What are Shingles Stages? Treatment and Their Complications

shingles stages treatment
Medically reviewed by Dr. Ola Tarabzuni


The varicella-zoster virus (VZV), which also causes varicella, reactivates to cause herpes zoster, popularly known as shingles. (Chickenpox) Varicella is a primary infection with the VZV. The chickenpox virus stays dormant in the neurological system after a person has recovered. The virus may reactivate later in your life and cause shingles. This post will discover the causes, signs, and treatments of shingles.

What are Shingles?

Herpes zoster, sometimes known as shingles, is a common nerve illness. A painful rash or tiny blisters appear on the skin due to shingles. It can occur anywhere despite often just affecting one side of the face or body. Early symptoms of the infection include tingling or itching, as well as burning or shooting pain. The pain may linger long after the rash for months or even years.

What are the Stages of Shingles?

Shingles develop throughout time and go through many stages. Although there might be individual variations in the severity of symptoms and length of each stage, it typically follows a general pattern. Let’s examine the normal shingles timeframe.

Pre-eruptive phase 

The pre-eruptive phase, also known as the preherpetic neuralgia stage, typically lasts 48 hours but occasionally up to 10 days. One or more dermatomes, which correspond to regions of the skin primarily supplied by a single spinal nerve, are characterized by sensory experiences that occur along them. Headache, tiredness, sensitivity to light, and fever are typical of this stage.

Acute eruptive phase

The pre-eruptive phase’s physical symptoms continue during the acute eruptive phase, along with excruciating pain and the appearance of lesions. The lesions begin as flat, tiny, confined changes in skin color called macules and swiftly develop into clusters of fluid-filled blisters. Over three to five days, more blisters continue to build and burst. The virus is most easily spread to others during this stage. After up to 4 weeks, the blisters ultimately dry out and crust over. The lesions may result in persistent skin scarring and alterations to the skin’s pigmentation.

Chronic phase

For up to 20% of shingles patients, the chronic phase, commonly known as postherpetic neuralgia (PHN), develops. Recurrent discomfort that persists more than four weeks after the blisters have healed is referred to as it. Other signs include nerve injury and unusual skin sensations, including tingling, burning, and numbness brought on by pressure on a nerve (paresthesia). (dysesthesia). The ensuing discomfort, which can be agonizing and incapacitating, can linger for months or even years.

The shingles rash typically self-limits and goes away without medical help, but most patients need assistance with the pain and discomfort that come with it. Nonsteroidal anti-inflammatory medicines (NSAIDs), wet dressings, and calamine lotion can all be used to treat physical symptoms.

The antivirals acyclovir, famciclovir, and valacyclovir are also very effective, mainly when prescribed within 72 hours of the onset of symptoms. Hospital admission is reserved for patients with severe symptoms, immunosuppression, disseminated herpes zoster, ophthalmic involvement, and other serious complications.

Post Herpetic Neuralgia pain is notoriously difficult to manage. Two options include the topical analgesics found in lidocaine and capsaicin transdermal patches.

99% of individuals aged 50 years and older carry VZV in their bodies after having chickenpox as a child. Approximately 1 million of them will experience shingles each year.

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What Causes Shingles?

As a member of the herpes virus family, the varicella-zoster virus is responsible for chickenpox and shingles. The viruses that cause genital herpes and cold sores (oral herpes) are also a part of this category. However, the virus that causes genital herpes and cold sores differs from the varicella-zoster virus. Herpes simplex types 1 and 2 are the viruses that cause genital and oral herpes. 

You may develop shingles if you’ve had chickenpox. Varicella-zoster is dormant mainly in spinal or cranial nerves after chicken pox. When the virus reactivates, it can move along nerves and cause shingles, which manifests as a skin rash. But according to the National Institute of Neurological Disorders and Stroke, the reason for the reactivation is still a mystery.

What are the Symptoms of Shingles?

Blisters typically form a single stripe around the left or right side of the body when shingles are present. It can happen on one side of the face less frequently. It nearly always only affects one side of the body and is unilateral.

