Itching, tingling or burning pain in a specific location, such as one side of the waist or face, may start several days before other signs emerge. The pain may be moderate or severe and the skin may be hypersensitive. A person may also have nonspecific symptoms such as fever, fatigue, muscle aches, headache, nausea, or chest pain.
A reddened rash then appears and eruptions of blisters (vesicles) develop over several days within one or two characteristic bands of skin (dermatomes) on one side of the body at the waist, face, or other location. There may be few or many vesicles, and in some cases they may merge together. The vesicles typically have a clear fluid in them that turns cloudy over time. At some point the vesicles burst, become crusty, and then begin to resolve over the next few weeks. In most cases, the skin does not scar unless it is damaged by scratching or unless a secondary bacterial infection or complication develops. Rarely a person may have shingles without vesicle formation.
A variety of other symptoms and complications may be seen, depending upon which nerves are affected. Symptoms can be atypical and/or more severe and persistent with those who have weakened immune systems. Complications may include:
- Postherpetic neuralgia – this is severe pain that persists long after other signs of shingles have resolved.
- Herpes zoster opthalmicus – when shingles occurs next to the eye, it can cause a variety of eye-related symptoms, facial scarring, and it can threaten a person's vision. Eye involvement may appear weeks after other symptoms have resolved.
- Ramsay Hunt syndrome – when shingles involves the facial nerve and ear, it can cause facial palsy, persistent abnormal sounds in the ear (tinnitus), hearing loss, a loss of taste, and vertigo. Those affected may not fully recover.
- Herpes zoster encephalomyelitis (meningoencephalitis or encephalitis) – central nervous system involvement may occur in some immune compromised or severely ill people. This form of shingles can be life-threatening.
- Disseminated herpes zoster – shingles that affects many areas and clinically appears to be chickenpox. It may sometimes occur in those with weakened immune systems.