Herpes zoster: signs, symptoms and complications


Although shingles (herpes zoster) is most commonly associated with severe skin rashes, this can sometimes be misleading. Before any signs of blisters appear, you may feel like you just got the flu. However, very soon, the first of the typical two-stage symptoms of shingles will begin: the prodromal period, during which severe pain in a specific and localized area of the body, along with chills, fever and other symptoms. After a couple of days, the shingles rash stage begins, when the rash appears. A shingles rash consists of clusters of tiny, acne-like blisters that progress rapidly .

If you are familiar with the signs and symptoms of shingles, you will be able to recognize what is happening, quickly diagnose and treat it right away.

The earlier you start treating shingles, the less likely you are to develop the complications it is associated with, such as postherpetic neuralgia (PHN, nerve disease) or bacterial skin infections.

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Prodromal stage

Often times, the first signs that the varicella-zoster virus has reactivated in the body are similar to those that might be expected at the start of any infection. These symptoms sometimes occur when you feel stressed or exhausted and are systemic, meaning they affect your entire body. You can assume that you are overworked or have a cold when you actually have shingles. …

Prodromal symptoms

Systemic symptoms that can appear in the early days of the prodromal stage of shingles include:

  • Hot
  • Shaking chills
  • Stomach ache
  • Headache
  • Sensitivity to light

Whether you get the flu or not, the most prominent first symptom of shingles is usually pain. Excruciating discomfort is often described as burning, tingling, tingling, tingling, itching, numbness, pain, or shooting pains. It can be persistent or intermittent, but will be confined to one side of the body. However, this symptom can be misleading.

Because shingles pain is localized, it can be mistaken for other conditions depending on where it is concentrated. For example, a stabbing or persistent pain on one side of the lower back may be associated with kidney problems or sciatica , although it is actually an early sign of a shingles outbreak in that area. Similarly, shingles pain around the lips can indicate the onset of herpes, while pain focused on the eyes or ear can seem like the start of a migraine .

Eruption stage

The skin in the area of prodromal shingles pain is often tender to the touch and has a reddish tinge. As these symptoms worsen, a sunburn sensation may develop.

Within three to five days of the initial pain in shingles, several tiny pimples appear and multiply rapidly in clumps, forming a rash that feels stinging to the touch. From there, sometimes within a few hours, the pimples turn into blisters or water-filled blisters , which then consolidate into larger blisters. The rash is often accompanied by redness and swelling.

A shingles rash will form for three to five days and then gradually crust over. Although it heals in two to four weeks, the accompanying pain is sometimes so excruciating that simply touching the skin with clothing can cause what looks like an electric shock, sometimes lasting weeks, months, and sometimes , years.

The shingles rash is very similar to chickenpox with one key difference: Chickenpox blisters are spread widely throughout the body. In shingles, the rash almost always occupies a limited strip of skin, usually on the face, neck, or chest, on only one side of the body . The affected area of the skin is called a dermatome , that is, fibers of a specific spinal nerve.

Outbreaks can affect two adjacent dermatomes, but rarely two non-adjacent dermatomes. An exception may be people with a severe immune system, for example, with advanced HIV infection. They are often at risk of contracting disseminated shingles (which occurs in three or more dermatomes), shingles in the eyes or viscera, and reappearance of shingles within six months .

Frequent complications

In addition to the discomfort that can accompany shingles, it is especially concerning because of the potential complications.

Postherpetic neuralgia

The most common complication of shingles is a potentially debilitating condition called postherpetic neuralgia (PHN), which develops when nerve fibers are damaged. It is characterized by constant pain in the area where there was a rash on the waist. For example , when shingles attacks the nerves in the head, persistent facial pain can continue long after the rash is gone.

The symptoms of PHN can be severe enough to interfere with daily life and include :

  • Burning, sharp, or deep pain that lasts for three months or more after the shingles heals.
  • Allodynia (sensitivity to light touch): Even the feeling of clothing on the skin can be excruciating.
  • Itching and numbness
  • Difficulty determining temperature and vibration.

Age increases the susceptibility to PHN. The Centers for Disease Control and Prevention (CDC) report that up to 13 percent of people over the age of 60 who have shingles will have PHN.

Other risk factors include the appearance of a particularly severe and painful shingles. A rash on the face or torso also increases the risk of contracting the disease.

