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Warning Signs of Shingles

The signature rash isn’t the only symptom of the viral infection that is more common and more severe with age

Kimberly Goad,

AARP

Published March 25, 2026

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Cut It Out Design Studio (Getty, 5)

Key takeaways

Shingles pain often starts days before a rash, leading many adults to delay care.
Early antiviral treatment can shorten illness and lower the risk of lasting nerve pain.
Adults 50 and older face higher risks, but vaccination can prevent shingles and its complications.

Imagine the worst sunburn of your life, or being poked repeatedly in the same spot with a needle or knife, or maybe even the sort of shock-like jolt from touching an exposed wire. Perhaps picture some combination of all three, and you’ve got a good idea of just how painful shingles can be.

So how is it that adults who develop the condition often live with it for days before seeking treatment? In the absence of a rash — arguably the best-known symptom of shingles — they likely don’t realize they have it.

In its early stages, shingles likes to masquerade as any number of lesser offenders — a pulled muscle, back pain, kidney stones, sciatica, dental woes — so that by the time a rash appears and you realize you need to see a doctor, you’ve already had it for several days.

That delay in diagnosis can be problematic, especially for people over 50. Older adults who get shingles are at greater risk of complications; the sooner treatment begins, the faster and less painful the recovery.

“There are several antivirals that can be used,” says Dr. William Schaffner, an infectious disease specialist and professor of preventive medicine at the Vanderbilt University School of Medicine in Nashville, Tennessee. “If given early, they can really mitigate the severity of the infection, reduce the duration and make it less likely you’ll have post-shingles pain.”

What is shingles?

Also known as herpes zoster, shingles is caused by a reactivation of the same virus that causes chickenpox. After that bout of chickenpox you almost certainly had as a kid, the virus didn’t leave your body. Instead, it lay dormant in nerve cells, allowing it to be reactivated decades later.

For the estimated 1 in 3 adults in the U.S. who develop shingles, that’s exactly what happens.

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“It’s very much worth preventing,” says Schaffner. According to the Centers for Disease Control and Prevention (CDC), the shingles vaccine — recommended for everyone 50 and older and for immunocompromised adults 19 years and over — is more than 90 percent effective in preventing shingles and post-shingles nerve pain in older adults with healthy immune systems.

Causes and risk factors for shingles

If you had chickenpox as a kid — according to the CDC, more than 99 percent of Americans born before 1980 have had the virus — you’re at risk for shingles. And the risk increases with age.

About half of shingles cases occur in people 60 and older.

“After you recover from chickenpox as a child, the virus remains dormant along your nerves near the spinal cord,” explains Dr. Sara Moghaddam, a dermatologist in Selbyville, Delaware, and a spokesperson for the American Academy of Dermatology (AAD). “As we age, our immune system can weaken, allowing the virus to ‘wake up’ and travel down the nerve fibers toward the skin. By the time a rash appears, the virus has already been traveling down that nerve for days, which is why patients often feel a burning or aching pain before the rash is visible.”

Your risk of shingles also increases if you take certain medications (including steroids, immunosuppressive drugs for conditions such as Crohn’s disease or rheumatoid arthritis, or anti-rejection drugs given after an organ transplant) or have a medical condition (like leukemia or lymphoma) that can weaken your immune system.

Signs and symptoms of shingles

Although chickenpox and shingles are caused by the same virus, they show up differently in the body. For one thing, chickenpox typically causes a rash all over the body and is most common in children, while shingles usually causes a rash on just one side of the face or body and occurs mainly in adults.

The rash “starts as clusters of small, red bumps and follows a specific nerve path, staying on one side of the body, and never crossing the midline,” says Moghaddam. “The fluid-filled blisters eventually burst, crust over and form scabs. The total healing process usually takes two to four weeks.”

But a rash isn’t the first sign of shingles. In the days leading up to the rash, symptoms can include:

Burning, tingling or stabbing pain
Unusual skin sensitivity (even clothing brushing the skin can hurt)
Itching or numbness in a specific area
Fatigue or mild flu-like symptoms

How is shingles diagnosed and treated?

Doctors usually diagnose shingles based on the rash alone. The distinctive way it develops is a major tip-off.

“One of the most common places for shingles to occur — and it only occurs on one side of the body — is on the trunk,” says Schaffner. “The redness and the blisters form a stripe on the trunk going around from the back forward. That’s why it’s called shingles, as though they were shingles on the roof or the side of a house.”

The go-to therapy — antiviral medication — works best when given at the onset of symptoms, says Moghaddam. “Since the rash isn’t immediately visible, people often ignore the pain or mistake it for a pulled muscle,” she says. “Treatment is most effective when started within the first two to three days after the pain begins.”

Treatment outside that window puts you at greater risk for what’s known as postherpetic neuralgia (PHN), or post-shingles nerve pain, “a common complication where patients experience long-term pain for months or even years after the rash has resolved,” says Moghaddam.

It occurs more frequently in people who delay treatment, she says. About 10 to 18 percent of people with shingles develop PHN.

But post-shingles pain isn’t the only serious complication associated with the condition. Shingles on the forehead or around the eye is considered a medical emergency, as it can cause vision problems, including permanent vision loss, says Dr. Lauren Ploch, a dermatologist in Aiken, South Carolina, and a spokesperson for the AAD.

What’s more, “some studies have shown a link between shingles infections and cognitive decline or dementia,” she adds. Accumulating research has found an association between the shingles vaccine and reduced dementia risk, including a recent study published in Cell that found vaccinated adults were more likely to remain cognitively healthy than those who didn’t receive the vaccine.

And since shingles can initiate an inflammatory response in the body — in much the same way the flu and COVID-19 do — it can also predispose you to heart attack and stroke, says Schaffner.

“Even though shingles is not an illness that will kill, it can impair your vision, leave scars and have a profound influence on how you carry out your life over a period of time,” he adds. “Getting the vaccine and avoiding the consequences is a good thing.”

The key takeaways were created with the assistance of generative AI. An AARP editor reviewed and refined the content for accuracy and clarity.

Kimberly Goad is a New York-based journalist who has covered health for some of the nation’s top consumer publications. Her work has appeared in Women’s Health, Prevention, Health and Reader's Digest.