Doctor checking a patient's skin for the shingles virus

Shingles Early On: Signs, Symptoms, & Treatment

Shingles, or herpes zoster, is a common viral infection of the nerves, which results in a painful rash or small blisters on an area of skin. It can appear anywhere on the body, but it typically appears on only one side of the face or body. Burning or shooting pain and tingling or itching are early signs of the infection. Even after the rash is gone, the pain can continue for months, even years.

In many cases, early signs and symptoms of shingles occur two to three days before the onset of the characteristic rash. These early symptoms can include chills, swollen lymph nodes, and a burning or shooting pain generally located on one side of the body or face. The shingles rash typically appears as several small fluid-filled blisters (similar to chickenpox). In some cases, shingles symptoms can lead to complications such as temporary or permanent blindness.

Diagram showing how shingles spreads early on

Early Signs and Symptoms of Shingles

Early symptoms of shingles include headache, sensitivity to light, and flu-like symptoms without a fever. You may then feel itching, tingling, or pain where a band, strip, or small area of rash camera may appear several days or weeks later. A rash can appear anywhere on the body but will be on only one side of the body, the left or right. The rash will first form blisters, then scab over, and finally clear up over a few weeks. This band of pain and rash is the clearest sign of shingles.

Early signs and symptoms and of shingles

The nerve roots that supply sensation to your skin run in pathways on each side of your body. When the virus becomes reactivated, it travels up the nerve roots to the area of skin supplied by those specific nerve roots. This is why the rash can wrap around either the left or right side of your body, usually from the middle of your back toward your chest. It can also appear on your face around one eye. It is possible to have more than one area of rash on your body.

Shingles Develops in 3 Stages

1. Prodromal stage (before the rash appears)

  • Pain, burning, tickling, tingling, and/or numbness occurs in the area around the affected nerves several days or weeks before a rash appears. The discomfort usually occurs on the chest or back, but it may occur on the belly, head, face, neck, or one arm or leg.
  • Flu-like symptoms (usually without a fever), such as chills, stomachache, or diarrhea, may develop just before or along with the start of the rash.
  • Swelling and tenderness of the lymph nodes may occur.

2. Active stage (rash and blisters appear)

  • A band, strip, or small area of rash appears. It can appear anywhere on the body but will be on only one side of the body, the left or right. Blisters will form. Fluid inside the blisters is clear at first but may become cloudy after 3 to 4 days. A few people won’t get a rash, or the rash will be mild.
  • A rash may occur on the forehead, cheek, nose, and around one eye (herpes zoster ophthalmicus camera), which may threaten your sight unless you get prompt treatment.
  • Pain, described as “piercing needles in the skin,” may occur along with the skin rash.
  • Blisters may break open, ooze, and crust over in about 5 days. The rash heals in about 2 to 4 weeks, although some scars may remain.

3. Postherpetic neuralgia (chronic pain stage)

  • Postherpetic neuralgia (PHN) is the most common complication of shingles. It lasts for at least 30 days and may continue for months or years. Symptoms are:
  • Aching, burning, stabbing pain in the area of the earlier shingles rash.
  • Persistent pain that may linger for years.
  • Extreme sensitivity to touch.
  • The pain associated with PHN most commonly affects the forehead or chest. This pain may make it difficult for the person to eat, sleep, and do daily activities. It may also lead to depression.

Early Treatment of Shingles is Absolutely Essential

According to physicians at the Mayo Clinic, treatment is most effective if initiated within 72 hours after the appearance of shingles. Antiviral medications are used to treat shingles and include acyclovir, famciclovir and valacyclovir. Early treatment can reduce complications, such as the chronic pain from shingles, and may speed up the healing process. Sometimes antiviral medication is combined with prednisone, a corticosteroid-based anti-inflammatory drug. Other medications may also be indicated depending on individual symptoms.

Man getting treatment for shingles from a doctorThe good news is that many people who get shingles can develop immunity to the disease. But for some, shingles recurs. The complications can include post-herpetic neuralgia, herpes zoster opthalmicus, otic zoster, and Bell’s palsy.

Pain, Medication, & More

Post-herpetic neuralgia is pain that can be persistent after the shingles rash has disappeared. The person no longer has shingles and the infection is over. The National Institute of Neurological Disorders and Stroke (NINDS) reports that the pain can be severe, but is not life-threatening. The nerve cells conveying pain sensations are involved in the shingles and appear to be sensitized by the virus. Scientists at NIH believe that the virus has damaged the cells in the sensory ganglia and associated nerves.

Gabapentin (Neurontin) and pregabalin (Lyrica) decrease the action of pain fibers and alter the way pain signals are perceived.

Medication and Treatment Options

Medications tend to stabilize the electrical activity of the nervous system that has been injured by the virus. These medications are used typically for managing seizures. Treatment options may include ointments containing capsaicin, the heat-producing ingredient in hot chili peppers. An adhesive patch containing the local anesthetic lidocaine for post-herpetic neuralgia is also used.

Antidepressants in low dosages may help as well. These medications affect the brain chemicals that tell the body how to interpret pain.

In addition to medications prescribed by your physician, you might try some things at home.

The first and the hardest, avoid stress. You may want to focus on things that take your mind off the pain, such as watching television or reading a book. If you use relaxation techniques, these will help as well.

A cool bath or cool, wet compresses may help reduce the itching and pain associated with the blisters. Over the counter pain medication is helpful. Some individuals use anti-itch or calamine lotion. You may find that an over the counter antihistamine helps.

Shingles is Contagious

When you have open blisters or sores, you should be aware that you can expose others to the varicella-zoster virus. Now, while no one will get shingles, they can develop chickenpox. If you have open lesions, it is best to avoid pregnant women, newborns, and anyone with a weakened immune system. Chickenpox can be serious for these individuals.

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