Shingles: Causes, Early Symptoms, How to Tell It from Herpes, and the 72-Hour Rule, Explained by a Dermatologist
Shingles (Herpes zoster) is caused by the chickenpox virus (Varicella-zoster virus, or VZV), which lies dormant in a nerve ganglion and becomes active again. It causes burning pain and clear blisters in a band on one side of the body, following the path of a nerve. Most rashes crust over within 7–10 days and heal within 2–4 weeks, and antiviral medicine should be started within 72 hours of the rash appearing.
Overseas data estimate that about 1 in 3 people will have shingles at some point in life, and it becomes clearly more common from age 50. How urgent it is depends on where the rash is and who has it, more than on how large it looks. A small band of rash on the tip of the nose is therefore more worrying than a long band at the waist. This article explains it location by location and group by group.
What causes shingles?
Shingles is not caught directly from another person. The virus is the same one that causes chickenpox. After chickenpox clears, the virus does not disappear. It stays quietly in the nerve ganglia beside the spinal cord and in the cranial nerve ganglia, sometimes for decades. When immunity specific to this virus drops, the virus multiplies and travels along the nerve out to the skin.
This pattern explains all of the symptoms. One nerve supplies one band of skin (a dermatome), so the rash forms a band and stops at the midline of the body. And because the nerve itself is inflamed, the pain is greater than the rash would suggest.
Factors that lower immunity to the virus include:
Age: the main risk factor. Immunity to VZV declines with age, especially from 50 years onward.
Immunosuppressive illnesses: HIV infection, blood cancers, organ transplantation.
Immunosuppressive drugs: chemotherapy, long-term high-dose steroids, biologic drugs and JAK inhibitors.
Underlying conditions: diabetes, chronic kidney failure, chronic lung disease and some autoimmune diseases.
Stress and serious illness: can act as a trigger, but many people get shingles with no clear trigger.
Young, healthy people can get shingles too, and in most cases it does not mean there is a hidden disease. A doctor will investigate further if it recurs, if the rash spreads across several bands, or if the history raises suspicion of weakened immunity.
How many days does shingles last? A timeline from day one to healed skin
The length of each stage is similar for most people. Knowing this timeline tells you whether what you are experiencing is normal or unusually slow.
1–5 days before the rash: burning pain, stabbing pain, itching or numbness in a band on one side. Nothing is visible on the skin yet.
Days 1–2 of the rash: red patches along the painful band, which turn into clusters of clear blisters within 12–24 hours.
Days 3–5: new blisters can still appear, and older blisters start to turn cloudy.
Days 7–10: blisters burst and crust over. Once all of them have crusted, the rash is no longer contagious.
Weeks 2–4: crusts fall off and the skin closes. Older adults and people with weakened immunity may take longer.
Afterward: dark or red marks can last for several months. Some people are left with scars if the wound was deep or became infected again.
The pain does not always end with the rash. Pain lasting more than 3 months from the day the rash appeared is classed as postherpetic neuralgia, explained separately below.
Early shingles before the rash: one-sided burning pain
What it looks like: burning, electric-shock-like pain, deep itching or numbness in a band on one side. Even clothing touching the skin can hurt. There may also be headache, tiredness or a low fever. This stage lasts about 1–5 days, most often 2–3 days.
Cause: the virus multiplies and inflames the nerve before it reaches the skin.
Severity/urgency: the symptom itself is not dangerous, but it is easy to misread. Pain in the left chest can resemble heart disease, flank pain can resemble a kidney stone, and lower abdominal pain can resemble appendicitis, so do not assume it is shingles on your own.
When to see a doctor: chest tightness, difficulty breathing, severe abdominal pain or high fever means going to a hospital immediately without waiting for a rash. If symptoms are not severe but you have a one-sided band of burning pain, check the skin there every day and see a doctor as soon as you notice the first red patch or blister.
Nerve pain without a rash (Zoster sine herpete)
What it looks like: the same burning pain as shingles, in a one-sided band, lasting well over several days, but no blisters appear at all. This is uncommon.
Cause: the virus reactivates in the nerve but does not reach the skin.
