Picture this: You wake up one morning, roll out of bed, walk into the bathroom, and look in the mirror. Uh oh—something’s up with your skin. There’s a strange red rash creeping up your chest, and a tingling feeling along with it. You wonder—could it be shingles?
Shingles, a.k.a. herpes zoster, affects one in three people in their lifetime, according to the Centers for Disease Control and Prevention (CDC). Shingles is what’s known as a “reactivation” virus that usually affects older adults, says Edward Jones-Lopez, M.D., an infectious disease expert with Keck Medicine at the University of Southern California in Los Angeles. Basically, once you’ve had chickenpox, the varicella zoster virus (which causes chickenpox) stays in your body. “After the initial infection, the virus goes into a dormant state for potentially decades,” he says. “Much later in life, when your immunity goes down, it can reactivate as shingles.”
The skin condition can be disconcerting, not to mention seriously uncomfortable. But how do you know if a rash is singles or something else? Stick with us while we review the facts about this skin condition, plus other shingles-mimicking conditions that might also cause a mysterious breakout.
Shingles Symptoms
If you’re an older adult and experiencing a blistery rash, one of the most likely answers is that you’ve got shingles. Unlike a chickenpox rash, the shingles rash is usually confined to a specific area of the body and appears in a single band, rather than spreading indiscriminately. “It typically happens somewhere on the chest or back,” says Dr. Jones-Lopez, although the head and other parts of the body can sometimes be affected. “The key thing that distinguishes the shingles rash is that it doesn’t cross the midline. If it spreads across your body, it’s not shingles.” For example, if you’ve got a rash on the left side of your face but another on the right side of your back, you can probably rule out this illness.
In addition to a rash (or before a rash even appears), you may have the following symptoms:
Shooting or burning pain
Itching
Tingling
Flu-like symptoms (fever, chills, upset stomach, and headache)
Thankfully, there are effective antiviral medications available to treat shingles if that ends up being the cause of your symptoms. These drugs—called acyclovir, valacyclovir, and famciclovir—help reduce the length and severity of shingles. They work best if given ASAP, says Anna Wald, M.D., head of the allergy and infectious disease division at the University of Washington School of Medicine in Seattle, so call your doctor right away if you suspect shingles. In addition to antivirals, your doctor may suggest pain relief medications and at-home itch relief methods, like calamine lotion or an oatmeal bath.
Photos of Shingles
Not sure if your symptoms resemble shingles? We’ve got you covered. Check out these photos to see what shingles typically looks like on the body.
Other Conditions That Cause a Rash
Other conditions can also cause a rash that you might mistake for shingles. Luckily, many of these causes are mild and easily treated. Below, we’ll break down the most common causes of an itchy skin rash, plus photos of each to help you get closer to identifying the culprit.
Chickenpox
First thing to know: Chickenpox is a skin condition caused by the virus varicella zoster. This virus is a member of the herpes family, says Dr. Wald. “There are eight different viruses in the herpes family,” she explains, including the herpes simplex viruses (which cause oral and genital herpes), Epstein-Barr virus (which causes mononucleosis), and more.
If you don’t remember getting the chickenpox as a kid, and you never got the vaccine—it’s technically possible that chickenpox is the cause of your suddenly itchy skin. However, more than 99% of people born before 1980 in the United States have had chickenpox, according to the Centers for Disease Control and Prevention (CDC) The vaccine became available in the U.S. in 1995, per the Food and Drug Administration (FDA).
But what if you’re convinced you are part of the 1% of people who never got chickenpox? Let’s take a look at the symptoms of this skin condition. “Chickenpox gives you a rash all over your body,” rather than hanging out in one isolated area, Dr. Wald says. That rash turns into fluid-filled blisters that are seriously itchy. These eventually scab over and heal after about four to seven days. While an itchy rash is the main sign of chickenpox, other symptoms include fatigue, fever, headache, and loss of appetite.
Even if you have some of these symptoms, it’s worth noting that the illness typically strikes when you’re young, says Dr. Jones-Lopez. “Typically, this infection occurs in childhood,” he says. “It’s one of those viruses that is transmitted between kids’ saliva and close contact.” That said, technically speaking anyone can get chickenpox. Unfortunately, if you do get it as an adult, it’s usually more severe than a childhood infection.
If you do come down with chickenpox, the treatments are similar to those for shingles, according to the CDC: Treatment with antiviral drugs (the faster you get these, the better they work), acetaminophen for fever, and at-home anti-itch remedies like oatmeal baths and calamine lotions.
A final word on the pox: Even if you got the chickenpox vaccine when you were a kid, it’s possible (though not probable) that you can still get the infection. The good news is that cases tend to be much milder (think rash but no blisters).
Hives
Hives, officially called urticaria, are a common cause of skin rashes. Unlike chickenpox and shingles, hives are not caused by a virus. Instead, they are usually the result of an allergic reaction—to insect bites or stings, medicines, food, or other environmental triggers, according to the American College of Allergy, Asthma, and Immunology (ACAAI). Sometimes, the cause is unknown.
While hives and shingles both appear as rashes, the similarities stop there. “Shingles doesn’t look like hives—the onset is very different,” says Dr. Wald. “There’s usually much more pain with shingles.” Meanwhile, if your prominent symptom is itching, it’s more likely to be hives.
The rash appearances are different as well. In lieu of shingles’ blistery surface, hives appear as red, raised bumps called welts or wheals that can vary in size and pop up anywhere on the body; if you press down on the center of one, it will turn white.
