Eczema vs. Shingles: What Are the Differences?

Shingles, or herpes zoster (HZ), is a condition caused by the varicella zoster virus (VZV). People with shingles typically develop a red rash and blisters.  Shingles is sometimes mixed up with other skin conditions, such as eczema. Like shingles, eczema causes symptoms like red rashes and skin inflammation. However, shingles is a viral illness. Eczema is a chronic condition with no single known cause. 

Learn more about shingles and eczema, including symptoms, causes, risk factors, and treatment options.

Overview

Though shingles and eczema are both skin conditions that cause rashes and swelling, they have different underlying causes, triggers, and risk factors. Read on to learn more about the differences between shingles and eczema.

What Is Eczema?

Eczema is a non-contagious, long-lasting skin condition that causes rashes, swelling, itching, and irritation. The most common kind of eczema is called atopic dermatitis, and sometimes the terms are interchangeable.

Atopic dermatitis is especially common among infants and young children. Some people continue to have eczema flare-ups—times when symptoms get worse—throughout their lifetime. During times of remission, eczema symptoms clear up. 

In addition to skin-related symptoms like inflammation, dryness, bleeding, oozing, and weeping, eczema flares can sometimes lead to complications. Potential eczema complications include:

• Skin infections
• Insomnia
• Blepharitis (eyelid inflammation)
• Conjunctivitis (pink eye)
  

What Is Shingles?

Shingles is a skin condition caused by a reactivation of the varicella zoster virus, which also causes chickenpox. Anyone who has ever had chickenpox can get shingles. However, older and immunocompromised people are especially at risk. Approximately 50% of people who get shingles are 60 or older, and the risk increases even more after you turn 70.

A typical case of shingles lasts around two to four weeks. Shingles symptoms usually include itching, tingling, and burning, followed by a painful rash that eventually turns into a crop of blisters and scabs over.

Some people experience complications from shingles, such as postherpetic neuralgia (PHN)—a type of severe, long-term nerve pain. Other possible shingles complications include:

• Hearing loss
• Vision problems
• Pneumonia
• Encephalitis (brain inflammation)
• Rarely, death

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Symptoms

The main symptom associated with both shingles and eczema is a skin rash. 

People with shingles tend to first notice burning, tingling, and/or itching in a certain area of the skin. After a few days, a red rash will appear, usually in a solid band or stripe across only one side of the body or face. The rash will then develop into fluid-filled blisters, which typically scab over and form a crust in about seven to 10 days. 

Some people with shingles may also experience flu-like symptoms, such as:

• Chills
• Fever
• Nausea
• Headache

Meanwhile, everyone experiences different eczema symptoms. The main symptoms of atopic dermatitis include:

• Itchy skin (pruritus)
• The “itch-scratch” cycle, caused by scratching itchy areas of the skin until they bleed
• Scaly, rough, and/or thickened patches of skin
• Swollen, inflamed skin
• Skin dryness and sensitivity
• Discolored skin—which can appear red, gray, brown, or purple, depending on your complexion
• Crusting, weeping, or oozing skin
• Extra skin creases
• An extra fold of skin under the eye
• Discolored under-eye skin

Eczema patches often show up on or around the neck, hands, feet, ankles, eyes, elbow creases, or knees. In babies and children, eczema rashes typically appear on the face, scalp, or joints. 

Here’s an overview of the main differences between shingles symptoms and eczema symptoms:

Causes

Eczema and shingles have different underlying causes. Shingles is caused by the same virus that leads to chickenpox, while researchers haven’t yet identified a specific cause of eczema.

Eczema

Eczema is not contagious, meaning that you can’t get it from anyone else. Eczema has no known cause, but researchers believe that environment and genetics both play a role. 

Though the cause of eczema is currently unknown, many different factors may trigger an eczema flare. Common eczema triggers include:

• Allergens, such as mold, pet dander, dust, and pollen
• Irritants, such as soap, shampoo, and other household products
• Food allergies, such as wheat, eggs, peanuts, or dairy
• Hot, cold, dry, or damp weather
• Hormonal shifts, especially during pregnancy or menstruation
• Skin infections
• Bodily fluids, such as saliva (especially for infants)
• Certain fabrics, such as wool clothing
• Cosmetics
• Jewelry
• Fragrances
• Certain medications, such as topical steroids
• Stress
• Lack of sleep

Shingles

Shingles itself is not contagious. Most people get it because they had chickenpox earlier in life. 

However, people with a shingles rash can spread the varicella zoster virus to people who haven’t had chickenpox in the past and haven’t been vaccinated against chickenpox. You can get it from someone with shingles if you come into direct contact with the fluid from their open blisters. 

If someone covers their shingles rash, they are unlikely to spread VZV.

Risk Factors

Anyone can get eczema or shingles. However, some factors may put you more at risk of developing one or both skin conditions.

Eczema

Eczema affects people of all ages and genders. However, it is somewhat more common among infants and children than adults, and among girls and women rather than boys and men. 

In some cases, eczema runs in families. Many people with atopic dermatitis also experience other medical problems, such as:

• Excessively dry skin
• Hay fever
• Allergies
• Asthma
• Anxiety
• Depression
• Insomnia
• Ichthyosis and other skin disorders
  

Shingles

Anyone who has had chickenpox in the past can get herpes zoster. However, the following risk factors make it more likely that you will develop shingles:

• Age, especially if you're 60 or older
• Taking immunosuppressants
• Human immunodeficiency virus (HIV)
• Cancer
• Diabetes
• Depression
• Heart disease
• Kidney disease
• Inflammatory bowel disease (IBD)
• Asthma
• Systemic lupus erythematosus (SLE)
• Rheumatoid arthritis (RA)
• Smoking
• Psychological stress
• Physical trauma

Women are slightly more likely to develop shingles than men. Children can develop shingles, but it is much more common in older adults.

