Symptom Checker: Is It Shingles or Some Other Rash?

Shingles, aka herpes zoster, is caused by the same virus that causes chicken pox. The virus lives in the body forever and can reemerge later in life as shingles. Shingles is serious business. It can lead to long-term complications, including post-herpetic neuralgia, which causes burning pain so intense it can make it hard to do simple things like get dressed, cook and even eat. If the rash appears near the eyes or ears, it can result in vision or hearing loss.

Early treatment can help shorten an outbreak, so it’s important to know the signs and symptoms.

Shingles can look very different in different people — at least to the untrained eye. A doctor usually can identify it by looking at it and evaluating symptoms, but you may not be able to tell the difference between shingles and, say, poison ivy, hives, psoriasis or eczema.  

Any rash that might be shingles should be looked at by a doctor. The sooner shingles is treated, usually with antiviral medication, the milder the rash, the faster it will disappear and the lower the risk of complications.

How do you know if it might be shingles?

 These six questions can help you figure it out.

1. Has the person had chickenpox? Shingles can occur only in someone who has had chickenpox, or who has had the chickenpox vaccine (which introduces a weakened form of the virus into the body to trigger an immune response). If they haven’t had either, consider that the rash could be chicken pox.

2. Do they have, or have they recently had, cold or flu symptoms? Since shingles is caused by a virus, it often brings on virus symptoms such as fever, headache, muscle pain, chills, upset stomach, sensitivity to light and fatigue.

3. Does it hurt? Although shingles, like many other skin conditions, can be itchy, the most common symptom is pain that develops before the rash appears. An area of skin affected by a shingles rash can be so sensitive to touch that the brush of fabric can set off searing pain. If the person complains of burning, tingling or numbness in a specific area of skin that’s still clear, it could be a sign of an oncoming breakout of shingles. Best course of action: Get them to a doctor. Don’t wait.

4. Is the rash blistery? The shingles rash starts with a constellation of tiny, fluid-filled blisters that are separate from each other but clustered together. The fluid in the blisters is highly contagious and can cause chickenpox in someone who’s never had it or been vaccinated for it. (Shingles itself isn’t contagious.)

5. Where is the rash? Shingles can occur just about anywhere, but it almost always affects only one side of the body or face. The most common areas are the torso (around the waistline or just below the chest), the shoulder, neck or upper back, and the upper side of the face, near the eye or ear or on the forehead. A shingles rash almost always develops as a stripe or band of blisters. This is because the little bumps are running parallel to a line of nerves. In contrast, skin conditions that sometimes are mistaken for shingles, such as plaque psoriasis and eczema, tend to be more widespread and random, or to affect other body parts. Psoriasis, for example, tends to appear on the knees, elbows, back, and scalp and behind or underneath the ears; it also causes flaking, which shingles does not.

6. Is the rash scabby? After shingles blisters open, they crust over and form scabs. Poison ivy, poison oak and poison sumac also cause blisters that open and scab over. If the person has been gardening or walking in the woods or other areas where these plants can grow, mention it to the doctor.

Considering how unpleasant and potentially dangerous shingles is, it’s worth avoiding. A shingles vaccine is available. The Centers for Disease Control and Prevention recommends that all healthy adults 50 and older get vaccinated. A person can get the vaccine even if they’ve had shingles in the past, to help prevent another episode.

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