Another clue as to whether your rash is hives has to do with duration. Chickenpox lasts about a week; shingles lasts up to a month. Hives, usually, are short-term: They typically appear and disappear within a few days (although in rarer cases they can be chronic).
Treatments for hives depends on the severity and may include the following, per the American Academy of Dermatology (AAD):
Non-drowsy antihistamines like Zyrtec (cetirizine) or Claratin (loratadine)
Anti-itch lotion or cream
Corticosteroids like prednisone
Omalizumab, an injectable drug used when antihistamines don’t work
An EpiPen, used to treat life-threatening allergic reactions that cause hives
Phototherapy
Eczema
Another non-viral cause of itchy rashes is called eczema, a.k.a. atopic dermatitis. This condition affects 10% to 20% of kids, but only 1% to 3% of adults, making it less likely to be the culprit, as many people outgrow eczema with age.
Compared with the other rashes, eczema’s appearance tends to be on the dryer, scalier side of things, with plenty of redness and itchiness as well. Eczema can be the result of an allergic reaction to things like dust mites or pet dander, along with other environmental triggers like certain soaps or perfumes.
To distinguish eczema from hives, look for small bumps filled with fluid, says the ACAAI. These bumps can leak liquid that is clear or yellow. Unlike chickenpox, shingles, or hives, eczema is a chronic condition that requires treatment to keep it under control. Treatments may include the following, per the Cleveland Clinic:
Gentle moisturizers
Topical medications, such as steroids
Oral medications, like anti-inflammatory drugs or steroids
Immunosuppressant medications
Phototherapy
Lifestyle changes, like avoiding triggers
Psoriasis
Another potential cause of skin changes is psoriasis, a chronic autoimmune condition in which the body generates skin cells too fast, causing them to build up and form thick, scaly patches. These patches, called plaques, can have some symptoms like those you get with shingles. For example, both can cause itching, along with a burning or stinging sensation, according to the AAD. Unlike shingles, though, psoriasis can spread across the body and show up in a range of areas. For example, you might develop plaques on your scalp, elbows, knees, lower back, or even your nails. Plaques usually appear as thick, raised skin with a silvery, scaly appearance.
Treatments can help manage psoriasis symptoms and target the underlying disease. They can include the following, per the AAD:
Medications applied to the skin, such as steroids, topical calcineurin inhibitors, salicylic acid, and others
Phototherapy, which uses lasers to treat plaques
Systemic medications that work throughout the body, such as biologics
Ringworm
Does your skin rash resemble a circle, like a ring? That means it could be caused by a fungus called ringworm. You can get ringworm if you come into contact with infected skin or surfaces, like towels or bedding, according to the CDC.
The ringworm rash is typically red and itchy, like shingles—but the telltale circular shape is unique to this fungal infection. Ringworm can sometimes be treated with over-the-counter medications, like antifungal creams. For more severe cases, your doctor may recommend prescription-strength antifungal medications, which may be applied to the skin or taken orally.
Heat Rash
Heat rash—sometimes called sweat rash or prickly heat rash—is a skin rash that occurs when sweat gets trapped in the pores of your skin, according to the Cleveland Clinic. Like shingles, heat rash can be painful, itchy, and red, but usually the pain and itch of heat rash are mild and more of a “prickly” feeling, and the rash usually shows up in the form of tiny blisters or pimples. Sometimes, the bumps can be flesh-colored or purple instead of red. Areas of the body that are most susceptible to heat rash are those that don’t get a lot of airflow or where the skin rubs together, like the underarms, groin, neck, or inner thighs. Heat rash can also spread on your body, particularly if you are sweating or wearing tight clothes.
To treat heat rash, do what you can to keep your skin cool and dry, like using a fan and wearing loose-fitting, breathable clothing that helps eliminate friction on the skin. Your doctor may also recommend an anti-itch cream like calamine lotion. In most mild cases, heat rash goes away within a day once you cool down.
Contact Dermatitis
A skin rash that appears after you are exposed to something you are sensitive or allergic to is called contact dermatitis, according to the ACAAI. For example, if you are allergic to or sensitive to certain fragrances or skincare ingredients, you might find that some soaps, deodorants, or even laundry detergents cause you to break out in a rash.
The skin rash of contact dermatitis is usually red and itchy with bumps or blisters, and the skin usually feels warm and tender. To treat it, your doctor might prescribe creams or oral medications to reduce the itch and heal the irritated skin. Identifying what triggered the rash in the first place is also key so you can avoid further irritation.
Insect Bites
Could a pesky insect be the cause of your skin rash, rather than shingles? Sometimes, bug bites can cause an alarming skin reaction. For example, flea, chigger, and mite bites may resemble small, raised lesions that are painful or itchy, according to Johns Hopkins Medicine, while stinging insects can leave a swollen, red, and painful area that feels warm to the touch. Usually, these rashes are mild compared with the skin rash that accompanies shingles. That said, some people may be allergic or hypersensitive to certain bug bites or stings and have more severe symptoms; for example, those allergic to bee stings may have skin symptoms along with dizziness or even breathing problems, which indicate a life-threatening reaction—call 911 if you have signs of such a reaction. For mild bug bites, taking an antihistamine for itching or acetaminophen for pain can help bring relief.
The Bottom Line
There are many possible causes for that itchy skin rash, including shingles, which can be painfully uncomfortable. While most skin rashes don’t cause long-term harm, it’s always a good idea to check with your doctor if there’s something strange going on with your skin. Shingles, for one, responds infinitely better to antiviral treatments if you get them right away. Seek the care of your family doctor or dermatologist if your skin rash persists or comes with other painful or concerning symptoms—they can give you an accurate diagnosis and put you on the road to relief.
