In the early stages, shingles can produce an extensive range of signs and symptoms. These vary from very mild skin irritation and pain to fever and other symptoms of severe illness.

Until a person develops additional shingles symptoms, they may not realize that this condition is causing their early symptoms.

The varicella-zoster virus, which causes chickenpox, also causes shingles. The virus lives in the body of every person who has ever had chickenpox. If the virus reactivates, it causes shingles. Shingles usually presents as a painful, burning rash that tends to affect an area on just one side of the body.

Keep reading to learn more about the early signs, symptoms, and stages of shingles.

Early signs and symptoms

Shingles outbreaks usually last 3–5 weeks. In the first few days, a person may not have a rash. Instead, early symptoms may include:

• burning or pain on one side of the body, usually in a small area rather than all over
• unusual sensations, such as numbness, tingling, or shooting pains, on a specific area of the skin on one side of the body
• feeling generally unwell or having less energy than usual
• headaches
• fever
• chills
• stomach problems, such as nausea, diarrhea, or vomiting
• People who experience these symptoms and have a history of chickenpox should consider that shingles may be the cause. If a person has several risk factors for shingles, it is even more likely to be the culprit.

For most people, a red rash appears 1–5 days after skin burning and tingling begin. A few days later, the rash turns into small fluid filled blisters. About 7–10 days after the blisters form, the fluid inside dries and causes crusty blisters. The scabs will typically clear up within a couple of weeks.

Symptoms but no rash?
It is common to have shingles symptoms without a rash for a few days. In some people, the rash takes longer than 5 days to appear. Although it is less common, some people develop zoster sine herpete, in which they have painful skin symptoms but no rash covering the affected skin area.

Anyone at risk of shingles and experiencing some of the symptoms should see a doctor as soon as possible. Although there is no cure for shingles, early treatment can reduce the severity of the outbreak.

Internal shingles
In people with internal shingles, the condition affects systemic areas of the body, aside from the skin, such as internal organs. Internal shingles is more common in people who are older or very unwell, and it comes with an increase in the risk of long-term complications, such as chronic pain.

The pain may be more intense with internal shingles, and some people develop symptoms in multiple locations on the body.

A person should not assume that they do not have shingles just because they do not have a rash.

Causes

Once a person has had chickenpox, even after the chickenpox rash clears up, the herpes zoster virus continues to live in the body. It will not cause chickenpox again. However, if something reactivates the virus, it causes shingles.

While anyone can get shingles, certain factors increase the risk. These factors include:

• Age: The risk of shingles and shingles-related complications increases significantly in people over the age of 50 years.
• A weakened immune system: People living with HIV, AIDS, diabetes, or cancer and those taking medications that suppress the immune system develop shingles more often than other people.
• Chronic illnesses: Certain chronic illnesses — such as type 1 diabetes, systemic lupus erythematosus, asthma, chronic obstructive pulmonary disease, and inflammatory bowel disease — elevate the risk of shingles, especially in younger people.
• Recent weight loss: A 2016 study linked recent weight loss to shingles outbreaks but did not identify the reason for this relationship.
• A history of shingles: People with a prior history of shingles are more likely to have an outbreak. A family history of shingles also increases the risk.
• Stress: People facing intense emotional stress may be more vulnerable to shingles, perhaps because stress weakens the immune system. Sleep deprivation is also a risk factor.
• Shingles is very common. About 1 in 3 people living in the United States will have at least one outbreak during their lifetime.

When to see a doctor
A person should see a doctor if they are experiencing any early symptoms of shingles, especially if they have a history of shingles or are at a higher risk of developing an acute outbreak of the virus due to any of the risk factors above.

A person undergoing treatment for shingles should follow up with a doctor if:

the symptoms get significantly worse after treatment
the symptoms do not go away within a few weeks
new or different symptoms appear in addition to the rash
there are signs of secondary infection, such as high fever, an open wound, or red streaks coming out of a shingles lesion
People should also speak to a doctor if they have lasting nerve pain in the affected region after the rash of shingles disappears. This complication, called postherpetic neuralgia, affects 10–18% of people who get shingles.

Diagnosis
A doctor can usually diagnose shingles by evaluating the person’s medical history and symptoms and carrying out a physical examination. However, shingles can sometimes resemble another rash, such as:

• herpes simplex virus infection
• an allergic reaction
• cellulitis
• eczema
• A doctor may take a swab from a lesion and send it to the lab for testing. If they suspect another infection, they may recommend blood work or additional tests.

Learn more about how to distinguish shingles from other conditions here.

Treatment
There is no cure for the shingles virus. As it is a virus, it will not respond to antibiotics, so it is important to avoid self-medication with old prescriptions.

In many cases, a doctor will prescribe an antiviral medication, such as famciclovir, valacyclovir, or acyclovir. Pain-relieving medicine can also help ease symptoms. Calamine lotion, colloidal oatmeal compresses and baths, and cold compresses may ease the itching of shingles.

It is important to refrain from scratching the affected area as this can irritate the blisters and increase the risk of infection.

Some people develop a superimposed bacterial skin infection over their shingles lesions. This infection can be very painful, and it may spread if a person does not receive treatment. Individuals who develop this infection in addition to shingles may require antibiotic treatment or even hospitalization.

People who do not have shingles can reduce the risk of an outbreak or postherpetic neuralgia by getting the shingles vaccine. This vaccine prevents chickenpox and shingles in people with no history of chickenpox who test negative for immunity to the varicella-zoster virus.

Some natural remedies can also help with the symptoms of shingles. Read about them here.

Summary
Shingles can be very painful and even debilitating.

Early symptoms can vary greatly, so if a person suspects that their symptoms may be due to shingles, they should see a doctor.

The absence of a rash does not mean that a person does not have shingles. It is possible to have pain over the skin without a rash or for the rash to appear later on.

In most people, especially those who are younger or healthy, the symptoms will go away with or without treatment within a few weeks.

However, because shingles can cause lasting pain, it is important to seek prompt treatment even if previous shingles outbreaks have not been severe.