Learn the stages of shingles with detailed images to help you understand the progression and identify symptoms.

If you’ve ever experienced the painful and uncomfortable rash known as shingles, you know how crucial it is to understand its different stages. By recognizing the signs and symptoms of each stage, you can take appropriate steps to manage the condition and relieve discomfort. In this visual guide, we will take a closer look at the different stages of shingles and provide images for better identification.

The stages of shingles:

1. Prodromal stage: Also called the preeruptive stage, this initial phase is characterized by mild pain, itching, or tingling in a specific area of the body. The skin may be sensitive and some people may experience flu-like symptoms such as fatigue, headache, and fever. It is important to note that not all people experience this phase.
2. Eruption phase: This is the most recognizable and painful phase of shingles. A red, swollen rash appears with clusters of fluid-filled blisters, usually limited to one side of the body or face. The rash follows the path of the affected nerve and may be associated with intense burning or stabbing pain.

Important information:

• The rash progresses through different stages, starting with small red bumps that quickly turn into blisters filled with clear fluid.
• After a few days, the blisters usually break, ooze and form a scab, causing discomfort and possible scarring.

To help you better visualize these phases, see the following table, which contains images and descriptions of each of them:

Stage	Description	Image
Prodromal stage	Mild pain, itching, or tingling
Eruptive stage	Red, swollen rash with fluid-filled blisters

The Stages of Shingles: A Visual Guide

The progression of shingles can be divided into several stages, each characterized by specific symptoms and visual changes on the skin. These stages include:

1. Prodromal stage

The prodromal phase is the initial phase of shingles and usually occurs before the rash appears. During this phase, people may experience flu-like symptoms such as fatigue, headache, and fever. They may also experience tingling, itching, or pain in a specific area of skin, often on one side of the body. These symptoms serve as early warning signs, alerting people to the onset of shingles.

2. Rash stage

After the prodromic phase, the eruptive phase begins. It is then that the characteristic eruption of Herpes Zóster appears. The eruption usually begins as an red and high area of the skin that becomes groups of fluid full. Ampoules usually hurt and can be accompanied by itching or tingling. The eruption usually affects a specific dermatome, which is the area of the skin irrigated by a single spinal nerve. It usually surrounds one side of the torso, but it can also appear in other parts of the body, including the face. The eruptive phase of the Herpes Zóster can last from 2 to 4 weeks, and the blisters end up drying and forming scabs.

• The prodromic phase is characterized by symptoms similar to those of the flu and the first skin sensations.
• The eruptive phase is characterized by the appearance of a blistering and painful eruption.

Herpes Zóster can be an distressing disease, which causes considerable discomfort and pain. Recognizing the phases of Herpes Zóster and seeking medical attention can quickly help relieve symptoms and prevent complications. If you suspect that Herpes Zóster can have, it is recommended to consult a healthcare professional to obtain an accurate diagnosis and proper treatment.

What is Shingles?

Symptoms:

• Red skin on the skin followed by small blisters full of liquid
• Pain, tingling or burning sensation in the affected area
• Touch sensitivity
• Itching
• Fever and headache in some cases

Herpes zoster stages:

1. Prodromal stage: This is the initial phase of the Herpes Zóster, in which the person can experience symptoms similar to those of the flu, such as fatigue, fever and headache. It can also feel pain, itching or tingling in the area where the eruption will finally appear.
2. Active phase: In this phase the characteristic eruption of the Herpes Zóster appears. It begins as red spots on the skin and then evolves to small blisters full of liquid. The eruption usually limits himself to the side of the body and follows the journey of a nerve.
3. Healing phase: After a few weeks, blisters begin to dry and form scabs. The scabs end up falling and the skin under is heals. However, some people may continue to experience pain in the affected area even after the eruption has been cured. This condition is known as postherpetic neuralgia.

Note: It is important to seek medical attention if you suspect that Herpes Zóster has, since early treatment can help relieve symptoms and prevent complications.

Herpes Zóster can be a painful and uncomfortable disease. It is recommended to consult a healthcare professional to obtain adequate diagnosis and appropriate treatment.

Stage 1: Prodromal Phase

In the prodromal phase, the virus responsible for herpes zoster, varicella zoster virus (VZV), reactivates after remaining latent in the body after a previous episode of chickenpox. As the virus becomes active again, people may experience malaise, fatigue, and flu-like symptoms. Some people may also experience headache, sensitivity to light, and a tingling or burning sensation in the affected area. These early symptoms may persist for a few days to a week before moving on to the next phase of shingles.

Key symptoms of phase 1: Prodromal phase:

• General discomfort
• Fatigue
• Flu-like symptoms
• Headache
• Light sensitivity
• Tingling or burning sensation

The prodromal phase of shingles is an important warning sign for people who have already had chickenpox. Recognizing these early symptoms and seeking medical attention quickly can help manage the progression and severity of the disease. It is essential to consult a healthcare professional if you experience any of the symptoms of the prodromal phase, as early intervention can help relieve discomfort and reduce the risk of complications.

Stage 2: Development of Rash

During phase 2, which usually occurs 2-3 days after the onset of symptoms, a red, raised rash begins to appear in the affected area. This rash is usually localized and restricted to one side of the body, following the distribution of the affected nerve. It usually appears in the form of a belt on the torso, but it can also affect the face, eyes or other parts of the body. The rash goes through several distinctive phases, each with its own characteristics, and can last two to four weeks.

