Condition

Shingles

Shingles is a painful, blistering rash that follows one nerve on one side of the body. It is caused by the chickenpox virus waking up years later. Antiviral tablets help most when they are started within three days of the rash appearing.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed September 8, 2026

Start here

The sentence I wish everyone knew is this: if you get a painful rash on one side of your body, be seen within 72 hours. Antiviral treatment works on a clock - started early it shortens the rash and lowers the chance of lasting nerve pain, and started a week in it does far less. Shingles pain is nerve pain, it can be severe, and treating it early seems to matter for how things go afterward, so do not tough it out quietly. The shingles vaccine is among the most effective we have, and I recommend it to essentially every patient over 50 who asks, including those who have already had shingles once.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

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How commonAbout 1 in 3 people in the United States will get shingles at some point in their life
Who gets itAnyone who has had chickenpox. Risk rises sharply after age 50 and with a weakened immune system
Curable or managedThe episode clears, but the virus stays in the body and can reactivate again later
Prescription neededYes - antiviral tablets, and they work best started within 72 hours of the rash
Time to improveThe rash usually crusts within 7 to 10 days and clears in 2 to 4 weeks. Nerve pain can last longer

What It Is

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Shingles is the chickenpox virus, varicella-zoster virus, waking up years or decades after the original infection. It causes a band of painful blisters on one side of the body, usually the trunk, sometimes the face, neck, arm or leg.

The band is the giveaway. The virus travels down a single sensory nerve and erupts only in the strip of skin that nerve supplies - a dermatome. Each nerve serves one side, so the rash stops at the midline in a way almost no other rash does.

Pain usually comes first. For one to five days there can be burning, stabbing, aching or intense itching in one area with nothing to see, which is why shingles gets mistaken for a pulled muscle, a heart problem, gallbladder pain, a kidney stone or a toothache.

Shingles is not chickenpox again, and you do not catch it from anyone. You can pass the virus from your blisters to someone who has never had chickenpox and never been vaccinated - what they get is chickenpox, not shingles.

Symptoms

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Burning on one side

Pain Before the Rash

Burning, tingling or sharp pain in a band on one side of the body, days before anything appears on the skin. It is often mistaken for a strained muscle or another problem. Antiviral treatment works best when it is started early.
Blisters in a stripe

Blistering Band

Crops of blisters on red skin in a stripe that stops at the midline, most often on the chest, back or waist. The blisters crust over about a week to ten days. Fluid from the blisters can give chickenpox to someone who has never had it.
Rash near the eye

Face and Eye

A rash on the forehead, around the eye or on the tip of the nose, which may come with eye pain, redness or blurred vision. This form can threaten sight. It needs same-day medical attention.

How It Looks by Skin Tone

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A band of small grouped blisters on fair light skin, curving from the spine around one side of the ribcage. The skin under the blisters is bright red, and the band stops at the middle of the back.A band of small grouped blisters on medium olive-tan skin, curving from the spine around one side of the ribcage. The skin under the blisters is dusky pink-brown, and the band stops at the middle of the back.A band of small grouped blisters on brown skin, curving from the spine around one side of the ribcage. The skin under the blisters is brown to violet with no redness, and the band stops at the middle of the back.A band of small grouped blisters on deep dark brown skin, curving from the spine around one side of the ribcage. The skin under the blisters is only slightly darker than the surrounding skin, and the band stops at the middle of the back.
LightMediumBrownDeep

On deeper skin tones the redness textbooks describe is often not what you see. The band may look brown, gray, violet or simply darker than the skin around it. The pattern is reliable: grouped blisters, in a strip, on one side only, in an area that hurt before anything appeared.

This matters more here because treatment is timed. A rash read as milder than it is, or dismissed as heat rash or an insect bite, can close the 72-hour window for antivirals. If you have one-sided pain and grouped blisters, ask for it to be looked at as possible shingles. After healing, deeper skin tones commonly keep flat dark marks along the band, called post-inflammatory hyperpigmentation, which can take many months to fade. Deep or infected blisters can leave true scars, which are permanent. Both are reasons to treat early and leave the blisters alone.

