Could your rash be a sign of shingles?

Mr. XX, a 48-year-old avid runner, first noticed what seemed like a simple pimple on his scalp. Thinking nothing of it, he ignored it. However, by the next day, the "pimple" worsened, spreading to his neck and shoulder. He felt increasingly fatigued, his usual jog becoming an exhausting task. A visit to the doctor led to a prescription for antibiotics and a wash to treat acne, but the rash only got worse.

What Mr. XX didn’t realize at the time was that he had shingles, a viral infection caused by the reactivation of the varicella-zoster virus—the same virus responsible for chickenpox. Affecting up to 30,000 people in Singapore each year, shingles is more common in older adults and those with weakened immune systems.

After his symptoms escalated, Mr. XX sought help from dermatologist Dr Kok Wai Leong, who confirmed his condition. He was prescribed oral antiviral medications and painkillers, but by then, the nerve pain had become unbearable, disturbing his sleep and making everyday tasks like driving impossible. This severe nerve pain, known as post-herpetic neuralgia (PHN), is a lingering complication that can persist long after the rash heals.

Shingles typically begins with early warning signs, including pain, burning, or tingling in a specific area of the skin, sometimes accompanied by fever or fatigue. The rash then develops into painful blisters, which scab over as they heal. Unlike other skin conditions, shingles usually appears on one side of the body, following a nerve pathway.

For Mr. XX, even after the rash cleared, the pain lingered for months. It took nine months for him to be pain-free, and the marks on his neck and shoulder remain as lasting reminders of the virus. Fortunately, a shingles vaccine is available to help prevent recurrence. Starting in September 2025, the Ministry of Health (MOH) will subsidize the vaccine to encourage more people, like Mr. XX, to get protected.

While shingles is often mistaken for other skin conditions such as eczema, hand, foot, and mouth disease, or chickenpox, it is crucial to recognize the differences and seek treatment early. If you develop a painful rash with blisters—especially near the eyes or on one side of your body—see a doctor immediately. Early antiviral treatment can shorten the duration of the illness and reduce complications.

Shingles can have a long-lasting impact on skin health, leaving scars and pigmentation changes. Managing the condition involves keeping the areas affected clean, avoiding scratching, and using prescribed medications to ease discomfort.

Though Mr. XX now has to wait until he turns 50 to qualify for the national vaccination program, he is relieved to know that protection is within reach. His story serves as a reminder that shingles is not just a rash—it is a serious condition that can disrupt lives. If you’re at risk, consider vaccination to protect yourself before it’s too late.

If you suspect you may have shingles, consult Dr Kok Wai Leong, our Dermatologist, for guidance on management and prevention.