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While herpes zoster can erupt on almost any part of the body, the most common areas are the face and the torso. The characteristic rash of herpes zoster is often preceded by a prodrome (a sensation occurring prior to the actual outbreak) of burning pain, itching or sensitivity of the affected area. The prodrome generally lasts one to two days but may precede the appearance of skin lesions by up to three weeks.

The prodrome is followed by development of fluid-filled blisters, called vesicles, on a reddened base in the dermatomal area. Shingles pain can be mild or intense. Some people experience mostly itching, while others feel pain from the gentlest touch or breeze. The outbreak of vesicles may be accompanied by flu-like symptoms and anxiety.

It is from these intensely itchy (pruritic) vesicles that infectious viral particles are shed into the air. The crusting over of the last crop of vesicles, therefore, marks the end of the contagious period. The possible infectiousness of individuals with varicella before the vesicles develop suggests an alternative site of viral shedding at this stage, such as the respiratory tract, but this has been more difficult to identify.

The vesicles eventually become cloudy and may bleed. Within 7-10 days, the vesicles crust over. As these crusts fall off, scarring and changes in skin color may remain. While the rash typically heals within 2-4 weeks, the pain that accompanies the rash may persist - a condition known as postherpetic neuralgia (PHN).

When rash healing has not occurred in a normal fashion in a person with an intact immune system, further evaluation by an infectious disease specialist is recommended.

Zoster sine herpete is defined as dermatomal-distribution pain without development of a rash. This condition can make diagnosis very difficult.

Second cases of shingles are uncommon in persons with intact immune systems, thought to be because the initial episode boosts immunity, thereby, preventing subsequent reactivations. Studies suggest that second cases of shingles occur in less than 5% of individuals.

In general, shingles in children is less severe and much less likely to result in severe acute and prolonged pain.