How Long Does Shingles Last? Stages and Timeline
Medically reviewed by Brian H. Wetchler, DO
The rash associated with shingles usually crusts over within seven to 10 days for people with a healthy immune system, but scarring and/or changes in skin pigmentation can last for months to years.
About 10% to 18% of people who have shingles experience what's known as postherpetic neuralgia (PHN), characterized by lasting pain at the site of the rash. People with PHN may continue to feel unwell for months to years after the rash has cleared up.
This article explains the stages of a shingles outbreak along with how long symptoms last. It also covers the diagnosis and treatment of shingles, and details some possible complications to be aware of.
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What Are the Stages of Shingles?
A shingles infection has three phases or stages.
Pre-Eruptive Phase
The pre-eruptive phase starts at least 48 hours before there are any blisters or rash. It begins with pain or burning sensations in the affected skin area. Some people may also experience other symptoms, such as:
Headaches
Sensitivity to light
A general feeling of being unwell (malaise)
Acute Eruptive Phase
The acute eruptive phase is marked by the development of blisters that often burst and then dry out within seven to 10 days. Pain during this stage can be quite severe and may not respond to over-the-counter pain medications.
Shingles rashes typically appear as a single strip around the left or right side of the body. The rash can appear in the following places:
Trunk area
Back
Belly
Chest
Face
When the rash develops on the face, it can affect the eye and cause vision loss. Although rare, people with weakened immune systems can develop more widespread rashes that look like chickenpox.
Chronic Phase
The chronic phase, marked by the occurrence of PHN, is the last phase of shingles. It's characterized by pain that can last months to years. Not everyone who has shingles will have PHN. People who are older or who have weakened immune systems are more likely to get PHN.
What Are the Worst Days of Shingles?
Pain, itching, and burning sensations typically peak about four to five days after the shingles rash first develops. For most people who do not have weakened immune systems, this phase does not last longer than 10 days.
People who experience postherpetic neuralgia can have lasting, severe pain and other nerve-related issues. The effects of PHN can be incredibly frustrating to deal with. In some cases, PHN-related pain may interfere with daily activities and require prescription medications to control long after the rash has gone away.
Other Symptoms
The virus responsible for causing shingles affects the body's nerve fibers. This means that, in addition to pain, a person with shingles may also experience itching and tingling.
Other symptoms shingles can cause include:
Fever
Chills
Headache
Muscle aches
Stomach pain
Vomiting
Symptoms usually improve towards the end of the acute eruptive phase when the rash clears.
How Long Do You Feel Unwell With Shingles?
People who develop PHN may feel unwell for quite a while after the initial shingles outbreak. PHN symptoms can be so severe that they interfere with your sleep and daily life.
There is no way to predict how long PHN will last. Some people have PHN for a few months; others have it for a few years. Some people experience PHN symptoms for the rest of their lives.
Older adults and people with weakened immune systems are most likely to have PHN. If you do not develop PHN, you can expect to start feeling better within 10 days after the shingles rash develops.
How Is Shingles Treated?
The mainstay treatment for shingles is a prescription antiviral medication. Antivirals work best when taken as soon as possible after the shingles rash develops, ideally within three days.
Antivirals will help reduce the severity and length of the infection, and minimize the chance of developing a serious complication from shingles. The three antivirals most commonly prescribed include:
Zovirax (acyclovir)
Valtrex (valacyclovir)
Famvir (famciclovir)
Other treatments for shingles include over-the-counter (OTC) medications, such as pain relievers like Advil (ibuprofen) and Tylenol (acetaminophen). If the pain is severe, a healthcare provider may prescribe a corticosteroid to help reduce rash inflammation and pain.
At-Home Treatments
Home treatments for shingles include calamine lotion, cool compresses, and colloidal oatmeal baths. These therapies may help alleviate itching and discomfort from the shingles rash.
The American Academy of Dermatology Association recommends following these steps to treat the rash until it heals:
Wash the rash area with fragrance-free soap.
Once dry, put a thin layer of Vaseline (petroleum jelly) on the rash.
Cover the rash with a nonstick sterile bandage.
Be sure to wash your hands after touching the rash.
Self-care is an important step in managing the symptoms, too. It includes:
Resting
Eating healthy meals
Using distractions to keep your mind off of the symptoms (e.g., TV, music, or board games)
Wearing clothes that are breathable and loose
What Are the Complications of Shingles?
The Centers for Disease Control and Prevention (CDC) reports that 10% to 18% of people who have had shingles will get PHN. People under 40 years old are highly unlikely to get PHN.
Postherpetic neuralgia refers to pain that lasts beyond three months after the initial shingles rash. The pain can be described as burning, pruritic (itchy), sharp, or stabbing and can be constant or intermittent. There is also usually allodynia, which is pain that is caused by something that otherwise would not cause pain, such as light touch. PHN can last anywhere from a few weeks to years.
People with weakened immune systems are more likely to have shingles complications than other individuals.
Risk factors for developing PHN include increased age, larger rash size, and increased levels of rash pain.
Other shingles complications include:
Vision changes
Bacterial infection of the rash blisters
Encephalitis (brain swelling)
How Is Shingles Diagnosed?
A healthcare provider will be able to diagnose the rash based on a physical exam and your medical history. If the healthcare provider is not sure if the rash is shingles, they can have it tested.
If the diagnosis is shingles, expect to be given an antiviral prescription and suggestions on how to care for the rash at home. The first couple of weeks can be painful; don't be afraid to reach out to your healthcare provider for ways to minimize pain.
Is Shingles Contagious?
Shingles can only occur if someone has had chicken pox. Shingles is not contagious. It occurs when the immune system is weakened and the virus resurfaces, causing the shingles rash.
With that said, if someone comes into contact with the fluid from a shingles blister, they could get chickenpox if they have not had the chickenpox vaccine or a chickenpox infection. They would not get shingles from contact with a shingles blister.
Preventing Shingles
The best way to prevent shingles is to get the shingles vaccine, Shingrix. This vaccine is over 90% effective at preventing shingles. Adults over 50 years of age are encouraged to get the vaccine, which comes in two separate doses.
When to See a Healthcare Provider
See a healthcare provider as soon as you suspect a shingles rash has appeared. It's best not to delay, since waiting longer than three days to have a shingles rash treated greatly increases the risk of developing PHN.
You should also see a healthcare provider if:
The shingles rash looks infected (with swelling or pus).
You are still in pain after the rash goes away.
You still feel sick after the rash goes away.
Since shingles that affects the eye can result in vision loss, it's also important to see a healthcare provider if the rash gets close to your eye.
Summary
Shingles is an infection in which the herpes zoster virus resurfaces from a past chicken pox infection. It produces a painful rash on one side of the body, usually around the side of the abdomen. Shingles can last for weeks to months. There is no immediate cure for shingles. The best thing you can do if you suspect you have shingles is to contact your healthcare provider within three days to start antiviral treatment.
Frequently Asked Questions
Is shingles curable?
There is no cure for shingles, but there is effective treatment available. Treatment is most effective when it is begun within three days of the start of symptoms.
Will shingles go away on its own?
If shingles is not treated, it may go away on its own. However, there is an increased risk of developing a long-term painful condition called postherpetic neuralgia (PHN). PHN can last for weeks or years. Do not wait for shingles to go away on its own. There are widely available treatments to reduce symptoms and the duration of the illness.
What triggers a shingles outbreak?
Shingles is caused by the reemergence of the chicken pox virus. Older adults and people with weakened immune systems are at risk of a shingles outbreak.
Read the original article on Verywell Health.
