The 4 stages of shingles and how the condition progresses
- The stages of shingles are tingling pain, followed by a burning feeling and a red rash, then blistering, and finally the blisters will crust over.
- You will typically develop a rash about 1-5 days after you feel numbness or tingling pain.
- During the blistering phase, you are contagious and can spread chickenpox if someone touches your blisters.
- This article was medically reviewed by Julia Blank, MD, family medicine physician at Providence Saint John's Health Centre in Santa Monica, California.
Shingles is a painful skin condition caused by the same virus as chickenpox. It most often affects people over 50 years old, and outbreaks usually last for 3 to 5 weeks.
There are four different stages of shingles, including a skin-blistering phase during which you can spread the disease to other people. Here's what you need to know about the different stages of shingles and the best way to treat and prevent this disease.
What is shingles?
If you have ever had chickenpox, an itchy skin rash caused by the varicella-zoster virus, you are at risk of developing shingles. Because after you heal from chickenpox, the virus stays in your body and hibernates inside of your nerve cells.
The virus is kept in check by your immune system but, "as you get older and your immune system is weaker, you can break out in shingles in a localized region of your body," says Brian Kim, MD, a dermatology professor at the Washington University School of Medicine.
About one in three adults will get shingles. A shingles outbreak can take weeks to heal, and the illness tends to follow a similar pattern, moving through several phases before becoming dormant again. Here is an overview of each stage of a shingles outbreak.
1. Tingling pain or numbness
During the first stage of shingles, before anything appears on your skin, a particular area of your body may begin to feel different. "When a shingles outbreak is starting, you may feel itching, burning, or pain," Kim says. Often you will feel this on only one side of your body.
The initial signs of shingles may feel different for each person. In some cases, shingles can cause intense sensitivity, making it painful to even wear clothes over your skin, while in other cases, your skin may feel numb.
2. Burning feeling and red rash
Between 1 and 5 days after you start to feel the tingling or numb feeling, a red rash will develop on the same area of your skin. Most often, the rash appears on one side of your torso, but it can show up anywhere on your body.
You may also have other symptoms along with the rash, such as:
- Headache
- Fever
- Upset stomach
When the rash starts, you should see a doctor for treatment as soon as possible. Starting antiviral medication treatment within 3 days of the rash first appearing can lower your risk of developing complications, like long-term pain.
3. Blistering
A few days after the rash appears, it will start to form painful blisters filled with fluid. These blisters can break open and leak fluid that contains infectious amounts of the varicella-zoster virus.
If someone who has not had chickenpox touches this fluid, the virus can infect them and cause a case of chickenpox. However, anyone who has already had chickenpox or the chickenpox or shingles vaccine will not be at risk of catching the virus from you.
Though it is possible, shingles is generally not transmitted from person to person," Kim says.
"Fortunately, most people have had chickenpox in childhood or are vaccinated now so this is very rare," Kim says.
4. Blisters crust over
About 7 to 10 days after the blisters appear on your skin, they will begin to dry up. The leaked fluid will form a crust over the rash and your sores will no longer be open.
"You will stop being contagious after the blisters have crusted over," Kim says.
Once the blisters have crusted over, your skin will gradually heal and the scabs will disappear over the next couple weeks.
How to treat and prevent shingles
Shingles is treated using antiviral medications, such as:
- Acyclovir (Zovirax)
- Valacyclovir (Valtrex).
To manage shingles pain, you can also use numbing creams like lidocaine, or place a cool, wet washcloth on your skin.
It's important to get treatment as quickly as possible because, "people with shingles can develop long-term pain or itch after the shingles resolves if the virus does too much damage," Kim says.
To stop yourself from spreading varicella-zoster to anyone else, try to cover up your rash when possible and avoid directly touching it.
The best way to prevent shingles is to get a shingles vaccine. The newest vaccine, called Shingrix, is 85% to 90% effective at preventing shingles in people who have already had chickenpox. If you have never had chickenpox, you will need to get the chickenpox vaccine instead.
The bottom line
Shingles is a common condition that can cause extreme pain if it isn't properly treated. If you develop a rash that you think may be shingles, see your doctor as quickly as possible to get treatment and prevent any serious complications.