even when there is no rash the pain of shingles may be apparent. before a rash is visible the patient may notice several days to a week of burning pain and sensitive skin. when the characteristic rash is not yet apparent it may be difficult to determine the cause of the often severe pain. shingles rash starts as small blisters on a red base with new blisters continuing to form for three to five days. the blisters follow the path of individual nerves that come out of the spinal cord in a specific "ray-like" distribution (called a dermatomal pattern) and appear in a band-like pattern on an area of skin. the entire path of the affected nerve may be involved or there may be areas in the distribution of the nerve with blisters and areas without blisters. generally only one nerve level is involved. in a rare case more than one nerve will be involved. eventually the blisters pop and the area starts to ooze. the affected areas will then crust over and heal. the duration of the outbreak may take three to four weeks from start to finish. on occasion the pain will be present but the blisters may never appear. this can be a very confusing cause of local pain.
what are symptoms and signs of shingles and how long does shingles last?