Severity/urgency: hard to diagnose because there is no rash to see. Other conditions usually have to be ruled out first, and blood or spinal fluid tests may be needed to look for evidence of the virus when there are neurological symptoms.
When to see a doctor: one-sided band pain lasting more than 1 week with no clear cause, or with other symptoms such as facial droop, eye pain, ringing in the ear or weakness.
Shingles on the trunk, waist and back: the most common location
What it looks like: clusters of clear blisters on a red base, arranged in a band from the middle of the back around to the front on one side, stopping at the midline. About half of patients have it on the trunk.
Cause: the virus reactivates from the thoracic ganglia, which supply skin in horizontal bands around the body. This is where the phrase "wraps around the waist" comes from.
Severity/urgency: in healthy people it is usually not dangerous, but medicine should still be started within 72 hours, especially from age 50 or when the pain is severe.
When to see a doctor: as soon as you suspect it, without waiting for the rash to complete its band. If a rash here comes with abdominal bloating or swelling on one side only, tell the doctor, because the nerves in this area also supply the abdominal wall muscles.
Shingles on the face, scalp and inside the mouth
What it looks like: a half-sided rash on the forehead, cheek or chin that does not cross the midline. On the scalp, combing the hair may hurt before any blisters are seen. Inside the mouth, there are several shallow sores on one side of the palate or gums, and the pain may feel like a toothache.
Cause: the virus reactivates from the trigeminal ganglion, which supplies the face in 3 parts: forehead, cheek and chin.
Severity/urgency: more urgent than on the trunk. A rash on the face is more likely to leave visible marks, a rash on the scalp can cause patchy hair loss, and some people are left with permanent scars. A rash on the forehead always needs the eye to be watched as well.
When to see a doctor: the same day when it appears on the face. Do not wait for the rash to spread. Go to the emergency room if there is severe headache, vomiting, stiff neck or confusion.
Shingles in the eye and on the tip of the nose (Herpes zoster ophthalmicus)
What it looks like: a rash on one side of the forehead and eyelid, swollen eyelid, red eye, eye irritation, sensitivity to light or blurred vision. Blisters on the tip or side of the nose (Hutchinson's sign) are an important clue that the virus may be entering the eye.
Cause: the virus reactivates in the first branch of the trigeminal nerve. This occurs in about 10–20% of shingles patients.
Severity/urgency: an emergency. Without antiviral medicine, about half have eye complications such as keratitis, iritis, glaucoma or retinitis, which can cause vision loss. Early treatment greatly reduces this risk.
When to see a doctor: see a doctor within 24 hours and an eye specialist urgently when there is a rash around the eye, on the forehead or on the tip of the nose, even if the eye looks normal. Do not use steroid eye drops on your own, because they can make a corneal infection spread.
Shingles in the ear: facial droop, ringing in the ear, dizziness (Ramsay Hunt syndrome)
What it looks like: deep ear pain, blisters on the outer ear, in the ear canal, or on the tongue and palate on the same side, followed by half of the face drooping, being unable to close the eye fully, a drooping corner of the mouth, ringing or noise in the ear, dizziness or altered taste. Some people have facial droop before the blisters appear, so it can look like Bell's palsy.
Cause: the virus reactivates at the geniculate ganglion of the facial nerve and spreads to the nearby hearing and balance nerve.
Severity/urgency: also an emergency. The chance that the face returns to normal depends on how fast treatment starts. If it starts within 3 days, about 70% recover fully. If later, the chance falls to about half or less. Doctors usually give antiviral medicine together with an oral steroid such as prednisolone, at their discretion.
When to see a doctor: the same day when there are blisters on the ear together with facial droop, ringing in the ear or dizziness, and an ear, nose and throat doctor should be seen as well. If the eye does not close fully, use artificial tears and tape or cover the eye at night as advised, to prevent corneal dryness.
Shingles on the arms, legs, buttocks and genitals
What it looks like: a rash in a band along the length of one arm or leg, or in a cluster on one side of the buttock, groin and genitals. Some people have weakness of the arm or leg in the same area. When it is on the buttock and genitals, there may be difficulty passing urine or constipation.
