What Can Be Mistaken for Shingles?

Certain skin conditions and viral rashes can be mistaken for shingles by some, but rarely by health professionals who know what to look for. While red and itchy like other rashes, the shingles rash is otherwise very distinct. Vesicles (fluid-filled sacs) are tingling and/or painful, and the rash has a very specific distribution on one side of the body that sets it apart.

Conditions that can be mistaken for shingles include:

• Psoriasis
• Eczema
• Allergic rash
• Ringworm
• Folliculitis
• Measles
• Chickenpox

If you have a rash that suddenly occurs, it's important to consult with a healthcare provider to determine what's causing it. Shingles and conditions that can be mistaken for it have very different causes and, thus, require very different treatments.

Shingles vs. Other Conditions

The main symptoms of shingles include:

• Pain, burning, itching, or tingling
• Red rash
• Fluid-filled blisters that break and crust 

Other, less common symptoms may include:

• Fever
• Headache 
• Muscle aches
• Stomach pain
• Light sensitivity
• Fatigue
• Vomiting
  

That said, the following are conditions that can sometimes resemble shingles.

Psoriasis

This photo contains content that some people may find graphic or disturbing.

See Photo

Psoriasis is an immune disorder that lasts for a person’s entire lifetime. With psoriasis, an immune system problem causes skin changes. The symptoms involve an itchy, sometimes painful rash that is much different than the one caused by shingles. There are many subtypes of psoriasis; plaque psoriasis is the most common type, comprising 80% to 90% of all cases.

A person with plaque psoriasis breaks out in a rash that most often starts as small red bumps; these eventually grow larger and form a scaly surface. A psoriasis rash progresses to red bumps and silvery-scaled patches, which are often seen on the knees, elbows, or scalp.

In contrast, a shingles rash is usually seen on one side of the torso, rib area, or face; it is rarely found on the knees, elbows, or scalp.  

Eczema

This photo contains content that some people may find graphic or disturbing.

See Photo

Eczema is a chronic (long-term) skin condition that often starts during early childhood, or even during infancy. It can manifest at any time during a person's lifetime, however.

Eczema is an inflammation of the skin associated with different underlying genetic and environmental factors. Food allergies, asthma, and allergic rhinitis are often linked with eczema.

Symptoms of the condition include dry or cracked, scaly skin with red patches or plaques on the back of the knees or the inside of the elbows.

To differentiate eczema from shingles, it's helpful to know that shingles may have fluid leakage and there are no plaques involved in a shingles breakout.

Allergic Rash

This photo contains content that some people may find graphic or disturbing.

See Photo

There are several types of allergic skin conditions/rashes, including:

• Hives (urticaria): Red, itchy welts may be accompanied by dangerous swelling of the deep layers of the skin, called “angioedema.”
• Contact dermatitis: Inflammation of the skin is a direct result of contact with an irritant.

One way to tell the difference between contact dermatitis and shingles is that shingles often appears as a strip or band of blisters that will not usually cross the body’s midline, as they appear on only one side of the body. Contact dermatitis will show up in the area that had contact with the irritant, which can be on any part of the body.

It's fairly easy to differentiate between hives and shingles. Hives are barely raised, larger in circumference, and paler in color than shingles.

A shingles rash involves a strip of small blisters, rather than wheals like in hives. Shingles also is not widespread; it usually manifests as a single strip or band of small blisters. 

Ringworm

This photo contains content that some people may find graphic or disturbing.

See Photo

Ringworm is a type of fungal infection that can affect the skin on any part of the body (including the fingernails and the scalp). The symptoms of ringworm depend on where the fungus is located on the body. Generally, ringworm symptoms include:

• A scaly, ring-shaped rash, commonly found on the trunk, arms, legs, or buttocks
• A scaly or clear area inside the ring
• Overlapping rings
• Red, scaly, cracked skin
• Hair loss  

Folliculitis

This photo contains content that some people may find graphic or disturbing.

See Photo

Folliculitis refers to inflammation (or infection) of one or more hair follicles. This can happen when hair follicles become damaged or blocked. It can result from shaving, waxing, wearing tight clothing, or being exposed to bacteria in a hot tub.

Symptoms of folliculitis include:

• Rash
• Itching
• Pimples or pustules (pus-filled blisters) near a hair follicle

Similar to a shingles rash, folliculitis can present with clusters of red bumps that crust over. However, unlike shingles, folliculitis is not limited to one side of the body and can affect anyone at any age.

Measles

This photo contains content that some people may find graphic or disturbing.

See Photo

Measles is much more than just a rash, particularly in babies and small children. Measles can be very severe and even dangerous. Symptoms of measles include:

• A high fever
• Cough, runny nose, and red, watery eyes
• Tiny white spots (Koplik spots) that may be found inside the mouth two to three days after symptoms start
• A rash, involving flat, red spots around the hairline that spread to the neck, trunk, arms, legs, and feet
• Small raised bumps appearing on top of the flat red spots
• The spots may join together as they spread throughout the body.

The most obvious difference between a measles rash and a shingles rash is the location. Measles spreads to multiple places on the body, while shingles is usually found in one location. 

Chickenpox

This photo contains content that some people may find graphic or disturbing.

See Photo

The chickenpox rash usually appears on the torso, scalp, and face first, then spreads over the entire body. Itchy, fluid-filled blisters appear and eventually scab over. Other symptoms include:

• Fever
• Fatigue
• Headache
• Loss of appetite
  

Although shingles is caused by a reactivation of the virus that causes chickenpox, shingles symptoms differ from those of chickenpox and they are not considered the same illness. The rash seen with chickenpox spreads over the whole body, while shingles spread is limited to a small area. Chickenpox is most commonly seen in children, while shingles is most common in adults 50 and older.

When to See a Healthcare Provider

It is important to consult with a healthcare provider for any persistent or widespread rash, especially if it is painful or accompanied by other symptoms, such as fever or respiratory problems. If you do have shingles, early intervention is key to successful treatment as well as to the prevention of long-term complications.

Summary

Shingles can sometimes be difficult to recognize or distinguish from other skin conditions if you have never seen it before. That said, it is important to see a healthcare provider who can confirm if you have shingles. Keep in mind that the shingles rash is typically confined to a small area on one side of the torso, neck, or face, shows clusters of fluid-filled blisters, and is painful to the touch.