Where It Shows Up

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Front view of a whole body with red marks forming a band down one side of the chest and waist, stopping at the middle of the body. The other side is clear.
A band on one side, stopping at the middle
Shingles follows one nerve, so it appears as a band on one side of the body and stops at the midline. The chest, the back and the waist are the most common places. A rash that crosses the middle of the body is almost certainly something else.
Back view of a whole body with red marks forming a band across one side of the back and waist, stopping at the middle. The other side is clear.
Round to the back on the same side
The band usually wraps from the spine round to the front on the same side, which is why the back is as common a site as the chest. It stops at the middle of the back too.
Front view of a head with red marks down one side of the scalp and forehead, over one eyebrow and eye, and on the tip of the nose. The other side is clear.
The forehead and eye, on one side
When it takes the nerve that supplies the forehead, it runs from the scalp down one side of the forehead to the eye and the tip of the nose. This one is treated urgently, because it can affect sight. A rash on the tip of the nose is the warning sign.

What Happens in the Skin

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This is what is going wrong under the skin, in the order it happens. Click a step to see it.

How Shingles happens
Skin basics
BARRIEREPIDERMISDERMISNERVE0A SLEEPING VIRUS1THE VIRUS REACTIVATES2IT TRAVELS ALONG ONE NERVE3THE RASH APPEARS IN THAT BAND4NERVE PAIN THAT CAN OUTLAST THE RASH

Anyone who has had chickenpox keeps the virus in a nerve bundle for life. The immune system holds it there without you knowing.

Age, illness, stress or anything that lowers immunity lets it wake up. Pain, burning or itching in one area often comes first, before any rash.

It multiplies and moves along a single nerve to the skin, which is why the rash appears in one band on one side of the body and stops at the midline.

Blisters come up in the strip of skin that nerve serves, painful out of proportion to how they look.

The nerve itself is inflamed and can stay sore for months after the skin heals. Treating early, within three days, is what lowers that risk.

The outer film of dead cells and oil. It holds water in and keeps irritants out, and it is thinner than a sheet of paper. Almost every dry, itchy, stinging skin problem starts here.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

Four things happen, in order. Varicella-zoster virus, caught as chickenpox in childhood, never leaves the body - once the chickenpox clears it retreats into clusters of nerve cells near the spine and the base of the skull and sits inactive for years. Then the immune control holding it there weakens, through age, illness or medication, and the virus multiplies again. It travels down one sensory nerve, which is why pain and tingling come before the rash. At the skin it produces blisters, but only in the strip that nerve supplies.

The nerve itself is inflamed and damaged along the way, and that is shingles pain. The rash is on the surface; the problem is in the nerve. That is why the pain can be out of proportion to what you see and why it sometimes outlasts the rash by months.

Risk Factors

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Most adults have had chickenpox, which is the main requirement. Whether the virus reactivates depends on how well the immune system keeps it in check, which you do not control.

Age
Age
The single biggest factor. Risk climbs after 50 and with each decade, as does lasting nerve pain.
Virus & vaccination
Having had chickenpox
Required. People vaccinated against chickenpox instead have a much lower risk, though not zero.
Virus & vaccination
Not being vaccinated
The recombinant vaccine is more than 90 percent effective in adults 50 and over - the largest changeable risk.
Other health conditions
A weakened immune system
Cancer and its treatment, transplant, and untreated HIV raise the risk substantially.
Other health conditions
Immune-suppressing medicines
Long-term oral steroids, biologics, transplant medicines. Ask your doctor, who can also advise about vaccination.
Other health conditions
Other illness
A major infection, surgery or hospital admission can precede an episode.
Other health conditions
Serious physical or emotional stress
Often reported around an episode. Less established than age or immune suppression.

Course

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An episode runs two to four weeks, the pain sometimes longer. Most people get it once, though it can recur if the immune system is suppressed.

Before the rashDays 1 to 5
Pain arrives before anything is visible

Burning, stabbing, aching, itching or extreme sensitivity in one area on one side, with nothing to see. Some people also feel unwell.

One area on one side of the body
Rash appearingDays 1 to 3 of the rash
Blisters cluster in a band

Pink, red or darker patches appear in a band, then small blisters cluster on them. New blisters can keep coming for about five days.

BlisteringDays 3 to 7
This is the contagious stage

The blisters fill, some turn cloudy, and they may join up. The fluid is contagious to anyone who has never had chickenpox.

CrustingDays 7 to 10
Once crusted, it is no longer contagious

The blisters dry and crust. Once everything has crusted, the rash is no longer contagious.

ClearingWeeks 2 to 4
The skin heals, the nerve may take longer

Crusts fall away, leaving pink skin, or brown to gray on deeper skin tones. Deep blisters can scar permanently. In some people, mostly older adults, nerve pain continues after the skin heals - postherpetic neuralgia. It can last months, and it is why early antivirals and pain control matter.

What Makes It Better & Worse

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Four steps - the virus reactivating in a nerve, multiplying and traveling down it, the blistering rash, and nerve pain that can outlast the rash. Shingles is the rare skin condition where hours count, because nearly all the benefit from antivirals sits at step two, and step two is over within a few days.

