Stages Of Shingles: Timeline Of Progression

Shingles is caused by the reactivation of the chicken pox virus (varicella-zoster). When you recover from chicken pox, the symptoms go away, but the varicella virus doesn't. It remains dormant in your body and reactivates later in life, causing shingles, also known as herpes zoster.

According to the Centers for Disease Control and Prevention¹ (CDC), shingles affects nearly one million people in the US every year. Everyone, including children, can get shingles, although the risk is higher in people aged 50 years and older.

The Washington State Department of Health² states that about half of shingles cases occur in people aged 60 and older.

Shingles develops in stages, and symptoms may vary for each stage. Here's a detailed look at the timeline of progression for herpes zoster.

Progression of shingles

Shingles doesn't form overnight; it goes through stages. The severity of symptoms and the duration of each stage can vary from person to person, but it usually follows a rough pattern.

Let’s look at a typical timeline for shingles.

Prodromal stage

The first stage of herpes zoster is the prodromal stage. This is the time between the initial appearance of symptoms and their full development.

The prodromal stage, also known as the pre-eruptive stage, lasts anywhere from one to five days and presents the following signs:

• Burning, tingling, or numbness on one side of the body

• Fever

• Malaise

• Chills

During this stage, you may also experience extreme sensitivity, and some people even find wearing clothes uncomfortable.

You cannot pass the varicella-zoster virus to another person during the prodromal stage.

Active stage

During the active stage, also known as the acute eruptive stage, you start developing physical signs of shingles. First, a blistering rash will form where you felt pain and tingling in the prodromal stage.

The blisters form on one side of your body and appear as a band. The rash will usually develop in the following areas of the body:³

• Torso

• Shoulders

• Around one eye

• Neck

The fluid-filled rash can be painful and may affect your daily activities. The blisters begin to crust over within seven to ten days and the scabs should heal within two weeks.

You may also experience other symptoms like:

• Fever

• Fatigue

• Headache

• Upset stomach

During the skin-blistering phase, you're more likely to spread the varicella-zoster virus to another person.

Shingles isn't contagious to the majority of people. However, if a person who has never had chickenpox or has never been vaccinated against it comes into contact with the fluid in the blister, they can become infected with chickenpox and later may develop shingles.

Chronic stage

Also known as postherpetic neuralgia (PHN), this stage doesn’t affect everyone with shingles. It occurs if recurrent pain is experienced over four weeks after the blisters have healed. Tingling, burning, and numbness may also be felt during this stage, which can last for months, even years, in some cases.

How long do shingles last?

Shingles can last up to five weeks, but the timeline can vary from person to person. Here's a precise timeline of shingles symptoms:

• One to five days: You experience a tingling sensation on one side of your body. The areas of tingling may become flushed in appearance or painful

• Seven to ten days: Painful blisters develop

• Within five weeks: The blisters and pain usually resolve

Complications from shingles

Sometimes, shingles may cause severe complications in some patients. The most common type of complication is postherpetic neuralgia (PNH). This is the chronic stage mentioned above and refers to pain that persists even when the shingles rash clears up.

PNH occurs in the area where the shingles rash was and can last for months or even years after the shingles blisters clear up.

This long-term nerve pain can be so severe and debilitating that it affects daily activities.

About 10%–18% of people who get herpes zoster will experience PNH. Older adults with shingles are more likely to experience PNH and will have more severe pain. People younger than 40 rarely experience this chronic stage of shingles.

Other rare complications include:

• Hearing problems

• Pneumonia

• Brain inflammation

• Death

How to treat shingles

Like any other viral infection, shingles has to run its course. Currently, there's no cure for shingles. However, various treatments can help shorten the course.

The medications are only effective when taken during the early stages of shingles. Therefore, it's essential to start taking the medication as soon as you notice shingles symptoms.

Antiviral medications that can shorten the course of shingles include:

• Acyclovir

• Famciclovir

• Valacyclovir 

Over-the-counter or prescription pain medications may also be needed during the painful stages of shingles.

Home remedies for shingles

Some home remedies may help ease pain, itchiness, and discomfort. The CDC recommends the following home remedies for shingles:

• Applying calamine lotion on the affected area

• Using wet compresses

• Taking colloidal oatmeal baths

Some lifestyle changes can also help you cope with shingles. Here are some recommendations from the National Institute on Aging:⁴

• Wear loose-fitting, natural-fiber clothing

• Keep the area clean and avoid scratching the blisters to prevent infection

• Eat well-balanced meals and get plenty of rest

• Avoid stress, as it can worsen the pain

• Do things that take your mind off the pain, like reading, watching TV, or carrying out a hobby

How to prevent shingles

There are various ways you can prevent shingles or stop them from spreading to others. First, consider getting the Shingrix vaccine (the vaccine for shingles). The CDC⁵ recommends two doses of the Shingrix vaccine to prevent shingles. The vaccine is recommended for adults 50 years and older and adults of any age with a weakened immune system.

You cannot get the Shingrix vaccine if you have active shingles or have an allergic reaction to any compound of the vaccine.

Another way to prevent shingles if you’ve never had chickenpox is to get the varicella-zoster vaccine. Two doses of the vaccine are about 90% effective in preventing chicken pox.

When to seek medical help

Seek medical help immediately if an unusual rash develops on one side of your body. This is because the shingles treatment is most effective in the early stages. Also, the trained eye of a medical professional can detect and diagnose the early signs of shingles.

If shingles symptoms do not improve after a few weeks, even after taking medication, you should seek medical help as soon as possible.

Also, to prevent possible vision loss, seek immediate medical care if shingles forms around one or both of your eyes.

The lowdown

Shingles (herpes zoster) are common in the US, affecting about one million people annually. Those aged 50 years and over are at a higher risk of contracting the illness, although herpes zoster can affect people of all ages. Since it's a viral infection, shingles follows a specific course of stages.

There are no physical signs during the first stage of shingles—the prodromal stage. However, you may experience a tingling sensation in the area where the shingles rash will form.

Physical signs start showing during the active stage of shingles, characterized by painful fluid-filled blisters on one side of the body. This can be the torso, face, or neck.

Generally, shingles lasts for up to five weeks. However, antivirals, over-the-counter medications, and home remedies can help relieve the symptoms of shingles.