Development of Rash – Stages Overview:

1. Macule/Papule: At the beginning of phase 2, small, red, flat spots known as macules begin to appear. These macules then progress to raised, blister-like lesions called papules. The skin may appear swollen and inflamed in the affected area.
2. Vesicle/ulcer: Papules become fluid-filled vesicles. These blisters are usually clear and filled with a yellowish fluid. As the rash progresses, these vesicles may burst or crust over, forming open, painful sores known as ulcers.
3. Scabs: Over time, ulcers dry out and develop a hard scab. The scabs eventually fall off, leaving pinkish or reddish marks that disappear over time.

It is important to note that the presence of an eruption is not a definitive proof of a Herpes Zóster infection. However, if you experience a painful eruption with the characteristics described, it is advisable to consult a healthcare professional to obtain an accurate diagnosis and proper treatment.

Stage 3: Vesicular Phase

During the vesicular phase, the eruption evolves from the initial redness and inflammation to the development of small vesicles full of liquid that are usually grouped. These vesicles can be quite painful and be accompanied by a sensation of tingling or burning. The eruption usually follows the route of a single nerve or nerve root, which is known as dermatoma, and usually limits to one side of the body.

• Moment: The vesicular phase usually occurs between 1 and 3 days after the appearance of the initial eruption.
• Aspect: The eruption consists of small blisters full of liquid that can vary in size and shape. Its appearance can be transparent or cloudy.
• Location: The eruption usually follows the distribution of a specific nerve or nerve root, appearing commonly in the torso, but can also affect the face, limbs or other parts of the body.

“The vesicular phase is a crucial stage in the development of Herpes Zóster, since it marks the presence of the characteristic eruption. It is important that the people who experience these symptoms go to the doctor to receive an adequate diagnosis and treatment.”

Shingles: Stage 4 – Crust Formation

During Phase 4 of Herpes Zóster, the previously formed ampoules begin to dry and form scabs. It is a natural part of the healing process, since the body works to contain and eliminate the virus. As the crust is formed, the affected person may experience itching and discomfort. It is important to resist the temptation to scratch the scab, since this can cause an infection and delay the healing process.

Key Points about Stage 4: Crust Formation

1. The scope formation phase occurs after the appearance of blisters.
2. Drying and formation of scabs in blisters is a natural part of the healing process.
3. As the crust is formed, itching and discomfort may appear.
4. Avoid stealing or scratching scab to prevent infections and accelerate healing.

In some cases, the crust may take longer to form and persist for a longer time. This can happen if there is a weakened immune system or if the infection is not effectively. Patients should consult a healthcare professional to indicate the appropriate treatment and management strategies.

Stage 5: Healing and Scar Formation

Ulcerative scab: As the blisters from the shingles rash dry and flatten, they eventually form ulcers. These ulcers will begin to scab over, gradually turning into scabs. It is essential to avoid scratching scabs, as this can delay the healing process and increase the risk of infection.

Important note: It is essential to keep the affected area clean and dry to avoid bacterial infections.

Cellular regeneration: Under the scabs, new skin cells begin to regenerate. The body begins a complex process of cell division, migration and differentiation to replace damaged tissue. As this process continues, the scabs gradually reduce in size and thickness.

1. Skin cell regeneration is primarily driven by fibroblasts, which synthesize and deposit collagen to rebuild the skin’s structural framework.
2. The production of collagen fibers helps restore the elasticity and resistance of the skin, contributing to the overall healing process.
3. Simultaneously, blood vessels in the area extend and grow to supply oxygen and nutrients to the healing tissues, promoting faster healing.

Scar formation: As the skin heals, some people may develop scars at the site of the shingles rash. The severity and appearance of the scar can vary depending on several factors, such as the person’s age, general health, and the size and depth of the ulcer. Most scars fade over time, but they may remain visible to some extent.

Complications and Long-term Effects

Complications:

• Postherpetic neuralgia: It is the most common complication of herpes zoster. It occurs when the pain from the rash persists even after it has healed. Postherpetic neuralgia can significantly affect a person’s quality of life, causing chronic pain and discomfort.
• Vision problems: Shingles can affect the eyes and cause complications such as corneal damage, inflammation and even vision loss. Prompt treatment is essential to avoid long-term vision problems.
• Bacterial skin infections: The rash caused by shingles can create openings in the skin, making it more susceptible to bacterial infections. These infections can cause additional pain, inflammation, and require antibiotic treatment.

Note: It is essential to seek medical attention if you experience persistent pain or notice any complications related to shingles. Your doctor can provide you with the right treatment and help you manage the long-term effects.

Long-term effects:

1. Scars: Shingles can leave scars, especially if the rash was severe or occurred on the face or other visible areas of the body. Proper wound care and early intervention can help minimize scarring.
2. Depression and anxiety: Living with the pain and discomfort of shingles, along with its potential complications, can affect mental health. It is essential to seek support and care to address any emotional or psychological effects.
3. Immunosuppression: In some cases, shingles can weaken the immune system, making people more susceptible to other infections or diseases. It is essential to maintain a healthy lifestyle and follow the recommendations of health professionals to strengthen immune function.

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Author of the article

Dr.Greenblatt M.

Medical oncologist at the Robert Larner College of Medicine, MD, at the University of Vermont