A Guide to the Stages of Shingles

By Krisha McCoy, MS

Medically reviewed By Lindsey Marcellin, MD, MPH

Chickenpox, a childhood disease, marks the first stage of shingles. This common childhood illness may be followed years later by shingles.



The shingles timeline generally spans many decades, from the itchy chickenpox rash you likely experienced in childhood, to the painful, blistering shingles rash you could develop years later, usually after age 50. Understanding the stages ofshingles infection can help you know what to expect if you develop this condition.

The First Shingles Stage: Chickenpox

Everyone who has had chickenpox is at risk of developing shingles later in life.

When you get chickenpox, your body has been infected with the varicella virus, which is part of the herpes family of viruses. Chickenpox is a highly contagious disease characterized by a red, itchy, blistery rash that eventually scabs over. Kids with chickenpox usually develop a fever and a headache along with their rash, and it generally goes away after 5 to10 days.

Once you've had chickenpox, you're immune to it and will not develop it again. But even after your chickenpox rash heals, particles of this virus remain in your body, burrowing into your nerve cells, where they remain dormant.

The Second Shingles Stage: Virus Reactivation

Your immune system usually does a good job of keeping the varicella virus dormant. But as you age, or if you develop certain health conditions — like cancer or HIV/AIDS — or take certain medications, like prednisone, your immune system can weaken. When your body's defenses are down, the varicella virus particles can reactivate, leave your nerve cells, and trigger the development of shingles.

Before the shingles rash appears, you will likely experience fever, fatigue, headache, and sometimes a burning or itching pain in the area of your skin where the rash will eventually appear. This can occur a few days before you notice any signs of a rash.

The Third Shingles Stage: Rash

The most characteristic shingles stage is the painful rash that accompanies the illness. In the earliest stages, patches of bumpy red blisters begin to erupt on your skin. These eruptions are usually confined to a single area of your body, such as one side of your waistline or part of your face. New patches of blisters may continue to appear for 7 to 10 days. Early in this shingles stage, antiviral medications can help decrease the severity and length of an outbreak. If given later, they will likely be ineffective.

A few days after the rash first appears, the blister patches will develop into fluid-filled blisters. As these blisters occur, many people report a stinging or burning pain in the area of the rash.

The Fourth Shingles Stage: Crusting

After 7 to 10 days, the blisters will crust over and begin to fall off. As the scabs fall off, you may notice that your skin pigmentation is irregular. This is usually a temporary change, but it can be permanent in severe cases of shingles. The shingles rash usually clears within three weeks.

The Fifth Shingles Stage: Postherpetic Neuralgia

For about one in five people who develop shingles, the pain that accompanies their rash will persist even after the rash has healed. This is a complication known aspostherpetic neuralgia. Similar to those with just the shingles rash, people with postherpetic neuralgia commonly complain of stinging or burning pain where their rash once was. For most people, postherpetic neuralgia resolves in one to three months, and almost everyone will become pain-free within one year.

If you think you may have shingles or be at risk for the disease, talk with your doctor. He can determine whether you have shingles and which stage you're in if you do have it. Based on that assessment, your doctor can recommend treatments to reduce the duration of your condition and make you more comfortable.