Classic shingles have a distinct set of signs and symptoms but there are types of shingles that don’t follow the rules. Generally, the number one sign of shingles in any form is pain, accompanied by numbness and tingling.
There are three distinct phases to shingles but most people only experience two of them.
1. Prodromal phase
This is when the first signs of shingles appear. The symptoms are vague and diverse and often confused with various other disorders. Some, but not all, might experience:
- Flu-like symptoms or just feeling ‘off’
- General weakness
- Skin hypersensitivity in one or more areas
- Stabbing pain
2. Acute phase
A few days after the onset of the first symptoms, a rash generally appears. If, however, you have zoster sine herpete, the rashless kind of shingles, you can experience all of the above but don‘t develop the classic shingles rash. (See: There’s no rash – could it still be shingles?)
The rash is generally the defining feature of shingles but even at this stage, it can be confused with hives, eczema, allergies, and impetigo. This is because shingles do not always follow the typical unilateral pattern of sticking to one side of the body and can, in rare cases, spread out like chickenpox.
The typical shingles rash is like a stripe or band on the left or right of the body that does not cross the midline. It appears in the same area as the pain, burning, and tingling experienced in the prodromal stage and is dermatomal, in other words affecting an area of skin corresponding to a particular set of nerves.
The rash can crop up anywhere on the body, like the legs and arms, but more commonly affects the face, neck, and torso. Sometimes, more than one set of nerves is affected and affects three or more dermatomes, known as disseminated zoster. [i]
The rash soon turns into clear fluid-filled blisters, called vesicles that bubble up continuously for a few days. These vesicles can be excruciatingly painful and itchy at the same time – a nasty combination. The pain is often described as being unbearable and akin to being stabbed intermittently. This tends to intensify as the condition evolves.
Some people cannot bear to have even so much as a sheet rest on the area because the skin is so hypersensitive to the merest touch. This is known as allodynia[ii], where something as innocuous as the wind touching the skin can cause discomfort. Obviously, sleep, wearing clothes, and performing normal activities is difficult in these circumstances.
The blisters persist for about a week to ten days, then scab over, shrink and eventually disappear within four weeks, sometimes leaving permanent marks on the skin. For most people, this is the end of shingles, unless they are unlucky enough to experience subsequent bouts of the infection or the final stage, which is considered a complication of shingles.
3. Postherpetic Neuralgia
PHN or postherpetic neuralgia is the last phase of shingles and possibly the worst. It affects roughly twenty percent of sufferers and involves chronic, debilitating pain, numbness, and tingling in the same region as the original pain. PHN can last for months to years.
If nerve fibers have been damaged, the pain is persistent and the aforementioned allodynia is too.