Cause: the virus reactivates from the cervical, lumbar or sacral ganglia, and may also affect motor nerve fibres. This weakness occurs in about 1–5%.
Severity/urgency: the rash itself is no different from that on the trunk, but a rash on the genitals is easily confused with herpes. Telling them apart affects both treatment and advice for sexual partners. Weakness usually improves over months.
When to see a doctor: if you cannot pass urine or have clearly noticeable weakness of an arm or leg, see a doctor that day. If genital blisters keep coming back in the same place, think of herpes rather than shingles.
Shingles in older adults
What it looks like: the rash is often wider with deeper blisters, the wounds heal more slowly and the pain is greater. Some people become confused or lose their appetite so much that they cannot eat.
Cause: immunity to the virus declines with age, along with underlying illnesses and multiple medications.
Severity/urgency: rises with age. The risk of chronic nerve pain climbs clearly after age 60. Antiviral doses must be adjusted to kidney function, and nerve pain medicines can cause drowsiness and falls.
When to see a doctor: everyone aged 50 and over should see a doctor within 72 hours even if the rash is small, and family members should watch for confusion, drowsiness or poor fluid intake, which mean going back to the doctor.
Shingles with weakened immunity: rash across several bands (Disseminated zoster)
What it looks like: a rash in several bands, on both sides, or with blisters scattered across the body like chickenpox. Medically, more than 20 blisters outside the main band, or a rash involving 3 or more bands, is classed as disseminated shingles. Some people have a chronic rash with ulcers or thick raised bumps that heal slowly.
Cause: the immune system cannot control the virus, for example in people with HIV, cancer patients on chemotherapy, organ transplant recipients or people taking immunosuppressants.
Severity/urgency: high. The virus can reach the lungs, liver or brain. Severe cases need hospital admission for intravenous acyclovir, usually 10 mg/kg every 8 hours, adjusted to kidney function, and in this group doctors often give the medicine even after 72 hours have passed.
When to see a doctor: see a doctor immediately when the rash appears in more than 1 band or there are blisters outside the band. If you are being treated for an immune disease or cancer, tell your treating doctor the same day. If you have shortness of breath, cough, severe abdominal pain or confusion, go to the emergency room.
Shingles in pregnant women
What it looks like: the same as ordinary shingles, a one-sided band of rash with burning pain.
Cause: a previously dormant virus reactivates, so the mother already has immunity to it. This is different from catching chickenpox for the first time during pregnancy.
Severity/urgency: most data suggest the mother's shingles has almost no effect on the baby, because the virus usually does not enter the bloodstream, but the choice of medicine still needs care. Acyclovir and valacyclovir are the drugs with more data on use in pregnancy.
When to see a doctor: see an obstetrician or dermatologist as soon as you suspect it, and do not buy medicine to take on your own. If you are pregnant and have never had chickenpox and have been in close contact with someone with shingles whose sores have not dried, tell your doctor within a few days, because there is post-exposure prevention that must be given within 10 days.
Shingles in children
What it looks like: a rash in a band like in adults, but usually with less pain and a milder rash.
Cause: more common in children who had chickenpox before 1 year of age, or whose mother had chickenpox during pregnancy, because the immunity they built is not yet strong enough.
Severity/urgency: in healthy children it usually resolves well, and chronic pain is very rare. Children taking immunosuppressants or being treated for cancer need special care.
When to see a doctor: every time, to confirm the diagnosis, because many other conditions cause blisters in children. Children's doses are calculated by weight, so never split an adult's medicine for a child.
Can shingles come back?
What it looks like: a band-shaped rash appears again, in the same place or a new one. Long-term follow-up data show recurrence in about 5% within 8 years.
Cause: having shingles boosts immunity but does not protect for life. The risk is higher in older adults and people with weakened immunity.
Severity/urgency: a repeat rash is treated the same way as before, but if it keeps coming back in the same place, zosteriform herpes simplex, a form of herpes arranged like shingles, must be suspected, and the advice to the patient is different.
When to see a doctor: every time it recurs. The doctor may test fluid from a blister to identify the virus and check for weakened immunity.
