Early Stages of Shingles

Herpes zoster infection, or shingles, is the reactivation of the same virus that causes chickenpox, also known as varicella-zoster. Shingles is characterized by a painful blistering rash that can appear anywhere on the body, however is more common on the abdomen, chest or near the eye. Since 98 percent of adults in the U.S. have had chickenpox, all of them are at risk to develop shingles. In the U.S., there are approximately 1 million cases of shingles per year. Of those cases, about half occur in people 60 years of age or older. Shingles occur in 2 stages.

Is This an Emergency?

If you are experiencing serious medical symptoms, seek emergency treatment immediately.

Prodromal Stage

The early stage of shingles -- called the prodromal stage -- begins 3 to 4 days before the rash appears. Early symptoms resemble those of the common cold, including headache, nausea, general achiness, abdominal pain, fatigue, fever and chills. As shingles progresses, more severe symptoms begin to develop.

Eruptive Stage

The next stage of shingles is called the eruptive stage. Pain is usually the first symptom. For some, it can be excruciating and may include burning, itching, numbness or tingling in the area where the rash will form. The pain may be felt penetrating from front to back, especially in the chest or face. In the absence of a rash, these symptoms can be confusing for both patients and physicians, and the disease may be mistaken for an ulcer pain, heart attack, migraine, appendicitis or a lower back disorder. For most people, the pain associated with the rash decreases as it heals.


A few days after burning and tingling occurs, a rash consisting of fluid-filled blisters on a red base appears on the skin, which is highly inflamed and tender. A slight touch can be extremely painful. Typically, shingles rash occurs on one side of the body in a band-like distribution and may wrap around one side of the chest. The blisters are clear. It takes two to four weeks before the blisters will no longer contain the virus.


Antiviral drugs such as acyclovir, valacyclovir or famciclovir, in combination with tapering doses of steroids, are used to treat shingles. These can significantly decrease long-term nerve pain, but they do not decrease pain duration or produce a more rapid resolution of the rash. A shingles vaccine is also available as a preventative measure, and is typically recommended for people age 60 and older. Shingles can lead to permanent nerve damage -- seek immediate medical attention if you suspect you have shingles to decrease your risk of serious side effects.