However, shingles rashes can show up anywhere, including the genital region, buttocks, legs, and feet, according to a case report led by Anne Louise Oaklander, MD, Ph.D., an associate professor of neurology at Harvard Medical School and the director of the nerve unit and skin biopsy lab at Massachusetts General Hospital in Boston.

According to the laws of chance, the torso is typically where shingles appear most commonly, explains Joseph Safdieh, MD, a professor of neurology at Weill Cornell Medicine in New York City. Twenty-four nerves in your body can house the virus, unlike the ten nerves in your lower back.

The condition’s presence is frequently indicated more by how you feel before and after the rash appears than by how it looks. The area where the shingles rash will often develop experiences discomfort, itching, or tingling up to a few days beforehand.

In the days before the rash appears, various other flu-like symptoms of shingles can occur. You may experience the following:

Even worse, you might feel the agony but not the rash. The shingles pain may be unlike any other pain you have felt because it comes from the nerves rather than the muscles.

As Dr. Safdieh puts it, “Neuropathic pain is burning.” It can be triggered by contacting the skin and is both numb and painful at the same time. Your skin could be so delicate that exposure to sunlight might cause a stabbing feeling.

Even if you are unsure that you have shingles, you should visit a doctor immediately because prompt treatment can avoid problems, including chronic nerve pain.

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How are Shingles Diagnosed and Treated?

Typically, shingles are identified based on their specific signs and symptoms:

  • One side of the body is hurting.
  • Rash
  • Blisters

A thorough physical examination, queries about your medical history, specifically on any instances of chickenpox, and possibly take a skin scrape for testing.

Medical History for shingles

A doctor may ask various medical history questions to help diagnose and treat the condition. Some of the questions a doctor might ask about shingles include the following.

  • Have you ever had chickenpox before?
  • When did you first notice the symptoms of shingles?
  • Have you ever had shingles before?
  • Any pain, burning, or itching in the affected area?
  • Are you experiencing any tingling or numbness in the affected area?
  • Are you experiencing any fever, chills, or other flu-like symptoms?
  • Have you been under any significant stress recently?
  • Are you currently taking any medications or undergoing any medical treatments?
  • Do you have other medical conditions, such as HIV or cancer, that could affect your immune system?
  • Any contact with anyone who has a weakened immune system or who is pregnant?
  • Have you recently received any vaccines, such as the shingles vaccine?
  • Have you had any recent travel or exposure to infectious diseases?

These questions help the doctor to gather important information about the patient’s medical history, current symptoms, and risk factors, which can be used to make an accurate diagnosis and develop an effective treatment plan.

Physical evaluation for shingles

When evaluating a patient with suspected shingles, a doctor will typically perform a physical examination to look for characteristic signs and symptoms of the condition. This may involve

  • Inspection: Visual examination of the affected area of the skin, looking for the characteristic rash that often accompanies shingles. You may also be checked for blisters, lesions, or other signs of inflammation.
  • Palpation: The doctor may gently touch the affected area to check for tenderness or pain.
  • Neurological examination: The patient’s sensory function in the affected area, checking for any loss of sensation or abnormal sensations like tingling or burning, may be assessed.
  • Vital signs: The patient’s temperature, blood pressure, and heart rate can provide additional information about the severity of the infection.

Investigations for Shingles

In most cases, a diagnosis of shingles can be made based on a physical examination and a review of the patient’s medical history. However, additional investigations may be recommended in some cases to confirm the diagnosis or rule out other possible causes of the patient’s symptoms.

Some of the investigations that may be recommended for shingles include

Viral culture: 

It involves collecting a fluid sample from a blister and sending it to a laboratory to test for the varicella-zoster virus (VZV), which causes shingles.

Polymerase chain reaction (PCR) testing 

This more sensitive test can detect tiny amounts of viral DNA in a fluid sample from a blister or other affected tissue.

Blood tests

A blood test may be performed to check for antibodies to the varicella-zoster virus, which can help confirm a diagnosis of shingles.

Imaging tests 

In some cases, imaging, including a CT scan or MRI, may be recommended if there is concern about complications or the diagnosis is uncertain.