Postherpetic neuralgia (PHN)
What it looks like: the rash has healed but there is still burning, stabbing pain or pain from light touch, such as clothing brushing the skin (allodynia), in the same band. The commonly used definition is pain lasting more than 3 months from the day the rash appeared.
Cause: nerve damage from inflammation, so the nerve keeps sending pain signals even though the virus has quietened. Risk factors are older age, severe pain from the start, a wide rash and a rash on the face.
Severity/urgency: not life-threatening, but it disturbs sleep and eating and can cause depression. It occurs in about 10–18% of shingles patients and is rarely seen under age 40. Most people gradually improve within 1 year, and some take several years.
When to see a doctor: if the pain is so severe during the rash stage that you cannot sleep, or you still have pain more than 4 weeks after the rash appeared. Do not wait for the full 3 months. If you still have pain and are starting to lose heart, tell your doctor plainly.
Is shingles dangerous? Warning signs that cannot wait
Most shingles is not life-threatening and heals in 2–4 weeks, but a group of symptoms means seeing a doctor that same day.
Blisters around the eye, on the forehead or on the tip of the nose: a risk to vision.
Blisters on the ear with facial droop, ringing in the ear or dizziness: the face may not return to normal if treatment is late.
Severe headache, stiff neck, confusion, seizures: suspected meningitis or encephalitis.
Weakness on one side of the body, slurred speech: research has found a temporarily higher risk of stroke in the first several weeks.
Weakness of an arm or leg, or being unable to pass urine: motor nerves are affected.
Rash across several bands, or blisters scattered outside the band: especially in people with weakened immunity.
High fever, a swollen red wound that spreads, a lot of pus, or pain that gets worse after day 5: there may be a secondary bacterial infection.
Is shingles contagious?
Other people do not catch shingles directly from a patient, but the virus in the blister fluid can spread. Someone who has never had chickenpox and has never had the chickenpox vaccine will get chickenpox, not shingles, if they touch fluid from the blisters. People who have already had chickenpox are generally not infected.
Contagious period: from when the first blister appears until all blisters have crusted, usually about 7–10 days. It is not contagious before the rash appears.
How it spreads: mainly by direct contact with fluid in the blisters. With a widespread rash or in people with weakened immunity, it can also spread through the air.
People to avoid: pregnant women without immunity, newborns, infants who have not been vaccinated, and people with weakened immunity.
How to reduce spread: cover the wound with non-stick gauze, wear a top that covers the rash, wash hands often and do not share towels.
Going to work: if the rash can be fully covered and you do not work with the at-risk groups above, you can usually go to work when you feel well enough. If you are a healthcare worker, kindergarten teacher or infant caregiver, consult a doctor first.
How to tell shingles from herpes, contact dermatitis and other blistering conditions
Shingles has 3 key features: one-sided, in a band, and preceded by pain. If all 3 are present, the diagnosis can usually be made from a physical examination.
Herpes simplex: small clusters of blisters a few centimetres wide, coming back in the same place, with less pain. Read more about what causes herpes and oral herpes (cold sores), the location most often confused with shingles on the face.
Contact dermatitis: the main symptom is itching, not pain. The rash is often a straight line or the shape of whatever touched the skin, and does not follow a nerve band.
Bullous impetigo: blisters burst easily and form honey-coloured crusts. Common in children, not in a band, and not preceded by burning pain.
Chickenpox: blisters scattered across the body on both sides, starting on the trunk and face, with fever, and blisters at different stages at the same time.
Insect or venomous bug reactions: a rash in a line along the brush mark, with stinging, but no pain for several days beforehand, and the rash does not match a nerve band.
How do doctors diagnose shingles?
Most of the time doctors diagnose it from the history of preceding pain and the look of the rash, without blood tests. Further tests are used when the rash is unclear, recurrent, in patients with weakened immunity, or when herpes arranged in a band is suspected.
PCR from blister fluid or the base of a sore: highly sensitive and tells VZV apart from the herpes simplex virus. It is the main test.
Tzanck smear: scraping the base of a blister to look at the cells. Results are fast, but it cannot tell shingles from herpes.
Eye examination with a slit lamp: done when the rash is in the forehead, eye or nose area.
