Is It Shingles or Something Else?
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Is It Shingles or Something Else?

Learn the difference between a shingles rash and other common skin problems such as hives and psoriasis.
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Updated on October 12, 2024
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A shingles rash usually occurs on one side of the face or body, most commonly on the trunk.

It’s easy to mistake a shingles rash for other health conditions that affect the skin. The shingles virus typically causes a painful rash and blisters, which can resemble many other skin conditions — psoriasis, eczema, and hives among them. However, there are a few signs that your rash is more likely to be shingles than something else.

Signs and Symptoms of Shingles

Shingles may cause mild to severe pain, and the viral rash most commonly appears on the trunk.

 You can only develop shingles if you have had chickenpox in the past.

The first symptom of shingles is usually pain, itching, or tingling in the area where the shingles rash will later appear. This may happen several days before the rash erupts, which leads to fluid-filled blisters like those of chickenpox. However, the shingles rash usually occurs on one side of the body or face, unlike chickenpox.

The blisters typically scab over in 7 to 10 days and clear up within two to four weeks, according to the Centers for Disease Control and Prevention.

The distinctive shingles rash is sometimes called the shingles “band” because it looks like a band on the affected area. The rash can appear red in people with lighter skin tones. In people with darker skin tones, the shingles rash may appear gray, pink, dark brown, or purple.

Other signs and symptoms of shingles may include:

How to Prevent Shingles: Get Vaccinated

The shingles vaccine is approved for adults ages 50 and older, as well as for those 19 and older with weakened immune systems or at increased risk because of a disease or treatment.

What Can Be Mistaken for Shingles

A number of skin rashes can look like a shingles rash, but there may be some obvious differences. Be sure to talk to your doctor if you have a mysterious rash, in order to get a correct diagnosis and prompt treatment. Conditions that can be mistaken for shingles include:

  • Chickenpox
  • Psoriasis
  • Eczema
  • Hives
  • Contact dermatitis
  • Ringworm
  • Herpes simplex
  • Athlete’s foot or jock itch
  • Measles

Is That Rash Psoriasis, or Is It Something Else?

Dermatologist Andrew Alexis, MD, walks through some ways to identify psoriasis and differentiate it from other skin conditions.
Is That Rash Psoriasis, or Is It Something Else?

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Chickenpox Rash Spreads Over the Entire Body

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The same virus, varicella zoster virus, causes both chickenpox and shingles.

Chickenpox typically causes an itchy rash that spreads over the entire body, as opposed to just one side of the body or face as with shingles. More than 99 percent of Americans born in or before 1980 have had chickenpox.

 If you don’t know whether you have had chickenpox, check with your family doctor, who can review your records.
Chickenpox blisters can appear red, pink, or darker. They can also appear as the same color as the surrounding skin. On people with darker skin, it may be more difficult to see the blisters.

Psoriasis Can Form Scaly Patches on the Skin

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Psoriasis is an autoimmune disease that is easy to confuse with the shingles rash. As with the shingles virus, psoriasis forms patches. But the psoriasis patches can resemble scales on the skin, as opposed to the raised rash associated with shingles.

On lighter skin tones, psoriasis plaques are often red and raised. On darker skin tones, the plaques can appear dark brown, purple, or gray.

One type of psoriasis — pustular — causes small pus-filled blisters known as pustules. Areas of skin affected by psoriasis often develop into silvery scales on the scalp, elbows, knees, and lower back.

Eczema Can Cause Itchy Skin With Oozing Bumps

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Like shingles, eczema can also cause discolored, bumpy, itchy skin.

These irritated areas may appear red or darker brown, purple, or gray.

The skin of someone with eczema can also be very dry. Small, oozing, fluid-filled bumps may also appear, especially when skin is infected. Eczema commonly occurs on the face, inside the elbows, behind the knees, and on the hands and feet.

Hives Can Cause Itchy Bumps That Appear and Disappear Quickly

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Hives are red or skin-colored bumps that can cause mild to severe itching. In people with darker skin tones, the bumps may be the same color as the surrounding skin, or slightly darker or lighter.

They typically appear suddenly and disappear quickly. Pressing the middle of a bump will make it turn white, which is known as blanching. Hives can be caused by a number of triggers, including allergies, cold or hot weather, and infections.

Contact Dermatitis Can Cause a Rash and Blisters

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Contact dermatitis can result in a rash, blisters, and an itching or burning sensation on the skin. It occurs when the skin comes into contact with an irritant or an allergen, such as certain soaps, laundry detergents, shampoos, metals, medications, and more.

In people with lighter skin tones, the rash may appear red. In people with darker skin tones, the rash may look like a leathery patch that is darker than the surrounding skin.

Allergens like poison ivy, poison oak, or poison sumac can cause itchy rashes that may include blisters.

Ringworm Causes an Itchy, Circular Rash

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Ringworm is a skin infection that, despite its name, is caused by a fungus.