What is driving yours?

FATNERVEBARRIEREPIDERMISDERMIS

Age, illness, stress or anything that lowers immunity lets it wake up. Pain, burning or itching in one area often comes first, before any rash.

It multiplies and moves along a single nerve to the skin, which is why the rash appears in one band on one side of the body and stops at the midline.

Blisters come up in the strip of skin that nerve serves, painful out of proportion to how they look.

The nerve itself is inflamed and can stay sore for months after the skin heals. Treating early, within three days, is what lowers that risk.

What helps

  • The shingles vaccine Two doses, more than 90 percent effective after 50.
  • Getting vaccinated after an episode One episode does not protect you.

What makes it worse

  • Age Longer episodes and more lasting nerve pain.
  • Immune-suppressing illness or medicine Raises reactivation, spread and complications.

What helps

  • Antivirals started within 72 hours Shorter rash, less lasting nerve pain.

What makes it worse

  • Waiting to see if it settles Antivirals work best within 72 hours.

What helps

  • Keeping the rash covered A loose, non-adhesive dressing until it crusts.
  • Call your doctor about eye or ear signs Eye involvement often needs a same-day specialist.
  • Loose cotton clothing Less pressure over the band, less pain.
  • Plain petrolatum on broken areas Stops cracking and lowers infection risk.

What makes it worse

  • Breaking or scratching the blisters Spreads virus and turns marks into scars.
  • Ignoring a rash near the eye Forehead, eyelid or nose blisters, same day.
  • Ear blisters with facial weakness Droop, hearing change or dizziness is urgent.
  • Not covering the rash Blister fluid gives chickenpox to anyone not immune.
  • Tight clothing and adhesive dressings Pressure worsens pain and tears blisters.

What helps

  • Proper pain control from day one Nerve pain has its own prescriptions.
  • Cool compresses and calamine lotion For burning and itching while blisters last.
  • Rest, and lowering expectations Pushing through shingles is not rewarded.

What makes it worse

  • Leaving severe pain untreated Linked with worse nerve pain later.
  • Poor sleep during the episode Pain and sleep loss feed each other.

How These Treatments Work

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Treatments for Shingles do not all work in the same place. Tap one to see where it acts.

Pick a treatment
Skin basics
BARRIEREPIDERMISDERMISNERVESTOPS IT MULTIPLYINGTREATS THE NERVE PAINKEEPS IT ASLEEPPROTECTS THE SKIN

Started early it shortens the rash and lowers the chance of lasting nerve pain.

The pain that lingers is nerve damage, so ordinary painkillers often do not touch it.

The one thing that prevents this rather than treating it.

Keeps the blisters clean while they crust over.

The outer film of dead cells and oil. It holds water in and keeps irritants out, and it is thinner than a sheet of paper. Almost every dry, itchy, stinging skin problem starts here.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

Over-the-Counter Products

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Everything here you can buy without seeing anyone.

Acetaminophen and ibuprofen
Acetaminophen and ibuprofen
Moderate evidence
The first step for shingles pain, and enough on their own for a milder episode. They work better taken regularly than only when the pain peaks. Shingles pain is nerve pain, so if these are not holding it, that is a reason to ring your doctor rather than to take more.
Four ointments on white: CeraVe Healing Ointment, a Vaseline jar, a petroleum jelly tube and Aquaphor16:9 hero for Petrolatum. Never cropped: the tone strip and the corner logo depend on the full frame.
Limited evidence
A thin layer of plain petroleum jelly on broken or crusting areas stops them drying and cracking, which lowers the risk of bacteria getting in. It has no effect on the virus itself. Use it under a loose, non-stick dressing rather than an adhesive one, which tears blisters when it comes off.
A white cream tube lying on its side on a white background, with a plain white label reading Calamine and a yellow swoosh beneath it.
Calamine lotion
Limited evidence
Dabbed on while the blisters are present, it cools the skin and takes the edge off the itching. A cool compress does much the same thing. Neither shortens the episode, and neither should be rubbed in, because breaking the blisters spreads virus and can leave scars.
Five colloidal oatmeal eczema products lined up on white: tubes, a jar and a pump lotion16:9 hero for Colloidal Oatmeal. Never cropped: the tone strip and the corner logo depend on the full frame.
Weak evidence
An oatmeal soak can settle itching while the rash is blistering, in cool rather than hot water. It is comfort only. It does not change how long shingles lasts or whether nerve pain follows.

