Psoriasis vs. Shingles: Reference Photos and Differing Signs | MyPsoriasisTeam

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Are Your New Rashes From Shingles or Psoriasis? Here’s How To Tell

Medically reviewed by Kevin Berman, M.D., Ph.D.
Written by Suzanne Mooney
Posted on April 18, 2023

If you notice a new rash or itchy area on your skin, you might wonder if it’s from psoriasis — or a different skin condition, such as eczema, poison ivy, hives, or shingles. The risk of shingles may be of particular concern for people with psoriasis: Research has found that people with psoriasis may be more likely to develop shingles and vice versa. Being informed about both skin conditions can help you identify potential symptoms and know what to expect from treatment.

“If you have psoriasis and one of your flare-ups looks different than usual, you should see a doctor to rule out shingles or another serious rash or allergy,” said a MyPsoriasisTeam member.

In this article, we compare psoriasis and shingles, two common skin diseases that have some similar symptoms but different causes and treatments.

What Are Psoriasis and Shingles?

Psoriasis is a chronic (long-lasting) autoimmune skin condition that causes cells to build up rapidly on the surface of the skin. Psoriasis commonly affects the knees, elbows, and scalp, but symptoms can develop anywhere on the body. One of the most common symptoms is raised, scaly patches or plaques that may flake, itch, burn, or sting. Psoriasis isn’t not curable, but treatments can help you manage your symptoms and improve your quality of life.

There are several types of psoriasis. The most common type is plaque psoriasis, which accounts for 80 percent to 90 percent of cases, according to Cleveland Clinic. Other types include:

  • Inverse psoriasis
  • Nail psoriasis
  • Guttate psoriasis
  • Scalp psoriasis
  • Pustular psoriasis
  • Erythrodermic psoriasis

According to the National Psoriasis Foundation, approximately 30 percent of people with psoriasis will develop psoriatic arthritis. Psoriasis is not contagious — you cannot spread it to others.

Plaque psoriasis — the most common type of psoriasis — usually appears as raised patches of skin that become scaly and inflamed. (CC BY-NC-ND 3.0 NZ/DermNet)

Shingles, or herpes zoster, is a viral infection caused by the same virus that causes chickenpox (varicella). This virus is called varicella zoster. When you first contract the virus, it causes chickenpox. The virus stays in your body after you heal and can reactivate later in life as shingles. The most common skin symptom of shingles is a painful, blistering rash on one side of the body — often on the torso.

According to the Centers for Disease Control and Prevention (CDC), approximately 1 in 3 people in the United States will develop shingles. A person’s risk of developing shingles increases with age.

Although shingles itself isn’t contagious, the virus is. If you have shingles blisters and spread the varicella-zoster virus to someone else, they may develop chickenpox if they haven’t already had the illness or the chickenpox vaccine. If the virus activates again later, they may develop shingles. Once the blisters have scabbed over and healed, the virus cannot be transmitted.

Shingles is an infection caused by the same virus that causes chickenpox. The most common skin symptom is a painful, blistering rash on one side of the body, usually on the torso. (Adobe Stock)

What Causes Psoriasis and Shingles?

Psoriasis is an autoimmune condition likely caused by genetic and environmental factors that disrupt the immune system. Researchers do not yet fully understand what causes psoriasis, but they have identified some causes and triggers that can lead to flare-ups.

Psoriasis causes and triggers include:

  • Family history
  • Stress
  • Injuries to the skin, like cuts, scrapes, or sunburns
  • Certain illnesses, like bronchitis or tonsillitis
  • Some infections, like a skin infection or strep throat
  • Cold, dry weather
  • Heavy alcohol consumption
  • Smoking

Anyone can develop psoriasis, but your risk is greater if one or both parents have it.

Shingles is caused by the varicella-zoster virus, which is also called human herpesvirus 3. Anyone who has had chickenpox or the live chickenpox vaccine can get shingles. It rarely develops in people under 40, but the risk increases with age. Most people who get shingles develop it in their 50s or later.

Shingles risk factors include:

  • Getting older
  • Having a weakened immune system
  • Undergoing cancer treatments, like chemotherapy or radiation
  • Using steroids, like prednisone, long term
  • Taking medications that suppress the immune system

You can reduce your risk of developing shingles by getting the recombinant zoster vaccine (Shingrix). The CDC recommends the two-shot vaccine for adults 50 and older. Getting the vaccine is the only way to protect against both shingles and postherpetic neuralgia, a shingles complication that can cause burning pain in the nerves and skin and continue after the painful rash and blisters have healed.

The U.S. Food and Drug Administration (FDA) has approved Shingrix for people with inflammatory and autoimmune conditions like psoriasis. If you have questions about the shingles vaccine, ask your health care provider for guidance.

Is There a Connection Between Psoriasis and Shingles?

Although research has found that people with psoriasis may have an increased risk of developing shingles, it’s unclear whether the connection is between psoriasis treatments and shingles, psoriasis severity and shingles, or both.

Authors of one study found a significantly higher risk of shingles in people with psoriasis than in people without. When they investigated further, they discovered that the risk appears to be highest for people treated with immunomodulatory therapy or phototherapy and those with severe psoriasis.

