What are the Symptoms of Herpes Zoster (Shingles)?

An outbreak of shingles usually begins with a burning, itching, or tingling sensation on the back, chest, or around the rib cage or waist. It is also common for the face or eye area to be affected.

The first sign of shingles is usually a tingling sensation followed by a sharp, burning pain. The rash, which begins a few days later, erupts into blisters that develop into open sores. It takes two to four weeks for he sores to crust over and heal. The pain continues throughout this process. It usually decreases gradually, but may continue for months.

Some people report feeling feverish and weak during the early stages. Usually within 48 to 72 hours, a red, blotchy rash develops on the affected area. The rash erupts into small blisters that look like chickenpox. The blisters seem to arrive in waves over a period of three to five days.

The blisters tend to be clustered in one specific area, rather than being scattered all over the body like chickenpox. The torso or face are the parts most likely to be affected, but on occasion, shingles breaks out in the lower body. The burning sensation in the rash area is often accompanied by shooting pains.

After the blisters erupt, the open sores take a week or two to crust over. The sores are usually gone within another two weeks. The pain may diminish somewhat, but it often continues for months -- and can go on for years.

Shingles can be quite painful. Many shingles patients say that it was the intense pain that ultimately sent them to the doctor. They often report that the sensation of anything brushing across the inflamed nerve endings on the skin is almost unbearable.

Shingles is painful since it involves the nervous system. When the shingles virus reactivates, it travels through nerve fibers, from the spine out to the skin. Inflammation along the nerve path causes the rash. And because the inflammation is in a nerve, it causes pain.

Some people get the pain but never develop the rash. These cases are much more difficult to diagnose and can be mistaken for other diseases. Your doctor would need to do a blood test to confirm the diagnosis. If there is a rash, but the diagnosis is questionable, skin scrapings from the sores can be used.

Diagnosis

A typical shingles case is easy to diagnose. The doctor might suspect shingles if:

• the rash is only on one side of the body

• the rash erupts along one of the many nerve paths, called dermatomes, that stem from the spine

The doctor usually confirms a diagnosis of shingles if the person also

• reports a sharp, burning pain

• has had chickenpox

• has blisters that look like chickenpox

• is elderly

Some people go to the doctor because of burning, painful, itchy sensations on one area of skin, but they don't get a rash. If there is no rash, the symptoms can be difficult to diagnose because they can be mistaken for numerous other diseases.

In cases where there is no rash or the diagnosis is questionable, doctors can do a blood test. If there is a rash, but it does not resemble the usual shingles outbreak, skin scrapings from the sores can also be used.

Source: NIH