Shingles Symptoms and Complications

Herpes Zoster or Shingles on a human arm.
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One million people in the United States experience shingles every year, according to statistics from the Centers for Disease Control and Prevention. Still, there is a lot of confusion over what shingles exactly is.

Shingles — also known as herpes zoster — is an infection of the nerve roots and is most common in people over the age 50. It is also frequently seen in people with weakened immune systems, such as those with HIV or certain cancers, especially leukemia and lymphoma.

Shingles develops when the chickenpox virus becomes reactivated, resulting in an outbreak of fluid-filled skin rash along specific parts of the body.Why the virus becomes active after years of lying dormant is not entirely understood.

But what is clear is this: anyone who has had chickenpox can get shingles. Understanding the early signs of the disease, as well as ways to prevent or shorten the course of an outbreak, can make dealing with shingles are the more manageable.


Shingles occur in two stages: the​ prodromal stage and the eruptive stage. The symptoms vary depending on the stage.

Prodromal Stage - This stage begins about two to seven days before the skin rash. Symptoms include numbness, tingling, burning, itching, or shooting pain on one side of the face or body.

Some people experience systemic, or whole-body, complaints during this stage as well. These can include:

  • fever
  • chills
  • upset stomach
  • headache
  • sensitivity to light

Eruptive Stage: During this stage, sores filled with clear fluid, known as vesicles, erupt on the skin in a cluster-like pattern. Often redness and swelling accompany the rash.

The rash forms over a period of three to five days and is often uncomfortable.

A person's pain is variable, ranging from very mild to severe. Eventually, the vesicles crust over and then heal within two to four weeks.

The pain from shingles can last for weeks, months, or even years after an outbreak. Long-term pain after shingles is called postherpetic neuralgia.

Where Do Shingles Erupt?

The shingles rash can affect many different parts of the body, depending on which nerve root is affected. According to the CDC, a common location is the trunk. Usually, the rash does not cross the midline, but it can.

How Do You Know if You Have Shingles?

Keep in mind that a shingles rash can often be mistaken for chickenpox or a poison ivy rash. The best way to find out if your symptoms are consistent with shingles is to see your doctor. 


People with weak or impaired immune systems, like people with HIV, are more likely to have complications from shingles. They are also more likely to have a severe, widespread rash that resembles chickenpox. Complications include:

  • potential vision loss if shingles involves the eye
  • bacterial infection of the shingles rash
  • organ-specific inflammation (e.g., encephalitis, if the brain is infected by the shingles virus)

Fortunately for people with HIV, shingles is now declining since the emergence of combination antiretroviral therapies.

Preventing Shingles 

In 2006, the shingles vaccine Zostavax was approved by the U.S. Food and Drug Administration for adults aged 60 and over, the recommendations of which were extended in 2011 to include adults age 50 and over. Clinical research has shown that Zostavax can reduced the risk of getting shingles by around 70%.

While no formal recommendations have been issued, there has been a call for the use of Zostavax in people with HIV who have suppressed immune systems (as measured by CD4 counts under 350 cell/mL). 

Take Home Message

If you think you are having a shingles outbreak, contact your doctor right away to ensure a proper diagnosis and treatment plan.


Centers for Disease Control and Prevention. "Shingles (Herpes Zoster): Clinical Overview."

Grabar S et al. 'Incidence of herpes zoster in HIV-infected adults in the combined antiretroviral therapy era: results from the FHDH-ANRS CO4 cohort". Clin Infect Dis. 2015 Apr 15;60(8):1269-77.