Treating PHN can be challenging, but it is important as the condition can lead to further complications such as depression, fatigue, trouble concentrating, trouble sleeping, and loss of appetite . However, there is no one-size-fits-all approach, and multiple medications are often required to relieve pain and other symptoms. Among the medications most commonly used to treat PHN :

  • Lidocaine patches (marketed under the brand name Lidoderm)
  • Capsaicin, a natural derivative of chili peppers, comes in the form of a cream or patch.
  • Anticonvulsants such as Neurontin (gabapentin) and lyrica (pregabalin)
  • Antidepressants, including Aventil (nortriptyline) and Cymbalta (duloxetine)
  • Opioids such as oxycontin (oxycodone) and morphine.
  • Steroid injections

Bacterial skin infections.

Shingles blisters can leave open sores, leaving skin vulnerable to germs that can cause what the CDC describes as "bacterial superinfection of lesions." The most common causative agents of such infections are Staphylococcus aureus and group A beta-hemolytic streptococcus .

One of the bacterial skin infections that is sometimes associated with shingles is impetigo , which most often affects children. It starts with itchy sores that break out and then form honey-colored crusts. Impetigo is extremely contagious, but it can be effectively treated with antibiotics .

Cellulitis is another skin infection caused by shingles, according to the American Academy of Dermatology . Unlike impetigo, which affects the outermost layer of the skin, cellulitis is an infection of the deeper layers and even the tissues under the skin. It starts with a red, swollen, warm and tender area. If left untreated, cellulite can spread rapidly and even affect the lymph nodes, which can eventually lead to blood poisoning. If treated immediately with oral antibiotics and the affected skin is cared for well, cellulite is highly curable and unlikely to leave permanent damage.

Facial pain and eye damage.

In 10-15% of cases, shingles affects the trigeminal ganglion, a triple bifurcated nerve that provides sensitivity to facial structures. The medical term for herpes zoster headache or facial pain is "painful trigeminal neuropathy attributed to herpes." roof tiles ".

In particular, the trigeminal node includes the eye (ophthalmic branch); cheek (maxillary branch); and the mandibular ramus (mandible). Of these, herpes zoster is most often affected by the branch of the eye.

According to the American Academy of Ophthalmology (AAO), 25 percent of the 300,000 to 500,000 cases of shingles that occur each year are shingles of the eye (HZO).

HZO can affect any part of the eye, from the optic nerve to the conjunctiva (the membrane that covers the front of the eye and lines the eyelid). Without antiviral treatment, nearly half of the people who have shingles near the eyes will experience eye damage or even lose their eyes, so it is vital to see an ophthalmologist right away .

Unusual complications

Other potential, though unusual, health problems associated with shingles include:

Ramsey Hunt syndrome

This is an inflammation of the facial nerve near one of the ears, also known as shingles. Symptoms include facial nerve palsy, earache, and small fluid-filled blisters (called vesicles) inside the ear canal. People with Ramzi Hunt often feel dizzy or insecure. This condition can also cause permanent hearing loss if it is not treated right away.


This is an infection of the meninges. Symptoms include fever, severe headache, sensitivity to light, and muscle pain. Because this type of meningitis is caused by a virus, it is treated with antiviral medications.


Like meningitis, it is a secondary viral infection. It affects the brain and can cause symptoms such as headache, memory loss, fever, and personality changes.

Motor neuropathy

Usually, the chickenpox virus affects only skin sensations, but in rare cases, it can penetrate deeper into muscle tissue, causing weakness or atrophy. In most patients with motor neuropathy, motor function is restored.

When to see a doctor

If you suspect you have shingles, you should see your doctor immediately. Then you can begin appropriate treatment to help relieve symptoms, speed recovery, and reduce the risk of complications. This is especially important if:

  • More than 60 years
  • You have a medical condition that weakened your immune system, such as HIV.
  • Take medications that can lower your body's immune response (such as chemotherapy, steroid, or immunosuppressant drugs after organ transplantation).
  • You live in the same house as someone with a weakened immune system.
  • Rash on the face: Blisters near the eye can cause serious damage to the eyes or even loss of vision in that eye.

Shingles Discussion Guide

Get our printable guide to your next doctor's appointment to help you ask the right questions.

If you experience any of the following symptoms during treatment for shingles, tell your doctor immediately:

  • It will not eliminate pain with treatment.
  • The pain does not go away after three to four weeks.
  • The eruption has spread beyond the original site.
  • You have symptoms of a secondary infection, such as a very high fever, chills, and a severe headache.

Frequently asked questions

  • You may experience pain, burning, tingling, or "electricity" at the site of the rash. The rash usually appears a couple of days after the onset of pain.

  • The skin will be sensitive to any pressure, even light touch, around the damaged nerves. The pain is often described as sharp, stabbing, or burning. It can be persistent or come and go, and it can get worse with movement.

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