The signs and symptoms of shingles

Unlike other skin conditions, shingles symptoms have a clear progression.

A shingles rash starts as blotchy red patches on one side of the body. In fair skin, the rash appears pink or red whilst on darker skin tones, the rash will appear a dark brown or grey.

After a few days, small fluid-filled blisters start to form. These blisters will then dry out and scab overtime.

Pictures of shingles

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One of the defining symptoms of shingles is a painful rash, this is because the virus affects your nervous system, targeting the nerve fibres in a particular area of skin.

The first signs of a shingles infection include a tingling, painful or burning sensation. After a few days of tingling, the rash develops and the pustules form.

For most, the pain will subside once the rash has disappeared. However, in rare cases, the pain continues months after the rash disappears.

Shingles can also cause you to feel quite unwell. Some will also experience:

• a fever
• headache
• sensitivity to light
• fatigue

Shingles can occur all across the body including the face and genitals, but it most commonly appears on the chest and stomach. However, a shingles rash distinctly appears on only one side of your body.

Shingles symptoms can also occur on the eye, a condition known as ophthalmic zoster, and on the ear, known as Ramsay hunt syndrome. These two conditions present slightly different symptoms than a standard shingles infection.

Ophthalmic zoster

Ophthalmic zoster is a specific condition caused by the shingles virus affecting the eye and the nerves around it. It causes some specific symptoms.

Like a typical shingles infection, the rash will start with pain or tingling one side of your face or nose. After a few days, this is followed by redness and swelling around your eye.

It can also affect your vision. Many will experience blurry vision and light sensitivity. If not treated quickly, this type of shingles infection can result in vision loss.

Warning: graphic image below.

Ramsay Hunt syndrome

Shingles can also affect the ear and the facial nerves, a condition known as Ramsay Hunt syndrome.

The infection starts as a skin rash in and around one of your ears. It then causes facial paralysis or weakness on the same side as the affected ear.

While these are the two main symptoms of Ramsay Hunt syndrome, others may also experience:

• ear pain
• hearing loss
• ringing in your ear (tinnitus)
• difficulty closing your eye
• spinning or moving sensation (vertigo)
• change in taste
• dry mouth and eyes

It should be treated as soon as possible, because it can cause long-term eye damage, hearing loss and facial weakness.

For most people, the painful rash will take up to 4 weeks to heal. However, in rare cases, some people feel the effects months and even years after the initial infection.

Some complications of shingles include:

• post-herpetic neuralgia - severe pain that lasts in the affected area long after the rash has disappeared due to damage to the nerve fibres in that area.
• varicella pneumonia - lung infection
• encephalitis - a condition that causes brain inflammation

However, the risk of shingles complications is very low and most cases of shingles occur with no serious complications.

Those at risk of more long-lasting symptoms include the elderly, pregnant women, young children and those with a weakened immune system (e.g. from being immunocompromised or after an organ transplant).

A lot of skin conditions can look very similar, so it's critical to know the differences so you can take the best course of action.

Any doubt about your symptoms, contact your healthcare provider. However, we’re going to discuss some common conditions that can be mistaken for shingles.

The difference between hives and shingles

Hives is an itchy, raised rash which is caused by an allergic reaction to food, pollen, insect bites or other chemicals. You may notice hives appear if you change your regular habits such as changing your laundry detergent.

Hives differ from shingles in that it is usually short-term and goes away once your immune response to the allergen has subsided.

Secondly, although hives can be irritating, it does not cause any nerve pain in the way that shingles does.

Finally the rash itself looks different. Hives can be more widespread and can either appear as large red patches or small raised bumps. Shingles, on the other hand, causes fluid-filled blisters, and the rash tends to occur on one side of your body.

See below for an image of hives.

The difference between eczema and shingles

Eczema (atopic dermatitis) is a common skin condition that can be caused by a combination of factors including environmental triggers and your immune system. Whilst some may experience occasional bouts, some experience it chronically.

The main symptom of eczema is patches of dry and sore skin. The skin will feel itchy, appear flaky and may crack and bleed if scratched too much. Shingles, on the other hand, does not cause dry skin.

See below for an example of eczema.

The difference between psoriasis and shingles

Psoriasis is a skin condition that causes an increased skin turnover rate, meaning your skin cells die and flake over at a much quicker rate. This results in scaly and flaky patches of skin on your body.

Similarly with eczema, this condition causes the skin to look dry and crusty which is different to shingles. Psoriasis is also often chronic in nature, and can flare-up in response to certain triggers. Shingles, however, is a unique event that rarely redevelops.

See below for an image of psoriasis.

You can alleviate the uncomfortable symptoms such as by using painkillers like ibuprofen for the nerve pain, or gentle lotions and cool compresses for the itching. However, the only way to treat the virus is by using prescription antiviral medications.

Antiviral medicines, such as Aciclovir (Acyclovir), Valaciclovir (Valtrex) and Famciclovir (Famvir), work by stopping the viral cells from reproducing. This gives your body a chance to naturally fight the infection and force the virus into an inactive state.

Early treatment can stop the virus in its tracks, and significantly reduce the risk of developing the most common complications of shingles.

There are also two vaccines (Zostavax and Shingrix) available for people in their 70s on the NHS. However, you may be able to get it privately if you are particularly concerned about developing shingles and are younger than 70 years of age.