Shingles Vs Impetigo: What You Should Know

Shingles are a common condition, with one in three¹ Americans developing it during their lifetime. Every year, one million people get shingles. It’s caused by VZV, the varicella-zoster virus, which also causes chickenpox. You can’t spread shingles to other people, but you can give them chickenpox, which could cause them to develop shingles in later life. 

Impetigo mainly affects children 2–5 years old, and it’s a bacterial infection of the skin. While impetigo is highly contagious, complications are very rare. 

Keep reading to learn the difference between the two conditions, their symptoms, and treatment. 

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Shingles explained

Shingles² (herpes zoster) affects the nerves in a limited area and causes a skin infection. The cause is VZV (varicella-zoster virus), which also causes chickenpox. VZV stays dormant in your body after you get chickenpox and can reactivate at any time in your life.

Reactivation can happen because of certain things weakening your immune system, such as: 

  • Getting older means your immune system is less effective

  • Stress chemicals can stop your immune system from working properly

  • Recent bone marrow or organ transplant

  • Chemotherapy

  • Being immunocompromised, such as having HIV or AIDS

Shingles often affect people over 50 or those with a weakened immune system. It causes a painful, itchy rash, with peak pain appearing after four to five days. 

The rash transforms into blisters filled with a clear fluid before scabbing over after a few days. The skin discoloration caused by the rash may take months to completely clear. There is also a chance that the associated pain may not disappear, a condition termed postherpetic neuralgia (PHN). The risk of PHN increases with age. 

Different shingles stages

Generally, there are three stages of shingles. Although the duration of each stage is generally predictable, the length and intensity of the symptoms vary from one person to the next. 

Prodromal phase 

This phase consists of a tingling sensation or pain before a skin rash appears. It usually lasts between one to five days.

The active phase 

This is when the rash appears on the area that felt pain or a tingling sensation previously. It often appears on one side of the body in a stripe. After several days, fluid-filled blisters will develop and crust over within one week. The discoloration will clear within one to two months.

Postherpetic neuralgia (PHN) phase

This is when the pain associated with the rash continues. Approximately 20%³ of shingles patients will experience this stage. 

Shingles symptoms

Some common symptoms of shingles include:

  • Fever

  • Fatigue

  • Nausea

  • Headache

  • Other symptoms similar to the flu

However, those with PHN may develop symptoms like: 

  • Continued stabbing, burning, shooting, aching, and throbbing pains in the affected area

  • Pain sensitivity in the area (known as hyperalgesia and allodynia)

  • Anxiety

  • Insomnia

  • Weight gain

  • Depression

The symptoms of PHN may make it challenging to perform daily tasks and physical exercise.

Treatment and prevention

As with other viral conditions like the flu, shingles must run their full course. However, various treatment options can reduce the symptoms and the duration of the condition. 

Some effective treatment options include:

  • Use of antiviral drugs, like famciclovir, acyclovir, and valacyclovir

  • Over-the-counter (OTC) pain-relieving drugs

  • Topic skin treatments like calamine lotion, cold compress, and colloidal oatmeal baths

  • Opioid pain drugs

  • Antidepressants and antiseizure drugs

When it comes to prevention, shingles is not contagious. However, if you have shingles and don’t cover the blisters, you can spread VZV, causing someone to develop chickenpox if they have never had it before. 

To effectively prevent the spreading of VZV, you should:

  • Wash your hands often

  • Keep the rash loosely covered

  • Avoid physical contact with: 

  • People who have not had chickenpox or received the Shingrix vaccine, especially pregnant women

  • Immunocompromised people

  • Premature babies

Impetigo explained

Millions of bacterial microorganisms cover the skin. While most are safe and even beneficial, dangerous germs can develop on the skin. If these bacteria penetrate the skin's outer layer, this may result in impetigo. 

Impetigo is a bacterial infection affecting the epidermis, the skin's outer layer. Group A strep, also known as Streptococcus pyogenes or Staphylococcus aureus, is the bacteria responsible for this condition. It primarily affects children but can also affect adults. 

There are three different types of impetigo:

  • Bullous impetigo causes large skin blisters

  • Nonbullous impetigo causes thick and honey-colored crusts

  • Ecthyma manifests as ulcerative sores that penetrate deeper skin layers

Some cases of impetigo may result from methicillin-resistant Staphylococcus aureus (MRSA) germs. This type of bacteria is difficult to eradicate and treat. 

Impetigo symptoms

Common symptoms of impetigo include red-colored skin lesions on your legs, face, or arms. These bumps become blisters, which rupture, scab over, and develop a crusty yellow-brown color. The area where the blisters have burst may make the skin look crimson or raw. 

The rash often begins in a single location, but it could spread to other body parts if you scratch it. If you have bullous impetigo, your blisters might be bigger and filled with clear fluid. Those with ecthyma will notice deeper lesions with purple borders and a yellow skin crust.

Treatment and prevention

The diagnosis of impetigo by your doctor or dermatologist involves asking about the symptoms and your health history. It may also include a physical examination of the skin, which involves taking a pus sample from the blisters to test for bacteria. 

People at risk of developing impetigo include those with:

  • Diabetes

  • Liver issues

  • Eczema or atopic dermatitis

  • HIV/AIDS

  • Immune system deficiencies

  • Sores on the skin

  • Intravenous (IV) drug use

  • Dialysis

The sooner you treat impetigo, the faster it disappears, minimizing the risk of developing complications. You can develop ecthyma if you don’t get treatment, which is known as deep impetigo, as it affects deeper skin layers. With early treatment, impetigo won’t leave scars, but ecthyma does. 

Some effective ways to treat impetigo include:

  • Applying an antibiotic cream or ointment for shallow blisters

  • Taking oral antibiotics for severe infections

  • Washing the affected regions and your hands with soap and water regularly

  • Ensuring that the blisters remain loosely covered

To prevent this condition, you must:

  • Avoid sharing personal items like hairbrushes and towels

  • Wash your towels and sheets in hot water

  • Wash your hands with soap and water after coming into contact with an affected person

  • Wash your hands after handling contaminated tissue

  • Sneeze into the crook of the arm to avoid spreading germs

If impetigo often affects you, your physician should examine you to find out what’s interfering with your ability to combat the illness effectively. 

Shingles vs. impetigo: Is there a difference?

When it comes to herpes zoster and impetigo, both conditions can be confused with the other since they share similar symptoms. However, there are several differences between the two, including the following:

  • A virus causes shingles, while impetigo is a bacterial infection.

  • Impetigo mostly affects children, while shingles mostly affect those above 50 years.

  • The rash from shingles is painful and causes skin discoloration, lasting up to two months, while the rash from impetigo is not painful and clears up after a week or less.

  • Shingles and impetigo have different treatment methods.

The lowdown

The differences between shingles and impetigo are easily differentiated by a medical professional. If you suspect you have either of these conditions, consult your doctor immediately. The faster you get treatment, the sooner the symptoms will resolve.

  1. Shingles (Herpes zoster) | Centers for Disease Control and Prevention

  2. Shingles | National Institute on Aging

  3. Herpes zoster and postherpetic neuralgia: Prevention and management (2017)

Other sources:

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