Symptoms During the Stages of Shingles

The symptoms of shingles, a painful blistering skin condition caused by the reactivation of the chickenpox virus, progress in three stages: the pre-eruptive stage (before the rash appears), the acute eruptive stage (when the rash appears), and the chronic phase (in which healing begins put pain can persist). The timeline of these events are relatively consistent.

Shingles often starts with a tingling or burning sensation one to five days before the actual rash appears. The rash will then form painful, fluid-filled blisters that eventually break open and crust over, usually within seven to 10 days. It can take two or more weeks for the scabs to clear up.

All told, the duration of a shingles outbreak may be up to five weeks.

This article walks you through the stages and symptoms of shingles so you know what to expect if you or a loved one develops this common condition.

Early Signs of Shingles

During the initial period when the varicella-zoster virus (the virus that causes shingles) becomes reactivated, there are some early signs and symptoms of shingles, including:

• Headaches
• Malaise
• Fever (more common in those with compromised immune systems)
• Sensory phenomena (an early sensation of tingling, prickling, burning, and itching of the skin)

Tingling Pain (or Numbness)

Before there are any signs of a shingles rash, a feeling of itching or tingling pain may begin on one side of the body at the site where the shingles rash will eventually erupt. A common symptom of shingles is called paresthesia, which is an abnormal tingling or a pins and needles sensation.

Burning Sensation

The discomfort caused by shingles has been described in a variety of different ways. Some people report shooting pain, tingling, or itching; others feel a stinging or burning sensation.

Like the tingling or numbness, the burning sensation is usually felt on one side of the body, in the region where the rash will break out. Sometime between one and five days, after the tingling or burning feeling on the skin begins, a red rash will appear.

Pain at the site where the shingles rash will erupt is more common than itching or paresthesia during the early phase of shingles.

Rash

Within three to five days after the tingling pain and burning sensation begins, an erythematous (red), maculopapular (flat, discolored area of the skin with small raised bumps) rash will erupt in the same area of the skin in which the discomfort was experienced.

The rash usually appears in just one area, such as on one side of the torso or face, but it can appear anywhere on the body.

When you first notice the rash, it's important to seek medical treatment as soon as possible. Treatment during this stage of shingles is primarily aimed at the prevention of long-term complications like postherpetic neuralgia (PHN) and to control the pain and make the rash go away more quickly.

Rarely, a person with shingles has pain without an eruption of blisters.

Treatment during the rash stage of shingles may include:

• Antiviral medication
• Steroids
• Topical treatment (such as calamine lotion for itchiness)
• Pain control

Blisters

After the shingles rash has erupted, the rash progresses over the next seven days into fluid-filled vesicles (blisters). The blisters burst open and the fluid leaks out.

During the blister stage of shingles, the condition is highly contagious for anyone who touches the blisters who has not had chickenpox. This is because shingles is caused by the same virus (called the varicella-zoster virus) that causes chickenpox. Until the blisters are completely crusted over and healed, the virus can easily be transmitted.

Management during the blister stage of shingles involves preventing the spread of the disease by:

• Covering the rash
• Avoiding touching or scratching the rash
• Washing hands frequently
• Avoiding contact with those who have not had the chickenpox or the chickenpox vaccine
• Avoiding contact with infants and pregnant people

Crusting

Between two to 10 days after the rash stage of shingles begins, the blisters will begin to dry up, leaving behind yellow, crusting scabs. The significance of the liquid in the blisters crusting over is that the rash is no longer contagious.

Management of shingles during this stage of the illness includes:

• Home remedies to relieve pain and itching (such as cool compresses)
• Use of over-the-counter topical medications (such as calamine lotion)
• Avoiding the use of ointment (such as petroleum jelly) that will keep the sores from drying up
• Pain management

Rash Clears

Once the vesicles (blisters) crust over, the scabs will begin to heal up and disappear. The process of complete healing of the rash can take up to a month. In some instances, there can be scarring left behind (once the rash has healed). Initially, the scars are dark red, but they usually fade in time.

A Word From Verywell

Dealing with the pain from a condition such as shingles is no small undertaking. Speak with your healthcare provider to make treatment decisions aimed at lowering your pain level and shortening the duration of your illness.