Hearing test and facial nerve function check: done when Ramsay Hunt syndrome is suspected.
Shingles treatment: antiviral medicine and the 72-hour rule
Antiviral medicine is the main treatment. It helps new blisters stop appearing sooner, sores heal faster and acute pain lessen. Most guidelines recommend starting within 72 hours of the rash appearing. Three drugs in this group are mainly used.
Oral acyclovir: 800 mg five times a day for 7–10 days. It is widely available. The problem is that it must be taken so often that doses are easily forgotten, and missed doses are one reason treatment results decline.
Oral valacyclovir: 1 g three times a day for 7 days. It is absorbed better and is more convenient to take.
Oral famciclovir: 500 mg three times a day for 7 days. Also convenient to take.
What decides whether the medicine works is how early it is started and whether the full course is taken. Still having pain on day 3–4 does not mean the medicine is not working, because nerves need time to recover. Signs that mean going back to the doctor are new blisters appearing after 7 days, or the rash spreading outside the band.
Can it still be taken after 72 hours? In many cases yes. Doctors often still prescribe it when new blisters are still appearing, the rash is on the face or ear, the patient is older, or immunity is weakened.
Precautions: all 3 drugs are cleared by the kidneys. If kidney function is reduced the dose must be lowered, otherwise confusion or acute kidney failure from the drug itself can occur. Drink enough water while taking them. Common side effects are nausea and headache.
Topical antiviral: not used to treat shingles, because the medicine does not reach the cause, which lies in the nerve.
Oral steroids: not given to everyone. Used only in some groups, such as Ramsay Hunt or severe nerve inflammation, and they do not help prevent chronic pain.
Antiviral medicine does not prevent chronic pain in every patient. Pooled research is still unclear how much it lowers the chance of PHN, but it reduces the severity of the acute stage and is the main treatment that should be given. Choosing the drug and dose is the doctor's job, which depends on age, kidney function, current medications and the location of the rash. See a doctor before starting medicine.
Pain relief during the rash: how to choose
Severe pain early on is a risk factor for PHN, so good pain control is part of the treatment, not only a matter of comfort.
Mild to moderate pain: paracetamol 500–1,000 mg every 6 hours when needed, not more than 3–4 g per day, or an NSAID anti-inflammatory such as ibuprofen 400 mg for a short period. If you have kidney disease, stomach ulcers or take blood thinners, consult a doctor first.
Burning, stabbing pain, or pain that keeps you awake: the doctor may add gabapentin or pregabalin, starting at a low dose at bedtime and increasing gradually. These medicines can cause drowsiness and dizziness.
Severe pain: a short course of an opioid painkiller such as tramadol may be used under a doctor's supervision.
Cold compress: apply a clean cloth soaked in cold water for 15–20 minutes several times a day. It helps reduce burning without adding medicine.
How is postherpetic neuralgia treated?
A realistic goal is to reduce pain by about 30–50% so that you can sleep and live normally, not to make the sensation vanish immediately. These are medicines the doctor must adjust a little at a time, and they must be taken or used continuously, not only when in pain.
Oral gabapentin: start at 100–300 mg at bedtime and increase gradually up to 1,800–3,600 mg/day divided into 3 doses. Assess the result 2–4 weeks after reaching the intended dose. Drowsiness and dizziness are the main side effects.
Oral pregabalin: start at 75 mg twice a day and adjust up to 300–600 mg/day. Older adults usually start lower than this. It may cause swelling and weight gain. Both drugs must be adjusted to kidney function and must not be stopped suddenly.
Low-dose amitriptyline or nortriptyline: start at 10–25 mg at bedtime and adjust to symptoms. It takes several weeks to see an effect. Be careful in older adults and in people with heart disease, glaucoma or an enlarged prostate, because of dry mouth, difficulty passing urine and irregular heartbeat.
5% lidocaine patches: apply up to 3 patches to the painful area for 12 hours, then leave off for 12 hours. They must be applied to unbroken skin. Suitable for pain in a narrow area, for people who fear drowsy medicines, and for older adults. Assess the result within 2–4 weeks.