Prescriptions

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These need a prescription.

A white medicated skin patch on a white background, with a plain white label reading Lidocaine Patch and a blue swoosh beneath it.
Lidocaine 5% patch
Moderate evidence
A numbing patch worn over the area for pain that carries on after the rash has healed. It goes only on intact skin, never on blisters or open areas. It helps some people a great deal and others hardly at all, so it is worth a proper trial before deciding.
A white medicated skin patch on a white background, with a plain white label reading Capsaicin Patch and a blue swoosh beneath it.
Capsaicin 8% patch
Moderate evidence
A high-strength patch applied in a clinic for lasting nerve pain, with one treatment lasting up to three months. It burns while it is on, so the skin is numbed first. It is used after simpler options, and only once the skin has fully healed.
16:9 hero for Mupirocin. Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Mupirocin works in the skin
Limited evidence
An antibiotic ointment used only if the crusts turn hot, swollen or start oozing pus, which means bacteria have moved in on top. It does nothing to the shingles virus. If the infection is spreading, antibiotic tablets are needed instead.
A white cream tube lying on its side on a white background, with a plain white label reading Antiviral and a blue swoosh beneath it.
Topical antiviral cream
Weak evidence
Antiviral creams sold for cold sores do not work for shingles. The virus is in the nerve, not just on the surface, so treatment has to be swallowed or given by drip. Reaching for a cream instead is one of the ways the 72-hour window gets missed.
An amber pill bottle labeled Valtrex tipped on its side with white tablets spilling out
Strong evidence
The usual first choice for shingles: three doses a day for seven days. Started within 72 hours of the rash it shortens the episode and lowers the chance of lasting nerve pain. It does not clear the virus from the body, and it does much less once everything has crusted over.
An amber prescription bottle lying on its side on a white background with a plain white label reading Famciclovir, and six small round white tablets spilled out in front of it.
Famciclovir
Strong evidence
An equally effective alternative to valacyclovir, taken three times a day for seven days. It is used when valacyclovir does not suit. The same 72-hour clock applies, and it is usually the more expensive option.
An amber prescription bottle lying on its side on a white background with a plain white label reading Acyclovir, and six small round white tablets spilled out in front of it.
Acyclovir
Strong evidence
The oldest of the three antiviral tablets and the cheapest. It works just as well, but it has to be taken five times a day for seven days, which is harder to keep up. The dose is lowered if your kidneys are not working well.
An amber prescription bottle lying on its side on a white background with a plain white label reading Gabapentin, and six small round white tablets spilled out in front of it.
Gabapentin and pregabalin
Strong evidence
Nerve pain medicines rather than ordinary painkillers. They are the main treatment for pain that carries on after the rash heals, and they are often started during the episode when pain is severe. The dose is built up slowly, and they can make you drowsy or unsteady at first.
An amber prescription bottle lying on its side on a white background with a plain white label reading Amitriptyline, and six small round white tablets spilled out in front of it.
Amitriptyline
Moderate evidence
A low dose of an old antidepressant, taken at night for nerve pain. It suits people whose shingles pain is keeping them awake. It takes a few weeks before you can judge it, and it is used carefully in older adults because of dry mouth, dizziness and confusion.
16:9 hero for Prednisone. Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Prednisone works in the skin
Limited evidence
A short course of steroid tablets is sometimes added to antivirals for severe pain or when the facial nerve is involved. It can speed up rash healing and early pain a little. Studies have not shown that it prevents lasting nerve pain, and it is never given on its own for shingles.

Procedures

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These are done in the office, usually over several visits.

Shingles vaccine (Shingrix)
Strong evidence
Two injections a few months apart, more than 90 percent effective at preventing shingles in adults 50 and over. It prevents rather than treats, so it is not used during an episode. It is still recommended once an episode has cleared, because having had shingles does not protect you from having it again.

When to See a Dermatologist

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Appointment timing changes the outcome here, so a painful rash on one side of the body, especially a band of blisters, should be seen within 72 hours - say you think it might be shingles when you call, because it changes how fast you get a slot. Go the same day, or to an emergency department, if the rash involves your forehead, eyelid, or the tip or side of your nose, if an eye becomes painful, red or blurred, if there are ear blisters with facial weakness, hearing change or dizziness, if the rash spreads well beyond one band, if you have a high fever and feel very unwell, or if your immune system is weakened. Book if pain is not controlled at home, if the rash turns hot, swollen and oozing pus, or if pain carries on after the skin heals. Say so if you are pregnant, because both the illness and its treatment need managing by the doctor looking after your pregnancy. Most cases need no test. If one-sided pain came first and a rash appeared in the same place, say that early - it is what gets you inside the treatment window.

