virus causes the acute onset of a rash and can go on to cause complications depending on the nerves that are affected. While most people heal within 3 to 5 weeks, the immunocompromised may find it harder to recover from shingles. The rashes take different forms but typically form on one side of the body and appear as blisters filled with clear or cloudy fluid, which eventually form scabs over time. While shingles may be misdiagnosed for other skin conditions such as hives and psoriasis, it is a much more severe condition and is characterized by sharp pain. While this article can help identify symptoms, one should visit a doctor for an accurate diagnosis. Getting an accurate diagnosis and getting treated early will help reduce the disease’s severity and duration.

Bond, G., & Panesar, P. (2021, February 19). Case-based learning: Shingles. The Pharmaceutical Journal. Retrieved November 8, 2021

Cohen, K. R., Salbu, R. L., Frank, J., & Israel, I. (2013). Presentation and management of herpes zoster (shingles) in the geriatric population. P & T : a peer-reviewed journal for formulary management38(4), 217–227.

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