Shingles and Chickenpox (Varicella-Zoster Virus) - Symptoms

The prodrome stage lasts one to five days before the infection becomes active and the skin rash erupts. Occasionally, the pain can last for weeks or even months before the rash erupts.

Active Shingles. The rash that marks the active infection follows the same track of inflamed nerves as the prodrome pain. Between 50% and 60% of cases occur on the trunk. The second most common side is the head, particularly on one side of the face. It may also erupt on the neck or lower back. If the face is affected, there is a danger that the infection can spread to the eye or mouth. A rash that follows the side of the nose is a warning that the cornea of the eye is endangered.

This is a picture of herpes zoster (shingles) on the neck and cheek. Shingles are caused by the same virus that causes chickenpox. Outbreaks of shingles often follow the distribution of nerves in the skin. This distribution pattern is called a dermatome (see the "dermatomes" picture).

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The active infection is typically marked by the following sequence:

A rash appears, which starts as well-defined, small, red, clear spots.
Within 12 to 24 hours, these pimples develop into small fluid-filled blisters.
The blisters grow, merge, and become pus-filled.
Pain is common during the active infection.
Within about seven to ten days (as with chickenpox), the blisters form crusts and heal. In some cases it may take as long as a month before the skin clears completely. Healing takes even longer in patients who have impaired immune systems, and, in such cases, the blisters may persist for up to months.

Zoster Sine Herpete. Sometimes pain develops without a rash, a condition known as zoster sine herpete. This usually occurs in elderly patients. Symptoms include burning or shooting pain, numbness, tingling, itching, headache, fever, chills, and nausea. An accurate early diagnosis of shingles in such cases is often difficult. Some evidence suggests that some cases of Bell's palsy (in which part of the face becomes paralyzed) might actually be an indication of zoster sine herpete.

Postherpetic Neuralgia. Postherpetic neuralgia (PHN) is pain that persists for longer than a month after the onset of herpes zoster. (Some experts define persistent pain as subacute herpetic neuralgia if it last between one and three months and as PHN if it lasts beyond three months.) PHN occurs in approximately 10% to 20% of shingles patients.

Risk for Recurrence of Shingles. Shingles can recur, but the risk is low (about 1% to 5% chance). There is some evidence that a first zoster episode boosts the immune system to ward off another attack. To support this, some elderly people with zoster who are exposed to children with chickenpox appear to have extra protection against a second zoster attack. Note: in people with impaired immune systems, such as those with AIDS, such a booster effect does not occur, and these patients are at particular risk for multiple recurrences of shingles.