A Comprehensive Guide To Shingles On Black Skin: Appearance, Diagnosis, And More

Shingles is a skin infection caused by the reactivation of the chickenpox virus in the body. The condition is characterized by a painful maculopapular rash. The shingles rash can vary in color, depending on your skin tone.  

Photos usually show the rash on white skin, where it appears red. On black or brown skin, however, this rash may look different. Keep reading to learn more about the appearance of shingles on black and brown skin, additional symptoms to look out for, and when to consult a doctor.

What is shingles? 

Shingles is a viral infection characterized by a painful, itchy, or tingling skin rash that blisters. Shingles is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox. To develop shingles, you must have the chickenpox virus inside your body. 

After you recover from chickenpox, the VZV moves to nerves inside your body, where it stays dormant. It remains inactive inside your body for the rest of your life. If it reactivates, the virus may resurface years later as shingles.  

While the rash can occur anywhere on your body, it usually appears as a single stripe of blisters on one side of the torso. According to the CDC, more than 99% of people born in the United States before 1980 have had it. 

Is shingles contagious?

You can't catch shingles from someone else with the condition or someone with chickenpox. However, the shingles blisters still contain the live varicella-zoster virus. Direct contact with the fluid from the rash blisters can spread the virus. 

Coming into contact with VZV will cause chickenpox, not shingles. In a nutshell, it's possible for someone who has never had chickenpox — or never received the chickenpox vaccine — to catch it from someone with shingles.  

Do black people get shingles?

So, do black people get shingles? According to the CDC, approximately one in three people in the US will develop shingles in their lifetime. Anyone who's had chickenpox can get shingles.¹

However, the risk of developing shingles varies by ethnic background — among other factors. 

According to the CDC, herpes zoster is at least 50% less prevalent in black people than in people of non-Hispanic white ancestry.²

What does shingles look like on black and brown skin?

Most pictures of the shingles rash show how it appears on white skin. On white skin, the shingles rash appears red due to inflamed blood capillaries. Reddening of the skin due to infection is known as erythema, and it's not unique to white people. 

While erythema can affect anyone, its effects can be more difficult to discern on black and brown skin. As a result, it can be hard to identify the shingles rash in people with darker skin tones. So, how can you identify shingles on black and brown skin? 

Listed below are the symptoms of shingles on black and brown skin to help you identify the condition and get treatment early:

Burning or stinging sensation around the affected area

The first sign of shingles is usually a burning or stinging sensation in one side of the trunk. The skin around your stomach, waist, back, or neck may become incredibly sensitive to even the softest touch. You may also experience itching. 

The initial shingles rash

After a few days, maybe even a week, the tell-tale shingles rash will appear in the affected area. The initial shingles rash will usually appear as small bumps. These bumps may appear pink, grayish, dark brown, or even purple on black and brown skin.

The bumps will look different from the surrounding skin. The early rash from shingles can hurt, but it may also be itchy. As a result, the early shingles rash can be easily mistaken for other skin conditions, such as eczema or another type of dermatitis. 

Vesicles

The initial small bumps on the skin will continue to develop and turn into clusters of fluid-filled sacs under the skin. These fluid-filled sacs are known as vesicles and look like blisters. The vesicles are typically filled with pus and may appear pink, grayish, dark brown, or purple.

In some people with shingles, the clusters of blisters may merge to create a region that resembles a burn or a plaque. In others, vesicles may be scattered throughout the affected area. The blisters may break open or ooze fluid at this stage and eventually scab over.

The 'shingles belt'

Shingles typically appear in a single stripe on one side of the body, usually around the rib cage or waist or across the face. It may look like a 'belt' or 'half belt,' hence the term 'shingles belt.' Doctors can quickly recognize this rash pattern and use it to confirm the diagnosis.

Early treatment will reduce the duration and severity of herpes zoster. 

Is the shingles rash painful?

You may experience pain, itchiness, or tingling from a shingles rash. When it comes to shingles, everybody experiences pain differently. For some, the discomfort may only be minor, but for others, even the gentle touch of the bed sheets can be excruciating. 

