How to Identify Shingles on Black and Brown Skin

Once you’ve had chickenpox, VZV lies dormant in nerve cells where it can reactivate later in life to cause shingles. What exactly causes VZV reactivation is unknown but is likely a weakening of the immune system due to age, stress, or illness.

The characteristic symptom of shingles is a rash. Pictures of this rash most often show it on white skin, where it appears inflamed and bright red. However, this rash can look different on black or brown skin.

Read on to learn more about how the shingles rash can look on black or brown skin, what other symptoms to watch out for, and when to seek medical attention.

Appearance on black and brown skin

Many images of the shingles rash show how it appears on white skin. These images typically display a patch of skin that’s very red and inflamed. This is called erythema and is due to the dilation of blood vessels in the skin.

While erythema can happen in all people, its effects can be harder to see on black and brown skin. Because of this, it can be hard to identify some types of skin conditions.

For example, a 2020 study found that medical students only correctly identified hives on skin of color 57.5 percent of the time, compared to 82.2 percent of the time for white skin.

The shingles rash generally has a very distinct appearance and co-occurring symptoms. In fact, medical students in the study above identified shingles correctly at a similar rate for skin or color and for white skin.

Nevertheless, it’s important to be able to recognize the signs of shingles on black and brown skin. This is because when identified and treated early, the duration and severity of shingles can be reduced. We’ll describe what to look out for below.

Early rash

When the shingles rash first starts, it often appears as small bumps in the affected area. You may also notice that the skin around these bumps appears slightly swollen.

Early shingles lesions are typically discolored compared to your surrounding skin. Depending on your skin tone, they may appear purplish, dark pink, or dark brown in color.

Shingles rash can be painful, but in some cases, it may also itch. Because of this, it’s possible to mistake the early stages of a shingles rash for eczema or another type of dermatitis.

Vesicles

As the shingles rash continues to develop, it will form vesicles. A vesicle is a fluid-filled sac that forms under your skin. Vesicles from shingles can resemble blisters.

Some people with shingles only have scattered vesicles throughout the affected area. However, in others, the vesicles can merge and form an area that looks like a burn or a plaque.

The raised, fluid-filled part of the vesicles can appear white or grey in color. Meanwhile, the skin surrounding the vesicles is typically discolored and, depending on your skin tone, may appear purple, dark pink, or dark brown.

Pain and itching can continue during this stage. Eventually, the vesicles will break open and scab over.

Symptoms

Now, we’ll take a look at some other symptoms of shingles, as well as when and how they develop.

Early symptoms

The initial symptoms of shingles last for at least 48 hours. You’ll often notice pain that’s localized to one side of your body, typically in a bandlike pattern. Some commonly affected areas include the:

  • chest
    • back
  • waist
  • stomach
  • face, especially over the eye, which may require medical attention

Pain from shingles can be described in several ways, including:

  • tingling
  • itching
  • burning
  • stinging

The intensity of shingles pain can vary by individual. Some may only experience mild pain while for others, even the light touch of bed sheets can cause intense pain.

During this time, you may also experience other common symptoms of a viral infection, such as:

  • fever
  • fatigue
  • headache
  • feeling unwell, known as malaise
The rash develops

The characteristic shingles rash develops in the affected area as small bumps that eventually turn into fluid-filled vesicles, which can break open and crust over. This stage lasts for about 3 to 5 days.

The shingles rash is typically painful, itchy, or tingling. In some cases, these sensations may be severe.

Once the vesicles have burst and crusted over, it can take 2 to 4 weeks for the affected area to heal. It’s possible that the skin in this area may have scarring or changes in pigmentation afterward.

Risk factors

Anyone who has had chickenpox can get shingles. People who were vaccinated for chickenpox can also develop shingles, but this is less common. Some additional risk factors for shingles include:

Age

Your risk for getting shingles increases with age. Most people who develop shingles are over age 50. This is because your immune system naturally weakens as you get older.