Capsaicin: 0.075% cream applied 3–4 times a day, with strong burning at first. The 8% patch is applied by a doctor for 60 minutes at a time, with at least 3 months between applications.
Tramadol or other opioids: the next option when the drugs above are not enough. Use for a short time, only as needed.
Intradermal botulinum toxin injection, nerve block injection, or referral to a pain clinic: used in treatment-resistant cases. Most of the evidence comes from small studies.
What decides success is reaching an adequate dose for long enough. Quite a few people stop in the first week because of drowsiness or because they see no result yet, before reaching a dose that works. If the first drug does not work, it can still be changed or combined, and the doctor decides based on age, other conditions and current medications.
Self-care can help too, such as wearing soft clothing, using clear film or a thin fitted top to prevent fabric rubbing, applying a cold compress when there is burning, keeping regular sleep, and telling your doctor if you start to feel depressed or cannot sleep.
Caring for yourself at home with shingles
You can shower as usual: use comfortably warm water, wash gently and pat dry without rubbing the sores. Showering does not spread the rash.
Do not pick or pop the blisters: let them dry by themselves. Picking makes the wound deeper and causes scars.
Wound care: if blisters burst, dab gently with saline and cover with non-stick gauze.
Things not to apply: toothpaste, powder, crushed herbs, white liquor or oils can irritate and cause a secondary infection.
Clothing: wear loose, soft, breathable clothes.
Food: eat as normal. There is no evidence that chicken, eggs or other "forbidden foods" need to be avoided. Focus on eating enough and drinking enough water.
Medicine: take the antiviral medicine for the full course, even when symptoms have improved.
Shingles vaccine: who should get it and how many doses
The shingles vaccine is a well-evidenced way to prevent the disease. It lowers both the chance of getting shingles and the chance of chronic nerve pain, but it is not used to treat shingles while the rash is present.
Recombinant zoster vaccine: the vaccine current guidelines recommend. It contains no live virus and is given by intramuscular injection in 2 doses, 2–6 months apart. Both doses are needed for full immunity.
Who should get it: people aged 50 and over, including people aged 18 and over with weakened immunity or who are about to start immunosuppressive medicine. The latter group may have the second dose as little as 1–2 months later, and vaccination should be planned before starting immunosuppressive drugs.
Effectiveness: the main studies found about 97% protection against shingles in people aged 50 and over and about 90% in people aged 70 and over, and follow-up of about 10 years still shows protection of nearly 90%.
Side effects: pain and swelling at the injection site, tiredness, muscle aches or a low fever for 2–3 days. About 1 in 6 people have symptoms bad enough to take time off temporarily, so choose the day of vaccination sensibly.
Already had shingles: you can still be vaccinated to lower the chance of recurrence. Wait until the rash has healed and the acute stage has settled.
Previously had the single-dose live attenuated vaccine: that type protects about 50% and declines over time, so the recombinant vaccine can be given again, with at least 8 weeks in between.
Who should postpone or avoid it: people who had a severe allergic reaction to a previous dose or to a vaccine component. Pregnant women should postpone, and people who are seriously ill should wait until they recover.
The chickenpox vaccine and the shingles vaccine are different vaccines and do not replace each other. For people aged 50 and over who cannot remember whether they ever had chickenpox, most have already been exposed to the virus. Ask your doctor which vaccine suits your underlying conditions and current medications.
"Shingles that wraps around the waist means death" and other myths
"If it wraps all the way around the waist you will die": not true. The virus follows the nerve on one side only, so the rash stops at the midline. Having it on both sides is very rare, and if it does happen it is a sign of weakened immunity that needs prompt treatment. People do not die because the rash completes a circle.
"You need a folk healer to blow on it or write a remedy": there is no evidence that it helps treat shingles. A rash that looks better is simply the natural course of the disease, and waiting means missing the 72-hour window.
"Apply toothpaste or herbs to dry the blisters": it does not help and risks irritation or secondary infection.
"Do not eat chicken, eggs or forbidden foods": no evidence. Cutting out too much food leaves the body short of protein.
"Once you have had it, you will not get it again": not true. It can recur, though not often, so the vaccine is still worth considering.
"You catch shingles from being near someone who has it": not quite. If someone does catch it, they get chickenpox, and only if they have no immunity.