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Treating shingles

Although there is no known treatment for shingles, attacks can be shortened and made less painful by taking prescription antiviral medications such as acyclovir, valacyclovir, or famciclovir as soon as symptoms appear. Early intervention can lessen or stop acute discomfort and hasten the healing process for blisters. Antiviral medications can cut the likelihood of developing postherpetic neuralgia by around half.

Antiviral medications should be used when the first shingles rash occurs or when symptoms suggest a rash is about to appear. Anti-inflammatory corticosteroids like prednisone are additional treatments to consider when the eyes or other facial nerves are impacted.

The majority of shingles sufferers may be treated at home.

  • Additionally, shingles patients should try to unwind and lessen their tension. (stress can make the pain worse and lead to depression)
  • Frequently consume balanced meals.
  • Gentle exercises like stretching or walking can help you stay active and distract you from discomfort. (but check with your physician)

When not wearing a topical ointment or patch, applying a cool, moist towel to the blisters helps hasten their healing and reduce pain. Maintaining cleanliness also helps prevent subsequent bacterial infections.

How to Prevent Shingles?

For persons 50 and older who have experienced chickenpox, the Food and Drug Administration (FDA) has licensed two vaccines: Zostavax and Shingrix. The shingles vaccination serves as a preventive measure rather than a cure for postherpetic neuralgia or shingles.

People can avoid acquiring chickenpox by obtaining varicella or chickenpox vaccination, which is currently advised in the US for all kids between 18 months and adolescence. Because the weak, “attenuated” form of the virus used in the vaccine is less likely to remain in the body for decades, people who have had the chickenpox vaccination are probably less likely to get shingles.

Postherpetic Neuralgia

Sometimes, especially in elderly individuals, shingles pain lasts long after the rash disappears. The most severe cases of this postherpetic neuralgia, which is pain that lasts three months after the beginning of the inflammation, can cause incapacity, insomnia, weight loss, and depression. Feelings like tingling, coldness, or loss of sense could also exist. Postherpetic neuralgia is not immediately fatal and may go away with time. Treatment options include:

tricyclic mood stabilizers

  • Anticonvulsants
  • Opioids
  • Topical local anesthetics like capsaicin or lidocaine 

Postherpetic itch

The itching, which can be extremely painful, can occasionally happen during or after shingles. According to clinical evidence, the postherpetic itch is more complicated than postherpetic neuralgia. Some people find that topical local anesthetics briefly numb the skin and provide profound relief. It is crucial to refrain from scratching because postherpetic irritation frequently manifests in the skin with profound sensory loss. Too much or too long of a scratch might hurt numb skin.

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How Long Does a Shingles Outbreak Last?

A shingles outbreak typically lasts for 2-4 weeks. The rash usually appears in one area of the body and can be accompanied by pain or burning sensations. Over a few days, the rash may progress from redness to fluid-filled blisters, which eventually scab over and heal.

It is also worth noting that some people may experience ongoing pain or other symptoms, such as postherpetic neuralgia (PHN) after the rash has healed. PHN can last months or even years and can be severe and debilitating. If you are experiencing ongoing pain or other symptoms after a shingles outbreak, it is vital to seek medical attention.

What are the Complications of Shingles?

Ophthalmic shingles and shingles that affect the ears and face are more likely to cause complications than other types of shingles. (herpes zoster oticus or Ramsay-Hunt syndrome). Consult an ophthalmologist if shingles appear in or near the eye since painful eye infections can occasionally result in either temporary or permanent vision loss. Symptoms can include redness and swelling involving:

  • Just the white of the eye (sclera)
  • The transparent front of the eye (cornea)
  • Internal parts of the eye

Treatment is required if the cornea is affected to avoid long-lasting scarring and visual loss. The illness can harm or kill the nerve cells that respond to light. (acute retinal necrosis).

Infections with shingles inside or next to the ear might impair hearing or balance and weaken the facial muscles on the affected side. These issues may continue for a long time or be unfixable.