It’s possible for younger people to get shingles. When this happens, the condition is often milder.

Having a weakened immune system

You’re also at an increased risk of shingles if you have a weakened immune system. Some things that can cause this include:

  • taking immunosuppressive drugs
  • living with HIV
  • having received an organ or bone marrow transplant
  • having certain types of cancer, particularly lymphoma or leukemia
Other factors

The Centers for Disease Control and Prevention (CDC) notes other potential risk factors for shingles. However, more research is needed to further characterize them. According to the CDC:

  • Women typically develop shingles more often than men.
  • Shingles is about 50 percent less common in Black people than in white people.

Treatments

If you do get shingles, antiviral drugs can help to shorten the duration and severity of the condition. They may also reduce the risk of postherpetic neuralgia, a potential complication of shingles, by about half.

Some examples of antiviral drugs that are used for shingles include:

  • acyclovir
  • famcyclovir
  • valacyclovir

These medications are most effective when started early. Because of this, be sure to see a healthcare professional as soon as you notice any signs or symptoms of shingles.

Most people with shingles can recover at home. Here are additional tips that may help with your recovery:

  • Use a cool compress. Placing a cool compress on the affected area can help to soothe pain or itching.
  • Take over-the-counter (OTC) medications. OTC medications like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) may help to relieve pain and fever. Topical anti-itch products like calamine lotion can help with itching.
  • Don’t scratch. It may be tempting, but try not to pick or scratch at your rash, as this can potentially lead to a bacterial infection. It can also increase your risk of scarring or pigmentation changes.
  • Keep calm. Stress may make your symptoms worse, so try to manage your stress levels. There are a variety of stress-reducing activities that you can try out.

When to talk with a professional

Regardless of your age, it’s important to see a healthcare professional right away if you develop symptoms of shingles. Antiviral drugs can help reduce the severity and duration of illness as well as lower your risk of complications.

Seeking timely medical attention is particularly important if you have:

  • severe symptoms
  • shingles that affect a large area of skin
  • shingles around the area of your eyes, ears, or face
  • a weakened immune system

Antiviral drugs are most effective when started within 72 hours after the rash begins. Because of this, don’t hesitate to seek care if you suspect that you have shingles.

The bottom line

Shingles is caused by the reactivation of VZV, the virus that causes chickenpox. One of the main symptoms of shingles is its rash, which can appear differently on black and brown skin than it does on white skin.

Shingles rash starts as small bumps that are discolored compared to your surrounding skin, often appearing dark pink, purple, or brown. These then turn into raised white or grey vesicles surrounded by discolored skin.

Shingles vesicles eventually break open and scab over, taking several weeks to heal completely. Black and brown skin may be affected by PIH after shingles.

It’s important to see a healthcare professional right away if you think you have shingles, as antiviral drugs can reduce the condition’s length and severity. If you’re age 50 or older, the shingles vaccine can help to prevent you from developing shingles.

Read this next

It’s possible to get a shingles rash on your face. This can lead to vision or hearing complications. Learn about symptoms, treatments, and more.

Shingles without a rash is uncommon, but it can occur. It’s also difficult to diagnose because the usual shingles rash isn’t present. This condition…

Eating a balanced diet that’s low in high glycemic carbohydrates and processed foods can help your immune system fight off shingles. Here's how to try…

Eczema can appear differently on the skin of people of color, especially Black people. We explore eczema and how it affects people of color.

Acupuncture has been shown to help ease the pain of shingles and postherpetic neuralgia.

Shingles is a condition related to chickenpox. It mostly affects older adults. Learn the causes and how to avoid getting or spreading the virus that…

Shingles, sometimes called herpes zoster, is an infection caused by the varicella-zoster virus. Learn more here.

Shingles pain can last for a few days to up to a month or longer. We'll discuss why.

Once reactivated, the virus spreads to your skin by traveling down your nerves. Where your rash appears depends on which nerve the virus travels.

Read more on: skin