Quick summary
Shingles (Herpes zoster) is caused by the chickenpox virus lying dormant in a nerve ganglion becoming active again. It forms a one-sided band and is preceded by pain for 1–5 days.
It differs from herpes, which comes back in the same place as a small cluster; from allergic rashes, where itching dominates; and from chickenpox, which spreads across the body.
Antiviral medicine should be started within 72 hours of the rash appearing. The rash usually crusts in 7–10 days and heals in 2–4 weeks.
A rash around the eye, on the tip of the nose, on the ear, or across several bands means seeing a doctor that same day.
Pain lasting more than 3 months is PHN. It can be treated with carefully adjusted medicines and patches, and you do not have to put up with the pain.
The recombinant vaccine is 2 doses, 2–6 months apart, recommended for people aged 50 and over.
Frequently asked questions about shingles
What causes shingles?
Shingles is caused by the Varicella-zoster virus, the same one that causes chickenpox. After chickenpox clears in childhood, the virus does not leave the body but stays dormant in the nerve ganglia for decades. When immunity to the virus drops with age, or because of illnesses and drugs that suppress immunity, the virus multiplies again and travels along the nerve out to the skin, which is why it forms a one-sided band. People who have never been exposed to chickenpox do not get shingles. Young, healthy people can get it, but it is less common than in people aged 50 and over.
What are the early symptoms of shingles?
The early stage has no rash. Symptoms are burning pain, stabbing pain, itching or numbness in a one-sided band, coming about 1–5 days before the rash. Even clothing touching the skin may hurt. Some people also have headache or tiredness. Then the skin turns red where it hurts, and clusters of clear blisters follow within 12–24 hours. If you have one-sided band pain and begin to see blisters, see a doctor as soon as possible, because antiviral medicine should be started within 72 hours of the rash appearing. If you have chest tightness or severe abdominal pain, go to a hospital first without waiting to see a rash.
How many days does shingles last?
The shingles rash usually crusts in 7–10 days and the skin heals in 2–4 weeks. Older adults and people with weakened immunity may take longer. Dark or red marks may remain for several months before fading. The pain usually improves along with the rash, but some people, especially older adults, still have pain after the rash heals. Pain lasting more than 3 months from the day the rash appeared is called postherpetic neuralgia and needs further treatment. If new blisters appear after 7 days or the wound gets worse after the first week, go back to the doctor.
Is shingles contagious?
It is not caught as shingles directly, but the virus in blister fluid can give chickenpox to people who have never had chickenpox or the chickenpox vaccine. The contagious period runs from when the first blister appears until all have crusted, about 7–10 days. Cover the wound, wash hands often and do not share towels. During this time avoid being near pregnant women without immunity, newborns and people with weakened immunity. Household members who have already had chickenpox generally do not need separate rooms or isolation.
How is shingles treated, and what medicine is used?
The main treatment is oral antiviral medicine: acyclovir 800 mg five times a day, valacyclovir 1 g three times a day, or famciclovir 500 mg three times a day, for about 7 days. It should be started within 72 hours of the rash appearing, together with pain relief according to severity, such as paracetamol, or gabapentin when the pain is nerve pain. The doctor chooses the medicine and adjusts the dose by age and kidney function, so do not buy medicine to take on your own.
Is shingles dangerous?
Most of the time it is not life-threatening and heals within a few weeks. The idea that it wraps around the waist and kills is a myth. What matters is the location and complications. A rash around the eye or on the tip of the nose risks vision, a rash on the ear can cause facial droop and ringing in the ear, older adults risk chronic nerve pain, and people with weakened immunity may have a widespread rash and the virus reaching internal organs. If you have severe headache, stiff neck, confusion or weakness, go to the emergency room immediately.
Related reading: Chickenpox: causes and prevention · What causes herpes · Oral herpes: how many days does it last · Skin condition articles by a specialist
The information in this article is general knowledge, not a diagnosis or an individual treatment order. The doses mentioned are standard adult doses for people with normal kidney function. Choosing and adjusting medicine is the responsibility of the examining doctor.
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed November 4, 2026
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