Shingles vs. Scabies: What Are the Differences?

Shingles can sometimes be confused with other skin conditions, including scabies. Scabies is a condition caused by an allergic reaction to the human itch mite. 

Like shingles, scabies causes a skin rash. However, shingles is vaccine-preventable and not contagious. It can also sometimes lead to more serious medical complications. Meanwhile, there is no vaccine for scabies, which is highly contagious. 

Learn more about shingles and scabies, including symptoms, causes, treatment, and prevention.

Overview

Shingles and scabies are both skin conditions that cause an itchy rash. However, they have different symptoms, causes, risk factors, and approaches to treatment and prevention.

What Is Shingles?

Shingles is a painful rash caused by a reactivation of the same virus that causes chickenpox. You can develop shingles if you had chickenpox at any point in your lifetime. Older adults and those who are immunocompromised (have a weakened immune system) have a significantly higher risk of getting shingles.

The most common complication of shingles is postherpetic neuralgia (PHN), which causes long-term nerve pain in the area of the original rash. People over 50 have a higher risk of developing PHN and other shingles complications, such as:

• Vision loss
• Hearing loss
• Pneumonia (inflammation of the lungs)
• Encephalitis (inflammation of the brain)
  

What Is Scabies?

Scabies is an itchy skin rash caused by infestation with the Sarcoptes scabiei mite. It spreads through skin-to-skin contact. Scabies is especially common in tropical climates and crowded settings, such as nursing homes and childcare facilities. 

If left untreated, scabies-related itching can cause severe discomfort and insomnia (difficulty falling asleep or staying asleep). In extreme cases, scabies can lead to bacterial skin infections and kidney problems.

Crusted scabies, also known as Norwegian scabies, is an especially severe type of scabies caused by a large number of mites and mite eggs. Older, disabled, and/or immunocompromised people have a significantly higher risk of getting crusted scabies.

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Symptoms

Although both conditions cause a rash, the signs and symptoms of shingles and scabies are different. Here’s what to expect if you get either scabies or shingles.

Shingles

The first symptom of shingles is typically a painful, itching, tingling, numb, and/or burning sensation in a certain area of the skin. Several days later, a red rash will appear in the painful patch, followed by blisters. The fluid-filled blisters then scab over and form a crust within about seven to 10 days.

Other shingles symptoms may include:

• Headache
• Chills
• Nausea
• Fever

From start to finish, most cases of shingles last about two to four weeks.

Scabies

Scabies symptoms typically appear about four to eight weeks after exposure. However, if you’ve had scabies in the past, you might develop symptoms earlier, such as in one to four days.

The most prominent symptom of scabies is a pimple-like rash. You may also notice small blisters and scale-like patches on the skin.

Other scabies symptoms include:

• Itching, particularly at night
• Burrow marks (tiny lines) from mites digging into the skin
• Open sores from scratching

Causes

Shingles is caused by a virus, while scabies is caused by an allergic reaction to a mite. Learn more about how the two conditions are transmitted and who is more at risk of developing them.

Shingles

If you’ve ever had chickenpox, you can get shingles later in life. Most people only get shingles one time, but some people get it more than once. 

Certain risk factors may increase your chance of getting shingles, including:

• Age (over 50)
• Human immunodeficiency virus (HIV)
• Some types of cancer
• Stress
• Taking drugs that suppress your immune system, such as after an organ transplant
• Diabetes mellitus
• Autoimmune and inflammatory conditions such as rheumatoid arthritis (RA) and lupus

Varicella zoster virus, which reactivates in shingles, is contagious. If you’re not vaccinated against chickenpox and haven’t ever had chickenpox, you can get chickenpox from someone with chickenpox or someone with an active shingles rash.

The virus can be spread by direct skin-to-skin contact with the fluid from shingles blisters. However, this is not common. People who keep their rash covered have a very low chance of spreading the virus. If you've had chickenpox, you won't get shingles by contact with someone who has shingles.

Scabies

Scabies is transmitted through direct skin-to-skin contact, especially if it’s prolonged. After someone has been infested with scabies mites, their sexual partners and any people who live in the same household have a high risk of getting scabies. Sometimes, sharing personal items such as bedding, furniture, or towels can spread scabies.

Anyone can get scabies. However, scabies is more likely to spread in crowded spaces, such as: 

• Small, cramped homes
• Nursing homes
• Day cares 
• Group homes
• Schools
• Prisons
• Homeless shelters

Children, older adults, and people with large families have a higher chance of getting scabies. People who frequently travel to areas of the world where scabies is more common also have an increased risk.