On top of all these physical symptoms, you may also experience other typical viral infection symptoms if you develop shingles, including: 

• Headache

• Fever

• Digestive upset

Once the blisters burst and crust over, they may turn yellowish. The affected area may take up to five weeks to heal. Afterward, the skin in this area may become scarred or change in color as it continues to heal. 

Some people may be left with chronic pain, known as postherpetic neuralgia, long after the shingles outbreak has healed. The pain can be mild or severe and is felt at the location of the rash. Your likelihood of developing postherpetic neuralgia increases with age.

How do doctors diagnose shingles?

A medical professional can typically identify shingles by reviewing your medical history and rash. Your healthcare provider may occasionally collect a fluid sample from a blister to confirm the diagnosis. 

What are the risk factors for developing shingles?

We already know from previous sections that black people are at a lower risk of getting shingles than white people. But apart from ethnic background, what are the other risk factors for developing shingles? 

In addition to race, age, gender, and general health make the list of potential risk factors for shingles. 

Age

After the age of 50, there is a significant rise in the likelihood of varicella-zoster virus and the health problems associated with it, such as postherpetic neuralgia. The higher risk of developing shingles in later life is due to the deterioration of the immune system as people.³

Gender

Shingles is more common in women than in men, with menopausal and pregnant women being the most at risk. Although the exact cause is unknown, researchers link the increased risk of shingles in women to hormonal changes during pregnancy and menopause, which impact the immune system.

General health

A person may be more prone to developing shingles if they have specific medical conditions or are on immunosuppressive medications. For instance, people with HIV or cancer (lymphoma or leukemia) are at higher risk of getting shingles.  

Medications that suppress the immune system, such as steroids, chemotherapy drugs, and medications related to organ transplants, can increase the risk of developing shingles.

Can you get shingles if you've never had chickenpox?

As mentioned earlier in the article, the varicella-zoster virus is contagious. It can spread to people who've never had chickenpox or been vaccinated. If you've never had chickenpox, direct contact with someone with shingles when their rash is in the blister phase will cause chickenpox, not shingles.

Is there a cure for shingles?

There's no cure for shingles. However, antiviral medications can help the blisters clear up faster and mitigate the symptoms of the condition. You can also take a vaccine to prevent shingles and postherpetic neuralgia. 

Talk to your doctor as soon as possible after suspecting you have shingles. Your healthcare professional can determine if you have shingles and develop a treatment plan. It's imperative that you start treatment no later than three days after the rash appears. 

Can I recover from shingles at home?

Most people with shingles are able to recuperate at home. Here are some home remedies and tips to aid with your recovery:

Over-the-counter (OTC) medications. OTC medications such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) may help limit the pain and reduce fever during a shingles outbreak. 

Cool compress. To help soothe itchy skin during a shingles infection, apply cold compresses to the part of the skin that itches. The cooling sensation provides temporary relief from the itch on the affected area.

Avoid scratching. Avoid scratching or picking at your rash during a shingles outbreak to avoid spreading the infection. Excessive scratching will also lead to changes in pigmentation after your blisters heal.

Shingles can be treated at home when the symptoms are mild, for instance, if you only have some itching. Talk to your doctor if you notice any shingles symptoms and to confirm your diagnosis. 

The lowdown

Shingles is a viral infection that causes a rash with blisters. Shingles is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox. If you've had chickenpox, you are at risk of developing shingles. 

Anyone who's had chickenpox can get shingles. However, black people are at least 50% less likely to develop shingles than non-Hispanic white people. The shingles rash has a distinct appearance on white skin, but it can be harder to see on black and brown skin.

The condition itself is not contagious — you can't get shingles from someone who has shingles. However, the varicella-zoster virus can spread from someone with active shingles to someone who is not immune to chickenpox.  

Like many other viral infections, there's no cure for shingles. However, your doctor can prescribe antiviral medication to help with the duration of blisters and severe pain. Early treatment can prevent severe pain and help blisters dry faster, so talk to your doctor as soon as possible if you think you might have shingles.