Rarely, shingles can spread to the brain or spinal cord and lead to life-threatening consequences, including meningitis or stroke. 

VZV may affect blood vessels or cause an immunological response irritating the blood vessel surface. (vasculopathy). Stroke risk is somewhat higher in shingles patients, peaking in the first few weeks after blisters appear but lasting several months. People with ocular zoster are most at risk for an elevated risk of stroke.

Those with shingles should get checked out by a doctor immediately if they experience neurological symptoms other than where they first had the disease. Immunosuppressed people, whether due to illnesses like HIV and leukemia or drugs, have a higher chance of developing severe complications from shingles. They might get shingles that spread to other body areas or get shingles rashes that last a long time or come back frequently. Antiviral drugs should be taken regularly by many such people. 

Is a Vaccine Available to Prevent Shingles?

Yes, there is a vaccine available to prevent shingles. The vaccine is called Shingrix and is recommended for adults aged 50 years and older, including those who have previously had shingles or received the older shingles vaccine, Zostavax.

Shingrix is a two-dose vaccine, given 2 to 6 months apart. It is more than 90% effective at preventing shingles and reduces the risk of postherpetic neuralgia (PHN) and other complications.

The vaccine is generally well-tolerated, with the most common side effects being soreness, redness, or swelling at the injection site, fever, muscle aches, and fatigue. These side effects are usually mild and go away within a few days.

Consult one of our Doctors to Determine if the Shingrix Vaccine Suits you.

FAQs About Shingles Answered by Your Doctors Online Team.

What stage is most painful with shingles?

The most painful stage of shingles is typically the acute phase, which lasts for two to four weeks after the appearance of the rash. During this stage, the patient may experience intense pain, burning, or itching in the affected area, which can be debilitating and significantly impact their quality of life. The pain may accompany flu-like symptoms such as fever, fatigue, and headache. Postherpetic neuralgia is a disorder where the pain can last months or years after the rash has healed. (PHN). Early use of antiviral medication can lessen the intensity and length of the acute phase and the chance of developing PHN.

Are shingles contagious?

The virus that causes shingles, varicella-zoster virus (VZV), can be passed from a person with shingles to someone who never had chickenpox or is not vaccinated for chickenpox. Shingles itself is not transmittable. This can occur through direct contact with the fluid from the blisters of a person with shingles. It’s recommended that people with shingles take steps to prevent virus transmission.

Do shingles blisters always burst?

Shingles blisters may or may not burst. Some blisters may dry up and heal without bursting, while others may burst and become crusted over. The healing process of shingles blisters can vary from person to person, and it’s advised to keep the involved area clean and dry to prevent infection.

What triggers a shingles outbreak?

A shingles outbreak is caused by the reactivation of the varicella-zoster virus (VZV) in a person who has previously had chickenpox. The exact trigger for the reactivation of the virus has yet to be fully understood. Still, it is thought to be related to a weakened immune system due to aging, stress, illness, or certain medications.

Do you always get the typical rash if you have shingles?

Not necessarily. While a rash is a common symptom of shingles, not everyone will develop a rash. Some people may only experience mild symptoms or none at all.

How long are you contagious if you have shingles?

Shingles are comparatively less contagious than chickenpox, and the risk of transmission is lower if the rash is covered. Generally, a person with shingles is considered contagious until all the blisters have crusted over, which usually takes about 2 to 4 weeks. It’s essential to prevent spreading the virus to others at risk of developing severe chickenpox, such as pregnant females and people with weakened immune systems.

Who should be vaccinated with Shingrix?

Shingrix is a vaccine recommended for adults aged 50 and above to prevent shingles and related complications, such as postherpetic neuralgia. Even if you’ve had shingles before or have received the older shingles vaccine, Zostavax, it is recommended to get vaccinated with Shingrix.

Can you sleep in the same bed as someone with shingles?

It is generally safe to sleep in the same bed as someone with shingles as long as you are not in direct contact with the rash or blisters. The virus can be contracted through direct contact with the rash, so it’s essential to avoid touching the affected area or any clothing or bedding that may have come in contact with it.

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