Can Other Rashes Be Mistaken for Shingles?

Skin conditions like psoriasis, eczema, or an allergic rash can be mistaken for shingles by some, but rarely by health professionals who know what to look for. While red and itchy like some other rashes, the shingles rash is otherwise very distinct. Vesicles (fluid-filled sacs) are tingling and/or painful, and the rash has a very specific distribution on one side of the body that sets it apart.

Shingles can also present with flu-like symptoms, a fever, and severe fatigue (malaise), which other conditions do not.

If you have a rash that suddenly occurs, it's important to consult with a healthcare provider to determine what's causing it. Shingles and conditions that can be mistaken for it have very different causes and, thus, require very different treatments.

Below are other common rashes that would likely not be mistaken for shingles.

Psoriasis

Psoriasis is an immune disorder that lasts for a person’s entire lifetime. With psoriasis, an immune system problem causes skin changes. The symptoms involve an itchy, sometimes painful rash that is much different than the one caused by shingles. There are many subtypes of psoriasis; plaque psoriasis is the most common type, comprising 80% to 90% of all cases.

A person with plaque psoriasis breaks out in a rash that most often starts as small red bumps; these eventually grow larger and form a scaly surface. A psoriasis rash progresses to red bumps and silvery-scaled patches, which are often seen on the knees, elbows, or scalp.

A shingles rash is usually seen on one side of the torso, rib area, or face; it is rarely found on the knees, elbows, or scalp.  

Eczema

Eczema is a chronic (long-term) skin condition that often starts during early childhood, or even during infancy. It can manifest at any time during a person's lifetime, however.

An inflammation of the skin, eczema is associated with many different underlying triggers. Food allergies, asthma, and allergic rhinitis are linked with eczema.

Symptoms of the condition include dry—or cracked—scaly skin with red patches or plaques.

To help differentiate eczema from shingles, it's helpful to know that shingles may have fluid leakage and there are no plaques involved in a shingles breakout.

Allergic Rash

There are several types of allergic skin conditions/rashes, including:

• Hives (urticaria): Red, itchy welts that may be accompanied by dangerous swelling of the deep layers of the skin, called “angioedema”
• Contact dermatitis: Inflammation of the skin as a direct result of contact with an irritant

One way to tell the difference between contact dermatitis and shingles is that shingles often appears as a strip or band of blisters that will not usually cross the body’s midline, as they appear on only one side of the body. Contact dermatitis will show up in the area that had contact with the irritant, which can be on any part of the body.

It's fairly easy to differentiate between hives and shingles. Hives are barely raised, larger in circumference, and paler in color than shingles.

A shingles rash involves a strip of small blisters, rather than wheals like in hives. Shingles also is not widespread; it usually manifests as a single strip or band of small blisters. 

Ringworm

Ringworm is a type of fungal infection that can affect the skin on any part of the body (including the fingernails and the scalp). The symptoms of ringworm depend on where the fungus is located on the body. Generally, ringworm symptoms include:

• A scaly, ring-shaped rash, commonly found on the trunk, arms, legs, or buttocks
• A scaly or clear area inside the ring
• Overlapping rings
• Red, scaly, cracked skin
• Hair loss  

Viral Infection

Measles is much more than just a rash, particularly in babies and small children. Measles can be very severe and even dangerous. Symptoms of measles include:

• A high fever
• Cough, runny nose, and red, watery eyes
• Tiny white spots (Koplik spots) that may be found inside the mouth two to three days after symptoms start
• A rash, involving flat, red spots around the hairline that spread to the neck, trunk, arms, legs, and feet
• Small raised bumps appearing on top of the flat red spots
• The spots may join together as they spread throughout the body.

The most obvious difference between a measles rash and a shingles rash is the location. Measles spreads to multiple places on the body, while shingles is usually found in one location. 

It is important to consult with a healthcare provider. If you do have shingles, early intervention is key to successful treatment as well as to the prevention of long-term complications.