Shingles Symptoms

Symptoms of Shingles That Should Not Be Ignored

Some shingles symptoms may indicate complications or involvement of the eyes, nerves or skin and should be medically assessed promptly. The table below explains which symptoms of shingles require closer medical evaluation and what they could indicate:

Postherpetic neuralgia is the most common complication of shingles, while ophthalmic involvement, bacterial infection and nerve palsies are other recognised complications.

Why Do Shingles Symptoms Occur?

Shingles occurs when the varicella-zoster virus (VZV), which causes chickenpox, becomes reactivated after remaining dormant in nerve tissue. The reactivated virus travels along a sensory nerve towards the skin, causing inflammation and irritation. This can lead to burning, stabbing or throbbing pain, tingling, itching and increased skin sensitivity before or around the time the rash appears.

The immune system normally keeps VZV under control. The risk of reactivation increases with age and when the immune system is weakened by certain conditions or medicines. The virus can then cause a painful rash with clusters of fluid-filled blisters along the affected nerve pathway.

Symptoms of Shingles That Require Immediate Medical Attention

Certain shingles symptoms may indicate involvement of the eye, brain, spinal cord or other organs and require urgent medical assessment. These symptoms include:

• Severe eye pain, a rash around the eye or changes in vision

• A rash on or around the eye or nose

• New confusion or a significant change in mental state

• Seizures

• Loss of consciousness

• Sudden or significant muscle weakness

• Severe headache accompanied by other neurological symptoms

• Difficulty breathing

• A widespread rash accompanied by severe illness, particularly in someone with a severely weakened immune system

Shingles affecting the eye can cause serious complications and may threaten vision, while neurological symptoms can indicate involvement of the brain, spinal cord or facial nerves.

Symptoms of Shingles-Specific Conditions

Shingles can sometimes affect particular nerves or areas of the body or lead to recognised complications. The table below explains the symptoms associated with shingles-specific clinical presentations and complications:

These conditions can occur when shingles affects specific nerves or when complications develop. Disseminated infection is more likely in people with severely weakened immune systems, while postherpetic neuralgia can continue after the rash has resolved.

Symptoms of Shingles in Children

Shingles is less common in children than in older adults, but it can occur. Children generally develop symptoms similar to adults, including a painful or itchy rash with grouped fluid-filled blisters, usually affecting one side of the body.

Common shingles symptoms in children include:

• Burning, pain or tingling before the rash

• Itching or increased skin sensitivity

• A red rash followed by fluid-filled blisters

• Headache

• Tiredness

• Fever

• Blisters that later crust over

Symptoms of shingles can vary in severity among children. A child with a rash around the eye, widespread blisters, severe pain, facial weakness or other concerning symptoms should be medically assessed promptly. Urgent medical advice for children aged 17 or younger with symptoms of shingles is recommended.

Can You Have Shingles Without Symptoms?

Shingles usually causes symptoms, even when the typical rash is absent. In rare cases, VZV can reactivate without producing the characteristic blistering rash. This is known as zoster sine herpete and may cause localised nerve pain, burning, tingling or altered skin sensation.

Since these symptoms can have many other causes, nerve pain alone cannot confirm shingles. A healthcare professional may assess the symptoms and consider laboratory testing when the diagnosis is uncertain. Clinical diagnosis can be more difficult when there is no rash, and PCR testing may help confirm VZV infection in atypical cases.

When Can Shingles Symptoms Become Life-Threatening?

Most people recover from shingles without life-threatening complications. However, severe complications can occur, particularly in people with severely weakened immune systems, and may involve the brain, spinal cord, lungs or other organs.

The table below explains the serious complications that can occur when shingles spreads or affects important organs and the problems they may cause:

Sudden neurological changes, seizures, loss of consciousness, significant breathing difficulty or major vision changes require urgent medical assessment. Serious neurological, pulmonary and disseminated complications of shingles are uncommon but can be severe.

How are Shingles Symptoms Diagnosed?

Shingles is usually diagnosed based on the characteristic rash, its one-sided distribution, symptoms, and medical history. When the presentation is atypical or there is no clear rash, additional testing may be considered.

The table below explains the main assessments that may be used to evaluate shingles symptoms and identify possible complications:

Shingles is usually diagnosed clinically once the characteristic rash appears. PCR is the most useful laboratory test when confirmation is needed, particularly in atypical presentations.