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Shingles Stages for Seniors & What to Expect

shingles vaccination concept, vaccine vial, shingles vaccine

Understanding the basics of the primary shingles stages, how it can affect your day-to-day life, and the best available treatment options can make a big difference in your overall recovery for a better quality of life.

What Are Shingles?

Herpes zoster, or shingles, is a painful skin rash caused by the same virus that causes chickenpox. After an individual has had the chickenpox virus, typically very early in life, the virus remains dormant in the body. It can reactivate itself later in life to cause the symptoms of shingles.

The hallmark sign of shingles is a red rash that usually appears as a band or patch of painful blisters on one side of the face or body, typically lasting for several weeks. (1)

A widespread misconception is that shingles and cold sores are the same. Cold sores and shingles are caused by the varicella-zoster virus, which can stay dormant throughout most of our lives.

Cold sores typically appear around the mouth and lips, while shingles symptoms include a tingling or burning feeling often described as ‘tingling pain.’ This “shingles pain” and associated shingles blisters contribute to moderate to severe discomfort for many people, often much longer than cold sores.

If you’re unsure whether you are experiencing a cold sore or shingles, talk to your doctor to find the appropriate treatment.

Mixed race senior doctor in face mask vaccinating african american senior man in mask at home

Unfortunately, the virus that causes shingles cannot be prevented from reactivating once in the body. Still, you can take steps to reduce the risk of developing shingles. For example, the CDC recommends adults 50 years and older get two doses of the shingles vaccine, which is more than 90% effective at preventing shingles and long-term complications (2).

Luckily, shingles are not contagious and cannot be passed from person to person. However, people who have never had chickenpox can still catch the virus from someone experiencing shingles if they come into contact with the fluid from the blisters.

People with shingles should cover the affected skin area until their rash has cleared.

Physiotherapist writing prescription on clipboard for senior patient

Let’s break down the timeline for shingles in more detail:

The Stages of Shingles

Shingles occur in three stages: pre-eruptive, acute eruptive, and chronic (or post-herpetic neuralgia). Each of the three shingles stages has its symptoms and treatments. 

The Pre-Eruptive Phase 

The pre-eruptive phase is the first stage of the shingles outbreak progression. During this period, there are no visible signs of shingles, but you may feel itching, burning, or tingling in the area where the rash will eventually appear. This stage usually lasts between one and five days. 

The best way to manage the pre-eruptive phase of shingles is to start antiviral medication as soon as possible. Antiviral drugs can help reduce the severity of symptoms and may help shorten the duration of shingles. (3)

However, it’s essential to have a discussion with your doctor to ensure medication is safe for you, as many seniors are already taking multiple other drugs, some of which may conflict. 

Getting plenty of rest, staying hydrated, and keeping the affected area clean and dry are also essential. To make this phase more comfortable, avoid anything that could further irritate your skin, such as tight clothing or extreme temperatures.

The Acute Eruptive Phase

The second of the shingles stages is known as the acute eruptive phase. During this time, the hallmark shingles rash will form along one side of your face or body. As the rash develops, blisters or vesicles will typically appear along the rash, which can be very painful and sensitive to the touch.

shingles rash

In most cases, these blisters will rupture and then slowly crust over. During this phase, you may experience flu-like symptoms such as fatigue and fever, making self-care more challenging. 

In a typical shingles timeline, the rash and blisters of the acute eruptive phase take one to two weeks to heal completely but may require longer for some seniors, especially if you are living with other health conditions that may slow down your body’s natural healing process (4). 

The most important thing you can do during this phase is to get plenty of rest and stay hydrated, making sure to keep the affected area clean and dry.

Over-the-counter pain medications may help make the rash more comfortable, but discuss any self-care plan with your doctor first to ensure your safety and minimize side effects. It’s also crucial to avoid scratching or picking at your blisters, which could lead to complications or other infections. 

If you’re having difficulty managing your symptoms, or if the rash doesn’t get better after a few weeks, talk to your doctor about your self-care and other treatment options. 

Chronic Phase (Post-Herpetic Neuralgia)

The third and final of the three stages of shingles is the chronic phase, or post-herpetic neuralgia (PHN). This stage is considered a long-term complication of shingles progression that involves a variety of chronic symptoms.

If you begin developing post-herpetic neuralgia, you may experience pain in the area where your rash appeared for several months after the acute eruptive phase has ended. Additionally, symptoms like joint pain, fatigue, and difficulty sleeping are common when dealing with PHN.

The main goal of treating post-herpetic neuralgia is managing pain and other associated symptoms. Treatments such as pain medications, topical creams, and specialized patches are popular options that may help reduce discomfort levels when living with PHN.

To improve comfort, you can relax the affected area with a warm bath or shower, wear loose and comfortable clothing that isn’t irritating to your skin, and take regular breaks throughout your day to change positions and keep your body moving.

One essential treatment for seniors living with PHN is physical therapy. Regular physical therapy can help improve your overall strength, flexibility, and balance while reducing joint pain. (5)

Additional techniques, such as manual therapy or dry needling, may improve comfort and reduce symptoms. (6)

For long-term benefit, your physical therapist can provide educational information about managing your symptoms and making lifestyle changes to help you live your best life with PHN.

Be sure to talk to your doctor about which treatment options may be best for living with PHN.

Doctor checking size of lymph nodes


Understanding the main shingles stages and their treatments will better equip you to navigate them successfully. 

Shingles can be a difficult and painful condition for seniors, but with the proper treatment and self-care plan, you can help manage your symptoms and live your life to the fullest.

Remember to prioritize self-care and use the best treatment options as your doctor recommends, managing any long-term symptoms of shingles with physical therapy or other treatments that fit your lifestyle.

With the proper care plan, you can stay on top of your shingles and move toward recovery faster. 


  1. National Institute on Aging: Shingles. https://www.nia.nih.gov/health/shingles 

  2. Centers for Disease Control and Prevention: Shingles Vaccination https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html 

  3. Centers for Disease Control and Prevention: Treating Shingles https://www.cdc.gov/shingles/about/treatment.html 

  4. Patil A, Goldust M, Wollina U. Herpes zoster: A Review of Clinical Manifestations and Management. Viruses. 2022;14(2):192. Published 2022 Jan 19. doi:10.3390/v14020192 https://pubmed.ncbi.nlm.nih.gov/35215786/ 

  5. Vasileiadis P. Management of Neuropathic Pain and the Physiotherapeutic Rehabilitation of Patients with Chronic Post-Herpetic Neuralgia. Young Scientists’ Pages. Volume 73. https://www.eexot-journal.com/index.php/aoet/article/view/225/150 

  6. Cebeci D, Karasel S. Treatment Analysis of Patients Followed up With Postherpetic Neuralgia in Nothern Cyprus. Mater Sociomed. 2022;34(1):55-59. doi:10.5455/msm.2022.33.55-59. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9229281/ 

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