— Dr. Schwarz, Board Certified Dermatologist

Complications

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Postherpetic neuralgia

Nerve pain that carries on after the skin has healed, because the virus damaged the nerve it traveled down. It is the most common complication of shingles, and the risk climbs steeply with age. Starting antiviral tablets within 72 hours and controlling the pain properly from day one both lower the chance of it. It is treatable, so it is worth going back rather than waiting for it to fade.

Shingles in the eye

When the affected nerve serves the forehead and eye, blisters appear on the forehead, the eyelid or the tip and side of the nose, and the eye itself can be involved. It can cause lasting damage to sight. Blisters anywhere in this area are a same-day problem, and often need an eye specialist as well as antiviral tablets.

Shingles in the ear

Blisters in or around one ear, together with weakness on that side of the face, and sometimes a change in hearing, ringing or dizziness. It is uncommon. It needs urgent treatment, because the facial nerve recovers better the sooner antiviral tablets and steroids are started.

Lookalikes

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Cellulitis

In the first day or two, before the blisters arrive, shingles can look like a hot, red, tender patch on one side. Cellulitis spreads outward in every direction with a fading edge, does not stop at the midline, and usually comes with fever and feeling unwell. Shingles hurts first, then forms grouped blisters in a strip.

Contact Dermatitis

A plant or chemical reaction can blister in streaks, and poison ivy in particular can look like a band. It itches far more than it hurts, it can turn up on both sides of the body, and its streaks follow wherever something brushed the skin rather than one nerve. There is also no warning pain in the days before it appears.

Cold Sores

Both are grouped blisters on reddened skin caused by a herpes virus, and a cold sore that recurs somewhere other than the lip can sit in a small line that looks like a band. Cold sores are smaller, usually on or beside the lip, and they come back in the same spot again and again. Shingles is normally a one-off, covers a much wider strip, and hurts for days before anything appears.

Myths

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  • "You can catch shingles from someone who has it." You cannot. Shingles comes from a virus already inside you. Someone who has never had chickenpox and never been vaccinated can catch chickenpox from the blister fluid. Once the rash crusts, that risk is over.
  • "Only old people get shingles." Risk rises sharply with age and most cases are over 50, but anyone who has had chickenpox can get it, including children and healthy young adults.
  • "If I had the chickenpox vaccine I cannot get shingles." The vaccine strain is a weakened live virus that can also go dormant, so shingles is still possible - less common and generally milder.
  • "Shingles is just a rash." The rash is the visible part. The problem is in the nerve, which is why the pain can be severe, can start days before anything appears, and sometimes persists after the skin heals.
  • "Once you have had it, you cannot get it again." Recurrence is possible, and more likely if your immune system is suppressed. Having had shingles is not a reason to skip the vaccine.
  • "The vaccine gives you shingles." The recombinant vaccine used now is not live, so it cannot cause the illness. A sore arm, tiredness, headache or aching for a day or two is expected.
  • "If the rash has already appeared, treatment is too late." Not if you are inside about 72 hours, and often still worth it beyond that in older adults, anyone immunosuppressed, or if new blisters are still forming. Being late is a reason to be seen sooner.

Questions Patients Ask

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Am I contagious?

Not with shingles - nobody catches shingles from you. But the blister fluid can give chickenpox to someone who has never had chickenpox and never been vaccinated. Keep the rash covered, wash your hands, and stay away from newborns, pregnant people who are not immune, and anyone immunosuppressed until it crusts.

Is it too late for antivirals if I am past 72 hours?

Possibly not. The evidence is strongest inside 72 hours, but treatment is often still given if new blisters are forming, if you are older, if the rash involves the face or eye, or if you are immunosuppressed. Being late is a reason to be seen today.

What is postherpetic neuralgia?

Nerve pain that continues after the rash heals, from damage to the nerve the virus traveled down. Much more common in older adults, and it can last months. It is treatable with different drugs from ordinary painkillers, so go back rather than waiting it out.

Should I get the vaccine if I have already had shingles?

Generally yes. One episode does not protect you from another, and vaccination is recommended once an episode has cleared. Ask your doctor about timing.

Why is it only on one side?

The virus travels down a single sensory nerve, and each nerve supplies a strip of skin on one side. That is also why the rash stops abruptly at the midline - one of the clearest clues.

Can I get it more than once?

Yes, though most people do not. Recurrence is more likely if your immune system is suppressed. If it has happened more than once, ask whether anything underlying should be looked into.

References

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