Hives Vs Shingles: Learn The Difference

Can you tell the difference between hives and shingles?

Many people have trouble differentiating the two rashes due to some of their similarities.

But are hives and shingles the same thing?

Certainly, not. As much as they look similar, they are pretty different. Hives are usually caused by an allergic reaction, but they can also be caused by viral infections. Shingles, on the other hand, is a viral infection caused by the reactivation of the varicella-zoster virus (VZV). Shingles are contagious, while hives are not.

Misdiagnosing hives or shingles can lead to improper treatment and can worsen the condition. Therefore, it's crucial to understand the differences between these two conditions to receive prompt and appropriate medical care. 

In this article, we will discuss the differences between hives and shingles, their symptoms, causes, and treatments, to help you distinguish between the two and make informed decisions about your health.

What are hives?

Hives, also known as urticaria, is a skin reaction triggered by various factors such as medications, cold, heat or sun exposure, insect bites, certain foods (eggs, peanuts), infections, etc. A breakout of hives results in itchy and swollen patches or welts on the skin on any part of the body. 

According to studies, the lifetime prevalence of urticaria among the general population is about 20%, meaning it is really common. The itchiness may range from mild to severe and subsequently affect your quality of life.¹

Causes of hives

Hives can be triggered by various things, including:

• Infections:

• Viral

• Parasitic

• Bacterial

• IgE-mediated allergic cases:

• Medications

• Insects

• Stinging (yellow jackets, bees, wasps, hornets, fire ants)

• Biting (Triatoma [kissing bugs])

• Foods

• Blood products (urticarial transfusion reaction)

• Latex (contact or inhaled)

• Contact allergens (animal saliva, raw foods)

• Aeroallergens (rare)

• Food additives

• Direct mast cell activation:

  • Narcotics/opiates

  • Muscle relaxants (e.g., succinylcholine)

  • Radiocontrast agents

  • Vancomycin

• Physical stimuli:

• Dermatographism

• Delayed pressure

• Cold

• Cholinergic

• Vibratory

• Aquagenic

• Solar

• Exertion/exercise

• Other mechanisms:

  • Nonsteroidal anti-inflammatory drugs

  • Serum sickness

  • Transfusion reactions (distinct from IgE-mediated reactions)

  • Hormone-associated (progesterone)

  • Stinging nettle

Symptoms of hives

Hives appear on the skin as defined red welts and can appear anywhere else on the body.

The most common symptoms include:

• Raised itchy red welts

• The bumps blanch (turns white) when pressed

• A rash that occurs very soon after contact with the allergy-producing trigger if due to an allergy

Treatment of hives

Treatment for hives begins with identifying and eliminating/avoiding the allergy trigger. The doctor may also prescribe treatments to ease the itching, such as:

• Antihistamines

• Glucocorticoids

• Adrenaline injection (for a life-threatening anaphylactic allergic reaction that may also have urticaria)

Prevention of hives

There are various measures you can take to prevent hives, such as:

• Avoiding triggers mentioned above (foods that cause allergic reactions, pet dander, contact with skin-irritating plants, latex, intolerable medications, etc.)

• Applying sunscreen to protect your skin against sun exposure in the case of solar urticaria²

• Avoiding wearing tight and rough clothing 

What is shingles?

Shingles is a viral infection caused by the reactivation of VZV, causing painful rash/blisters on the skin. Like hives, shingles can appear on any body part but mainly develop on one side, limited to a single dermatome—a patch of skin innervated by a single “nerve.”

It's a common condition in the United States, with research showing a lifetime prevalence of one out of three people.³

While it's possible to get shingles multiple times, most people who suffer from the disease experience it once. Hospitalization rates are low at about 1–4% of those infected, with a significant number comprising older people and those with weakened immune systems.⁴

Causes of shingles

Shingles develop from the reactivation of VZV. 

VZV is the same virus responsible for chickenpox. Once a person recovers from chickenpox, the virus stays in the nerve cells and can remain dormant for decades.

The virus can reactivate itself at any time, causing shingles. Though the exact reason for reactivation is unknown, some risk factors include age, weakened immune system, certain medications, stress, etc.

However, not everyone who has had chickenpox will develop shingles.

Symptoms of shingles

Shingles appear on the skin (on one side of the body) as a painful red rash and progress to fluid-filled blisters. Before the rash appears, you often experience burning and tingling for several days. 

Sometimes, shingles can be severe and present systemic symptoms, such as:

• Fever 

• Fatigue

• Headache

• Chills

Prevention of shingles

Shingrix is a vaccine administered to prevent shingles. Any adult aged 50 and above should get the vaccine, even if you have had shingles before. The Shingrix vaccine has two doses, spread two to six months apart. 

How well does Shingrix work?

Shingrix is highly effective in reducing the risk of getting shingles. Studies have shown an effectiveness of 97% in adults aged 50–59, 91% in those aged 70 and above, and 68–91% in adults with weakened immune systems. Those immunized also experience reduced pain when they get shingles.⁵

In addition, Shingrix protects against postherpetic neuralgia (PHN), which is a severe sequela of shingles.

Treatment of shingles

Shingles is a viral infection with no definitive cure yet. However, some medications can help shorten the duration of the symptoms and minimize the chance of complications. The prescription may vary depending on your age, the severity of the condition, your health, and the duration of the infection. 

Common prescriptions include:

• Antiviral drugs  

• Topical creams 

• Pain relief medications (analgesics)

The lowdown

Differentiating between hives and shingles can be challenging for the untrained eye since they both appear as rashes on the skin. However, the two are not the same thing. Hives are mainly caused by allergic reactions, while shingles is caused by a reactivation of a viral infection.

The risk of developing hives can be minimized by avoiding triggers. However, anyone who has had chickenpox is at risk of developing shingles, especially if they have a weakened immune system or are older. Fortunately, getting vaccinated against shingles can significantly reduce the risk of developing the condition.

It's crucial to keep in mind that shingles is contagious, while hives are not. 

Frequently asked questions

How do you rule out shingles?

A doctor can determine whether you have shingles or hives by examining the rash and accompanying symptoms. But if the diagnosis is unclear, they can perform a lab test. Generally, if you have never had chickenpox, the rash is likely not due to shingles.

How long can hives last?

Acute hives can last for up to six weeks. But chronic hives last longer than six weeks.

Who should get Shingrix?

Adults aged 50 years and above and those above 19 years but with a weakened immune system should get vaccinated against shingles. Even those who have had shingles in the past or are unsure whether they have had chickenpox infection should get the vaccine.⁶