What are the Different Stages of Shingles?

Shingles is an extremely painful condition that significantly affects one’s quality of life. Shingles is caused by the varicella zoster virus (also known as the chickenpox virus), which lies dormant in your body until it is reactivated.

Shingles outbreaks are more common in adults over 60 years old. Other risk factors include physical and mental stressors, diseases such as AIDS, or conditions such as an organ/bone marrow transplant (Healthdirect, 2021), all of which are known to weaken the immune system. The symptoms of shingles include a tingling sensation followed by red patches on the skin that usually appear on one side of your body and then spread to other parts of your torso, face, scalp, fingers, and toes. Shingles sufferers often experience pain along with these characteristic signs and symptoms. If left untreated, a person’s risk of herpes zoster and other complications such as post-herpetic neuralgia (PHN) increases.

There are four stages of shingles: prodrome stage, viral shedding stage (also known as the contagious phase), latent period (the time and stage when a shingles sufferer is not contagious), and the resolution stage. Outbreaks typically last between 3 to 5 weeks.

The prodrome-phase of shingles usually lasts between three to five days but may last as long as two weeks. Shingles patients typically say that their pain was at its worst during this time because it happens before you see any rashes on your body. The initial symptoms of shingles include, but are not limited to:

  • pain
  • a burning, tingling, or itching sensation
  • a stabbing sensation
  • sensitivity to touch and/or sensitivity to light
  • numbness in the affected area of the body
  • flu-like symptoms such as fever, headache, and/or fatigue

The rashes begin to develop one to five days after one starts to feel a tingling or burning sensation on the skin. These rashes cluster along nerve pathways and may be accompanied by a sharp pain in the area of the rash.

The viral shedding stage, also known as the contagious phase, begins when shingles sufferers see the characteristic rashes associated with this condition. While it may look similar to the rashes caused by chickenpox, these blisters usually do not spread over your whole body. Instead, it typically affects only one side of the torso or face. It can form a stripe or band-like pattern, and it usually does not cross over the midline. The fluid oozing from the open lesions are capable of infecting others as it is highly contagious. Still, this infectious period lasts for only the days before and during their shingle rash breakouts. A person who has not had chickenpox before could get chickenpox through exposure to someone with shingles during this time. Fortunately, the virus is usually incapable of being transmitted via coughing or sneezing (Doerr & Stoppler, 2021). Fluid oozing from the blisters remains the primary mode of transmission. Therefore, direct contact with these active blisters should be avoided, and hands should be washed thoroughly if they have touched the blisters. Additionally, items or clothing contaminated with fluid from the blisters undergo disinfection to keep the spread of the virus to a minimum. Although the rashes can be very painful and itchy, scratching the blisters can cause scarring and is not recommended.

The latent period stage is where shingles sufferers are not contagious to others because the blisters have started to dry up and crust over, forming scabs. This takes about 1 to 3 weeks unless the rash is on your scalp, in which case it can take several months (LeBrun, 2021). The blisters will gradually begin to heal, becoming smaller and less painful.

The resolution stage is when the blisters scab and crusts fall off, and this may leave behind scars. Shingles symptoms will gradually start to ease up at this point of the infection course.

The above stages may vary depending on how your body responds to the virus and/or which parts of your skin were affected by shingles. It is essential to seek medical treatment quickly to prevent complications, such as post-herpetic neuralgia, full or partial blindness (if shingles spread to the eyes), pneumonia, loss of hearing, brain inflammation, and even death. The doctor may prescribe antiviral medicines such as acyclovir, valacyclovir, and famciclovir, which are known to be more effective when started within 72 hours of the onset of the rash. Additionally, painkillers, antihistamines, and other shingles cream containing calamine, lidocaine, or capsaicin may also be used to manage the pain, redness, and itchiness of shingles.

To help protect yourself and your family against shingles, going for a shingles vaccine is recommended. Immunocompetent adults 50 years and older should get two doses of the shingles vaccine about 2 to 6 months apart, whether or not they have already had shingles previously. It is said that the vaccination is more than 90% effective at preventing herpes zoster and PHN and that there is approximately 85% protection for the first four years after vaccination (CDC, 2020).

CDC. (2020, October 5). Clinical overview of Herpes Zoster (shingles). Centers for Disease Control and Prevention. Retrieved November 6, 2021

Doerr, S., & Stoppler, M. C. (2021, May 3). Shingles: Is it contagious? treatment, stages, vaccine & symptoms. MedicineNet. Retrieved November 6, 2021

Healthdirect. (2021, April 30). Shingles. healthdirect. Retrieved November 6, 2021

LeBrun, N. (2021, October 20). Recovery from shingles: What to expect. Healthgrades. Retrieved November 6, 2021

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