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What Does a Shingles Rash Look Like at First?

Shingles RashIf patients have had a history of chickenpox, the risk of reactivation of the chickenpox virus as shingles includes physical or emotional stress, age over 50 years, and others.

The typical shingles red rash or blisters occur after pain, itching, and tingling. They are usually limited to one side of the face and body.  

Shingles rash and blisters appear on one side of the face extending to the scalp and ear.

If the rash involves the ear, it can lead to hearing loss, imbalance, and weakness of the facial muscles. Shingles rash on the scalp causes pain while combing or brushing and bald patches. Shingles can occur in the mouth and are usually very painful, causing pain while eating and change in taste.

  • Shingles of the eye and forehead

Rash and blisters appear around the eye, over the eyelids and one side of the forehead, extending to the tip of the nose. Patients present with burning or throbbing in the eye, with watering of the eyes, swelling, and blurred vision.

Pain may be present after the rash disappears due to nerve damage but eventually improves. Without treatment, it can lead to corneal damage and vision loss.

  • Shingles on the waist and back

Rash and blisters appear on one side of the waist and back in a stripe pattern, extending up to the lower back. 

  • Shingles on the buttocks

Shingles rash and blisters appear on the buttocks, usually on one side.

What is shingles?

Shingles are also called herpes zoster. It is caused by the varicella-zoster virus, the same virus that causes chickenpox. Sometimes, in patients who have had a history of chickenpox, the virus may stay inactive in the nervous system for years and reactivate as shingles.

What are the risk factors of shingles?

If patients have had a history of chickenpox, the risk of reactivation of the chickenpox virus as shingles includes the following:

What are the signs and symptoms of shingles?

The signs and symptoms of shingles typically occur on one side of the face or body. The common signs and symptoms may include:

  • Pain (usually the first symptom in shingles and can vary in intensity)
  • Burning sensation, numbness or tingling and itching
  • Raised red rash that usually appears a few days after the pain
  • Multiple blisters that appear in a stripe pattern
  • Blisters that contain fluid and break open with crusting
  • Fever, chills, fatigue and body ache
  • Headache
  • Photophobia (sensitivity to light) if the facial rash is present
  • Fatigue

How is shingles treated?

Treatment is most effective when started within 72 hours of the appearance of a rash. Antiviral drugs (acyclovir, valacyclovir, etc.) can help patients recover faster and reduce the risk of complications. 

Shingles rash and blisters can cause severe pain and may not be relieved with over-the-counter pain medication. Treatment of pain includes:

  • Anti-seizure medicines
  • Antidepressants
  • Cool compresses
  • Medicated lotions to reduce pain and itching
  • Numbing creams
  • Over-the-counter painkillers such as paracetamol or ibuprofen 
  • Prescription painkillers such as codeine for intense pain 
  • Prevention: A vaccine is available against the varicella-zoster virus to prevent chickenpox and shingles.

What are the complications of shingles?

Shingles can have complications that last long after the rash is gone. Complications can also occur if the infection has not been treated appropriately:

  • Postherpetic neuralgia: Pain that lasts long after the infection resolves.
  • Facial nerve paralysis if the nerve supplying the face is affected.
  • Loss of vision if the cornea is affected.
  • Loss of hearing and balance problems. 
  • Infection of the brain in patients with severe suppression of the immune system such as HIV or transplant patients.
  • Bacterial infection of the skin that causes increased swelling, redness, warmth, pain, tenderness, and pus formation.

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