Early Signs of Shingles You Shouldn't Ignore

Shingles is a painful infection triggered by the varicella-zoster virus (VZV). This virus causes two types of disease, varicella (chicken pox) and herpes zoster (shingles). About one-third of the U.S. population will develop shingles in their lifetime.

People who have had chicken pox can get shingles later in life. VZV remains in the body but is dormant (inactive) after chicken pox has resolved. It can become reactivated, causing an outbreak of shingles.

This article will discuss the early signs of shingles, their treatment, and when to call your healthcare provider.

shingles rash

 Chokchai Silarug / Getty Images

What Is Shingles?

Shingles is a viral infection most commonly seen in people age 50 or over. It causes a rash and neuralgia (nerve pain). Although it's not contagious, it can cause chicken pox in someone who has never had chicken pox or the varicella vaccine.

VZV is spread by airborne droplets or direct contact with the zoster lesions (rash area). It's best to avoid people with a weakened immune system during a shingles outbreak, as they can contract it more easily. Some people can get shingles more than once.

People more likely to contract shingles due to a weakened immune system include those with cancer, human immunodeficiency virus (HIV) and AIDS, or who have received an organ transplant.

Internal Shingles

Shingles usually causes a well-recognized rash, so diagnosis is quick and straightforward. However, zoster sine herpete (ZSH) is a type of herpes zoster that does not produce a rash. Often referred to as internal shingles, ZSH affects the nerves under the skin. Diagnosis can be difficult and prolonged with ZSH.

This virus can be continually activated if antiviral treatment isn't started immediately. Pain, nerve damage, encephalitis (brain infection), and strokes can occur with untreated ZSH. Receiving the herpes zoster vaccine greatly reduces the risk of contracting VZV and ZSH.

What Are Early Signs of Shingles?

Early signs of shingles produce symptoms similar to a usual viral infection. The distinctive shingles rash may take days to appear despite itching and pain at the site of infection. This can lead to a missed or prolonged diagnosis. However, there are other early signs of shingles to look out for, including:

Active Phase of Shingles

The active phase of shingles begins with the appearance of a rash. The shingles rash is red, inflamed, and turns into fluid-filled pustules. The rash usually appears on one side of the body in a band.

The torso is the most common area affected by the shingles rash. It can take 14–21 days for the rash to crust over and no longer be contagious. Other symptoms that occur during the active phase include:

  • Acute neuritis (inflammation of nerves): Burning, throbbing, and stabbing pain at the infection site.
  • Postherpetic neuralgia (PHN): When nerve pain persists for 90 days after the onset of the rash, it is called PHN. Other symptoms of PHN are numbness, itching, and sensitivity to touch. About 10%–15% of people with shingles will develop PHN.
  • Cellulitis (skin infection): Immunosuppressed people and the elderly are at risk of developing skin infections from bacteria such as Staphylococcus aureus and Streptococcus pyogenes.
  • Vision deficit or blindness: If the virus involves the ophthalmic division of the fifth cranial nerve or the cornea, it can cause blindness.
  • Ramsay Hunt syndrome: Also known as herpes zoster oticus, can cause facial paralysis, ear pain, blisters in the ear, hearing abnormalities, altered taste, and tongue lesions.

Neurological Complications

Shingles can also cause neurological complications such as aseptic meningitis, encephalitis, myelitis, Guillain-Barré syndrome, and stroke. It is important to see your healthcare provider for any symptoms of shingles so you can start treatment.

Treatment

Shingles should be treated immediately to reduce complications. Here are ways to treat shingles:

  • Antiviral agents: Medications that help speed up recovery, decrease the severity of the rash, and help prevent chronic nerve pain include Zovirax (acyclovir), Famvir (famciclovir), and Valtrex (valacyclovir).
  • Steroids: Corticosteroids combined with antiviral medication is more beneficial than using an antiviral alone. Steroids help decrease inflammation which can improve the shingles rash and reduce pain.
  • Pain medication: Tylenol (acetaminophen), nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) and Aleve (naproxen), anticonvulsants (gabapentin), tricyclic antidepressants (amitriptyline), and topical numbing agents (lidocaine cream) can help reduce the intense pain of shingles.

Home remedies to alleviate the discomfort of shingles include:

  • Applying wet compresses
  • Taking colloidal oatmeal baths with lukewarm water,
  • Using calamine lotion
  • Keeping the rash clean and dry
  • Wearing loose-fitting clothes

Prevention

The best way to prevent shingles is to be vaccinated against varicella and herpes zoster virus. You qualify to receive Shingrix (shingles vaccine) if you are 19 and older and have a weakened immune system or are over age 50.

Shingrix is given in two doses that are two to six months apart. Although receiving Shingrix doesn't guarantee you won't get shingles, your symptoms could be reduced if you're vaccinated. Talk to your healthcare provider about getting the vaccine.

When to See a Healthcare Provider

See your healthcare provider for any new rash, especially if it's painful and unilateral (one side of your body). If you're being treated for shingles and your pain does not improve, or if you develop symptoms such as facial paralysis, blurry vision, or signs of a stroke, you should be evaluated immediately.

Summary

Shingles is a viral infection triggered by the varicella-zoster virus. A raised red rash and nerve pain are the most common symptoms of shingles. Not everyone with shingles develops a rash, making diagnosis difficult. To improve recovery time, decrease pain, and prevent complications, it's important to be treated immediately. Treatments include antiviral medications, steroids, and pain medicine.

A Word From Verywell

Shingles is a potentially dangerous disease, but there are many ways to treat and prevent it. Be sure to speak with your healthcare provider as soon as you begin experiencing symptoms. Knowing the early signs of shingles is key to protecting your long-term health and well-being.

Frequently Asked Questions

  • What can be mistaken for shingles?

    Although the shingles rash is usually easy to diagnose, it can be mistaken for psoriasis, an allergic reaction, eczema, or ringworm.

  • How long do shingles last?

    Shingles can last two to six weeks. In some cases, nerve pain from shingles can last for months.

  • Is shingles contagious?

    Shingles is not contagious. However, people without chicken pox or the vaccine can get chicken pox from someone with shingles.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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