What Are the Stages of Shingles?

What Are Shingles?

Shingles (herpes zoster) is a skin condition caused by the varicella-zoster virus or chickenpox virus. If you had chickenpox as a child, the virus remained inactive in your nerves and could reactivate years later as a shingles rash.

Shingles is characterized by a tingling or burning feeling and an itchy skin rash that occurs after healing from chickenpox. An outbreak can last for 3 to 5 weeks. Learn the difference between a rash and shingles on our blog.

This virus can remain inactive in your nerve cells for years. Normally, your body’s immune system keeps the virus in check, preventing you from developing shingles. However, as you grow older with a weakened immune system, the virus can become active again, and you can have an outbreak of shingles.

Around 1 in 3 adults in the United States get shingles at some point in their lifetime. Learn more about the different stages of shingles as well as the treatment and prevention of this condition.

What Are the Risk Factors for Shingles?

The exact triggers for the reactivation of shingles are not fully understood. However, scientists believe that a weakened immune system and stress may contribute to the development of the condition. Other risk factors for shingles include:

• Being 50 years old or older. The aging process is associated with reduced immunity, making shingles more common in this age group.

• Being immunocompromised, which includes individuals with cancer, being on chemotherapy, HIV (human immunodeficiency virus), or those who have received organ transplants.

• Experiencing prolonged stress.

• Recent illness or trauma.

What Are the Symptoms of Shingles?

A tingling and burning feeling and itchy skin rash caused by shingles typically develop in a small area on one side of the body or face. It is common to develop a shingles rash in a band-like pattern at the waistline. 

Symptoms of shingles can include:

• Localized pain (shooting, burning pain)

• Numbness, tingling, and itching of the skin

• Fluid-filled blisters

• Headache, fever, upset stomach, chills, malaise

Some people get shingles that only cause mild symptoms, such as itching. Others can have extreme pain triggered by even a gentle touch. 

It is important to get prompt treatment for shingles, especially if you develop shingles blisters on your face. Facial blisters can lead to serious complications like eye damage, hearing loss, facial paralysis, and (rarely) encephalitis (brain inflammation).

Is Shingles Contagious?

The fluid-filled blistering phase of shingles can be contagious and may be responsible for spreading varicella zoster. 

If someone has not had chickenpox in the past and comes in contact with the fluid, they can develop chickenpox. If someone has already had chickenpox or has had the varicella vaccine, they will not catch the virus. 

Because most people have had chickenpox or are vaccinated with the chickenpox vaccine, person-to-person transmission of shingles is rare.

What Are the Stages of Shingles?

1. Prodromal (early-stage) Stage

This is the first stage of shingles (also called the pre-eruptive stage) which may last from 1 to 5 days. The symptoms typically experienced during this initial stage of a shingles outbreak include: 

• Numbness, burning, or tingling sensation in a particular area on one side of the body or face. However, there are no visible skin changes during this stage. 

• Fever, chills, and malaise

• Headache

• Light sensitivity

• Unusual tiredness

2. Active Stage (Eruptive Phase)

During this phase of shingles, a red rash starts, typically developing in the same area as the initial signs of tingling or numb feeling. This stage can last 2 to 4 weeks. 

• At the beginning of this phase, the initial flat rash turns into crusty red or purple bumps. These discolored rashes typically appear on the torso (though they can be anywhere on the body).

• After the discolored rashes appear, fluid-filled blisters start to form. The blister fluids are generally clear but can be yellow if there’s pus. These blisters begin to break open and become crusty within a week, and this is when the risk for contagion is the highest. 

• The significant skin changes during this phase are painful and itchy. 

• Other symptoms that are associated with this stage are:

  • Fever

  • Headache 

  • Fatigue

3. Postherpetic Neuralgia

Approximately 10-18% of people experience persistent tingling pain after the red rash has cleared. This long-term pain is called postherpetic neuralgia (PHN pain) and can last for months or even years after a shingles outbreak. 

PHN pain can lead to neurological disorders and complications such as anxiety, depression, sleep difficulties, and weight loss. 

Older individuals with a weakened immune system are more likely to experience postherpetic neuralgia.

How Long Does Each Stage of Shingles Last?

An outbreak can last for a few weeks. Here’s the expected timeline of shingle symptoms:

• Prodromal stage: 1-5 days

• Active stage: 1-5 days

• Blistering stage: 7-10 days

• Healing of scabs and resolution of pain: about 3 to 5 weeks 

What Is the Most Painful Phase of Shingles?

The most painful phase of shingles is usually 4-5 days after shingles symptoms first develop when the red rash forms painful blisters filled with fluid. 

The shingles pain gets better when the blisters become smaller and start to scab over. If you experience severe pain, contact your doctor right away. 

How Do You Know When Shingles Are Healing?

You will know that shingles are healing when the blistering rash scabs over and starts to heal. Shingles recovery time can take anywhere from 1 to 3 weeks. If the rash appears on your scalp, it can take several months to heal. 

What Are the Possible Complications of Shingles?

If left untreated, shingles can lead to feeling symptoms for longer as well as:

• Postherpetic neuralgia (PHN) (persistent, long-term pain)

• Staphylococcus aureus (a bacterial skin infection)

• Eye and vision damage due to blisters around the eyes.

• Hearing loss

• Facial paralysis

• Loss of taste

• Tinnitus (ringing in your ears)

• Vertigo

• Encephalitis (brain inflammation)

• Pneumonia

• Hepatitis

What Is the Treatment for Shingles Rash?

It is important to seek early treatment from healthcare professionals when the shingles rash appears. You can lower your risk of developing complications, including postherpetic neuralgia (where you develop long-term pain), by having shingles diagnosed and properly treated.

Doctors recommend starting antiviral medication treatment within 3 days for optimal disease control.

Antiviral medications for symptoms of shingles may include:

• Acyclovir (Zovirax): Find out more Zovirax uses and side effects. 

• Valacyclovir (Valtrex): Learn more about valacyclovir for treating herpes.

Other medications used to treat shingles include:

• Lidocaine (numbing cream)

• Over-the-counter (OTC) pain and itch relief medications

In addition to antiviral drugs, home remedies to manage shingles pain include: 

• Covering the affected area with loose-fitting clothing

• Bathing in a colloidal oatmeal mixture

• Applying warm or cool wet compresses

• Applying calamine lotion

• Avoiding touching or scratching the blisters

• Minimizing stress and getting plenty of rest

How Do You Prevent Shingles?

You can prevent shingles by getting the shingles vaccine. Shingrix, the newest shingles vaccine, is up to 90% effective in preventing shingles in people who have had chickenpox in the past. People who have not had chickenpox before should get the chickenpox vaccine instead of the shingles vaccine. 

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