Diagnosis

Most healthcare providers will be able to diagnose you with eczema or shingles with a physical examination and information about your medical history. In some cases, they may need to perform additional tests.

Eczema

To diagnose you with eczema, a dermatologist will perform a physical examination of your skin and ask you about your symptoms. They may also ask questions about your medical history, such as any history of allergies or other skin conditions in your family. 

If it’s unclear whether you have eczema, a skin biopsy can help. By examining a small sample of your skin with a microscope, your dermatologist can confirm your eczema diagnosis.

Shingles

Usually, a physical examination of your shingles rash will be enough to confirm a shingles diagnosis. 

In rare instances, however, some people with herpes zoster don’t develop a rash. Meanwhile, some immunocompromised people develop a rash that looks more like chickenpox than the typical shingles outbreak. In these cases, your healthcare provider can confirm whether you have shingles with blood tests, swabs of the fluid from your blisters, and/or a skin biopsy.

Treatment

Eczema and shingles can’t be cured. However, they can be effectively managed with various treatments, including over-the-counter (OTC) medications, home remedies, and prescription drugs.

Eczema

Most eczema medications are applied directly to the skin to reduce inflammation and prevent flare-ups. Some are available over the counter, while others have to be prescribed by a dermatologist. Some healthcare providers may prescribe oral or injectable medications to treat recurring eczema.

Managing eczema symptoms commonly calls for one or more of the following treatments: 

• Topical corticosteroids, such as hydrocortisone
• Topical calcineurin inhibitors (TCIs), such as Protopic (tacrolimus) and Elidel (pimecrolimus)
• Eucrisa (crisaborole) ointment
• Coal tar ointment
• Janus kinase (JAK) inhibitors, such as Cibinqo (abrocitinib)

In severe cases, your dermatologist may suggest phototherapy (light therapy) or systemic treatments, which target the immune system. Systemic drugs for severe atopic dermatitis include:

• Mycophenolate
• Cyclosporine
• Methotrexate
• Azathioprine

Meanwhile, OTC antihistamines, such as Benadryl (diphenhydramine), may help if your eczema symptoms are triggered by allergies.

Shingles

When prescribed less than 72 hours after the onset of shingles, the following antiviral medications may be helpful in reducing the length and severity of the illness:

• Zovirax (acyclovir)
• Valtrex (valacyclovir)
• Famvir (famciclovir)

OTC pain medications, such as nonsteroidal inflammatory drugs (NSAIDs), may work to relieve shingles-related pain. Meanwhile, soothing home remedies like oatmeal baths, calamine lotion, and warm compresses can help with itching.

Prevention

Shingles is a vaccine-preventable disease. Meanwhile, eczema is primarily prevented by avoiding common triggers.

Eczema

To prevent eczema flare-ups, it’s important to identify and avoid your triggers. Here are a few things you can do to address common eczema triggers:

• Food: If you think that certain foods may be linked to your eczema symptoms, keep a food journal to confirm your suspicions. Avoid or limit your intake of foods that trigger eczema flares.
• Clothing: Opt for cotton clothing over fabrics like polyester or wool. Use fabric softeners and detergents that are free from fragrances and dyes.
• Sweat: Dress in loose, comfortable clothing and avoid getting overheated, especially at night.
• House dust mites: Wash your bedding at least once a week. Dust your home on a regular basis, and limit your use of throw rugs, pillows, and carpets. Use dust mite covers on your bedding and furniture if necessary.
• Chemicals in household products: Try to use shampoos, soaps, and detergents that are designed for people with sensitive skin. 
• Temperature: Make sure that your home environment is kept at a comfortable, consistent level of temperature and humidity.

Gentle at-home skin care, such as taking baths and applying moisturizer consistently, can also help to manage eczema symptoms. There is some evidence that certain supplements—such as probiotics and omega-3 fatty acids—may work to prevent eczema flare-ups.

Shingles

The following groups are recommended to get two doses of Shingrix (the recombinant zoster vaccine, or RZV) to prevent shingles:

• All adults ages 50 and over
• Immunocompromised adults ages 19 and over

The shingles vaccine effectively prevents herpes zoster and related complications, such as postherpetic neuralgia. Research suggests that Shingrix is over 97% effective in adults ages 50–69, over 91% effective in adults ages 70 and older, and 68–91% effective in immunocompromised adults.

Most side effects of the shingles vaccine are mild. Commonly reported Shingrix side effects include pain and swelling at the site of injection, as well as muscle pain, fatigue, fever, shivering, and nausea. For most people, these symptoms go away on their own in a few days.

Summary

Because both shingles and eczema are skin conditions that cause a rash and swelling, they are sometimes mistaken for each other. However, there are several important differences between the two conditions. Eczema rashes are often itchy and can appear anywhere on the body, while shingles rashes are painful and typically appear on only one side of the face or body.

Shingles can also cause flu-like symptoms, such as fever, headache, and chills. Eczema is a chronic condition with symptoms that come and go, while shingles is caused by a virus. Finally, shingles is a vaccine-preventable condition, while eczema can only be prevented by avoiding triggers.

A Word From Verywell

Skin conditions are common, but they can sometimes be uncomfortable or even scary. If you think you may have eczema or shingles, talk to your healthcare provider about available treatment options.