Ringworm can cause an itchy, circular rash on your skin. In people with lighter skin tones, the rash often appears red. In people with darker skin tones, the rash can appear gray or brown.

It may also cause scaly, cracked skin and hair loss. The rash can appear on any part of the body, and it spreads easily through skin-to-skin contact or contact with an item contaminated with the fungus, such as dirty clothes or a shower floor.

Herpes Simplex Can Create Sores Around the Mouth

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Herpes simplex virus type 1 (HSV-1) is a common viral infection that causes fever blisters or cold sores, usually on the lips or around the mouth but sometimes on the face or tongue or elsewhere on the body.

One or more painful, fluid-filled blisters may appear, then break open, ooze fluid, and form a crust before healing. In people with lighter skin tones, the blisters often appear reddish in color, but that red color may be difficult to see on darker skin tones.

The sores can last from 7 to 10 days. HSV-1 can be spread by skin-to-skin contact such as kissing or touching.

There is no cure for herpes, but treatment can relieve symptoms and shorten an outbreak.

Fungal Infections Can Cause Rashes

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Fungal infections other than ringworm can also cause rashes and blisters. Athlete’s foot causes an itchy, scaly rash that usually begins between the toes.

It can appear as white, flaky patches. It can also appear reddish in color, which may be difficult to see on darker skin tones.

Jock itch causes an itchy rash, often on the groin and inner thighs.

 It can appear red, gray, brown, or purple.
Yeast infections cause irritation and itchiness of the vagina and the vulva, and may cause symptoms including rash, pain, and burning.

Measles Rash Looks Like Flat Red Spots

Measles
Like shingles and herpes simplex, measles is caused by a virus. It is highly contagious. Symptoms of measles typically begin with a high fever, cough, runny nose, and red, watery eyes.

Three to five days later, a rash that looks like flat red spots appears, normally starting on the face at the hairline and spreading down the body to the neck, trunk, arms, legs, and feet. The distinctive spots may appear red on lighter skin tones, but they may be difficult to identify as red on darker skin tones.

Measles is a very serious disease that can lead to severe complications and death. Fortunately, it can be prevented with a measles vaccine.

The Takeaway

The shingles virus can lead to a painful rash and blisters that can cause serious discomfort. Its symptoms are similar to many other common skin conditions, including fungal infections, eczema, and psoriasis. If you have an unexplained rash, you can meet with a healthcare provider to determine the cause.

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Clinical Overview of Shingles (Herpes Zoster). Centers for Disease Control and Prevention. July 27, 2024.
  2. Ludmann P. Shingles: Signs and Symptoms. American Academy of Dermatology Association. January 3, 2024.
  3. Shingles Vaccine Recommendations. Centers for Disease Control and Prevention. July 19, 2024.
  4. Chickenpox. National Health Service (NHS) Inform. June 25, 2024.
  5. Psoriasis. Johns Hopkins Medicine.
  6. How Psoriasis Affects Black People and People of Color. Cleveland Clinic. May 1, 2023.
  7. Skin Allergy. American College of Allergy, Asthma, and Immunology. June 28, 2023.
  8. Kaufman B et al. Eczema in Skin of Color: What You Need to Know. National Eczema Association. September 22, 2023.
  9. Eczema. Cleveland Clinic. October 25, 2022.
  10. Ludmann P. Hives: Signs and Symptoms. American Academy of Dermatology Association. June 30, 2024.
  11. Contact Dermatitis. Cleveland Clinic. March 30, 2023.
  12. Contact Dermatitis. Mayo Clinic. May 2, 2024.
  13. Ringworm and Fungal Nail Infections Basics. Centers for Disease Control and Prevention. April 24, 2024.
  14. Ringworm: Signs and Symptoms. American Academy of Dermatology Association.
  15. Herpes Simplex: Overview. American Academy of Dermatology Association.
  16. Cold Sore. Mayo Clinic. January 5, 2024.
  17. Genital Herpes. National Health Service. June 27, 2024.
  18. Athlete’s Foot. Mayo Clinic. September 28, 2023.
  19. Athlete’s Foot. National Health Service. April 29, 2024.
  20. Jock Itch. Mayo Clinic. May 18, 2023.
  21. Yeast Infection (Vaginal). Mayo Clinic. January 11, 2023.
  22. Measles Symptoms and Complications. Centers for Disease Control and Prevention. May 9, 2024.
  23. Measles. National Health Service. February 21, 2022.
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Susan Bard, MD

Medical Reviewer
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Susan Bard, MD, is a clinical instructor in the department of dermatology at Weill Cornell Medicine and an adjunct clinical instructor in the department of dermatology at Mount Sinai in New York City. Her professional interests include Mohs micrographic surgery, cosmetic and laser procedures, and immunodermatology.

She is a procedural dermatologist with the American Board of Dermatology and a fellow of the American College of Mohs Surgery.

Dr. Bard has written numerous book chapters and articles for many prominent peer-reviewed journals, and authored the textbook The Laser Treatment of Vascular Lesions.

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