How to Identify Each

If you develop a skin rash, you may wonder whether it’s scabies, shingles, or something else. But there are a few ways to tell the difference between the two conditions:

Shingles Diagnosis

If you currently have a shingles rash, most healthcare providers will be able to diagnose you with herpes zoster after a physical examination. Your medical history can also provide clues about your risk factors for shingles. 

Rarely, immunocompromised people may have herpes zoster without a typical rash. In these cases, samples from your rash or blisters can be scraped and sent to a laboratory to confirm the diagnosis.

Scabies Diagnosis

Usually, scabies can be diagnosed with a physical examination and a review of your medical history. Burrow marks are often a telltale sign of scabies.

Your healthcare provider can confirm your diagnosis by performing a skin biopsy or by scraping your skin and testing the sample for mites, mite eggs, or mite feces.

Treatment

Shingles and scabies can be treated with over-the-counter (OTC) drugs, home remedies, and prescription medications.

Shingles

There’s technically no “cure” for shingles. However, the following antiviral medications can help to cut down on the length of your illness and reduce your chance of developing PHN:

• Famvir (famciclovir)
• Zovirax (acyclovir)
• Valtrex (valacyclovir)

Antiviral medications are most effective in treating shingles if they’re prescribed less than 72 hours after your rash first appears. 

Other treatments that can help soothe shingles symptoms may include: 

• Pain medication, such as non-steroidal inflammatory drugs (NSAIDs)
• Calamine lotion 
• Oatmeal baths
• Warm, wet compresses

Scabies

Scabies is typically treated with topical creams and lotions called scabicides. All members of your household, as well as anyone you’ve had recent close contact with (such as sexual partners), should be treated for scabies. 

Examples of scabicides include:

• Nix (permethrin cream)
• Eurax (crotamiton cream)
• Natroba (spinosad liquid)
• Benzyl benzoate lotion

Your healthcare provider may also prescribe other medications, such as antihistamines or steroid creams, to control itching. Home remedies for scabies-related itching include cool baths and calamine lotion.

Prevention

Shingles and related complications can be prevented through vaccination. Meanwhile, scabies can only be prevented by avoiding direct contact with people who have it.

Shingles

Shingles and shingles-related complications, such as PHN, can be prevented with Shingrix (recombinant zoster vaccine, or RZV). The CDC recommends that adults 50 years and over and immunocompromised adults 19 years and over get two doses of the shingles vaccine.

For most people, Shingrix is safe and effective. In fact, Shingrix is over 90% effective in preventing shingles among older adults and 68% to 91% effective in preventing shingles among people with suppressed immune systems. 

Common side effects of Shingrix typically include:

• Pain, redness, and swelling at the site of injection
• Fatigue
• Muscle pain
• Headache
• Nausea
• Fever

Most side effects from the shingles vaccine go away on their own within a few days. Seek immediate medical help if your side effects persist or get worse.

Scabies

The only way to prevent scabies is to avoid skin-to-skin contact with people and items (especially bedding) that have been infested with scabies mites. If you think you’ve been exposed to scabies, you and all of your close contacts should be treated right away. 

To avoid spreading scabies, thoroughly machine-wash and dry your clothing and/or bedding from the last several days before you were exposed. Vacuum your floors and clean your furniture thoroughly. Because scabies mites can only live on their own for about two to three days, you can usually resume normal activity after you’ve been treated.

Summary

Shingles is a painful skin rash caused by reactivation the varicella-zoster virus (VZV), which also causes chickenpox. Scabies is a condition that also causes an itchy skin rash. It is caused by infestation with a small mite.

A shingles rash can transmit chickenpox to those who have not had it or been vaccinated against it, You must first have chickenpox to develop shingles later in life. Scabies is highly contagious. It’s especially common in overcrowded areas, such as residential care homes and day cares.

Older and immunocompromised people are particularly likely to get shingles and experience complications afterward. To prevent shingles, the CDC recommends that all people 50 and over and immunocompromised people 19 and over receive the shingles vaccine. There is no vaccine for scabies.

Shingles can’t be cured, but antiviral medications may clear up your symptoms faster. If you or someone you know is exposed to scabies, talk to your healthcare provider about treatment with topical scabicides that can kill the mites.

A Word From Verywell

Skin conditions like shingles and scabies can be uncomfortable and alarming. Talk to your healthcare provider right away if you notice any signs of a rash.