Immunomodulatory therapy, which includes systemic treatments like biologics and immunosuppressants, is often used to treat severe psoriasis. So, is it the disease severity or the treatments making people more susceptible to shingles? More research is needed.

The opposite association also appears to be true. In another study, people with no history of psoriasis were nearly 1.66 times more likely to develop the skin condition after a shingles diagnosis. While researchers did not suggest what may cause the connection, they did note that in all cases, when psoriasis appeared, it developed in the same places as the shingles lesions.

Consult your health care provider if you have questions about the connection between psoriasis and shingles.

What Are the Symptoms of Psoriasis and Shingles?

Both psoriasis and shingles can cause a rash and itchiness, but they can produce other symptoms too.

Psoriasis symptoms include:

  • Raised scaly patches or plaques
  • A rash that varies by skin tone — Often red or pink with silvery white scales on lighter skin, and violet or dark brown with gray scales on darker skin
  • Areas of thickened skin from a buildup of skin cells
  • Dry skin
  • Cracked skin that may bleed
  • Itching
  • Burning
  • Stinging

Other types of psoriasis, like nail psoriasis and scalp psoriasis, can create additional symptoms. Unlike shingles, psoriasis usually affects both sides of the body.

The blistering rash from shingles starts as a crop of raised areas of skin called papules. New lesions can develop around the affected nerve and can blister or fill with pus and crust over. (CC BY-NC-ND 3.0 NZ/DermNet)
One form of psoriasis, called guttate psoriasis, can present with tear-shaped spots that could be mistaken for skin symptoms of shingles. (CC BY-NC-ND 3.0 NZ/DermNet)


A common sign of shingles is a painful, blistering rash that appears quickly on one side of the body. The rash often affects the torso but can develop anywhere on your skin. It can also infect the eyes and may cause blindness or affect the ears and hearing.

Shingles can present as a painful, blistering rash on one side of the body. Although the rash usually affects the torso, it can show up anywhere, including on the face. (CC BY 4.0/A. Winnifred Christy et al./Cropped)

Other symptoms of shingles include:

  • Blisters or lesions that may open, bleed, and scab
  • A stripe or “shingles band” on the face or body
  • A widespread rash similar to chickenpox
  • Pain
  • Itching
  • Burning
  • Tingling
  • Flu-like symptoms (e.g., headaches, fever, chills, and upset stomach)

Active shingles blisters or lesions are infectious. Cover them and avoid skin-to-skin contact with friends and family until the lesions dry and scab over.

How Are Psoriasis and Shingles Diagnosed?

If you have symptoms of psoriasis or shingles or suspect you might have another skin disease or a skin infection, consider seeking help from a doctor specializing in dermatology.

Your health care provider might take steps such as these to confirm a diagnosis:

  • Perform a physical exam
  • Gather details about your symptoms
  • Ask about your medical history and family history
  • Send fluid from a blister to a lab for analysis and viral culture
  • Perform a biopsy, which entails taking a small skin sample to examine under a microscope

Once your health care provider knows which skin condition you have, they can recommend effective treatment options. It’s possible to have psoriasis and shingles at the same time, but they’ll still require different treatments.

How Are Psoriasis and Shingles Treated?

Psoriasis is an autoimmune disease, so your health care provider will likely recommend treatments that target the immune system. For shingles, they will likely prescribe antiviral medication.

Treatments for psoriasis include:

  • Synthetic forms of vitamin D, like calcipotriene (Dovonex) and calcitriol (Vectical)
  • Over-the-counter topical steroids, like hydrocortisone lotions, creams, and gels
  • Prescription-strength corticosteroid creams or ointments, like triamcinolone and clobetasol
  • Light therapy (phototherapy), including sunlight and artificial ultraviolet light
  • ​​Calcineurin inhibitors, like tacrolimus (Protopic) and pimecrolimus (Elidel)
  • Retinoid gels or creams, like tazarotene (Tazorac)
  • Steroid injections
  • Methotrexate (Otrexup, Rasuvo, Trexall)
  • Cyclosporine
  • Biologics, including adalimumab (Humira), apremilast (Otezla), certolizumab pegol (Cimzia), etanercept (Enbrel), guselkumab (Tremfya), infliximab (Remicade), ixekizumab (Taltz), secukinumab (Cosentyx), tildrakizumab-asmn (Ilumya), and ustekinumab (Stelara)

You and your health care provider may need to try different drugs or therapy combinations until you find something that works. Before starting any psoriasis treatments, ask about the risks of side effects and allergic reactions.

According to the American Academy of Dermatology, a shingles rash can clear without treatment. However, they recommend seeking immediate care to ease your pain, shorten the duration, and reduce your risk of complications.

Treatments for shingles include:

  • Antiviral medications, like acyclovir (Sitavig or Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex)
  • Anticonvulsants, like gabapentin
  • Corticosteroid injections
  • Topical numbing cream or spray, like lidocaine
  • Topical pain-relieving patch, like capsaicin
  • Tricyclic antidepressants, like amitriptyline
  • Over-the-counter pain medications

It’s best to seek shingles treatment within three days of noticing symptoms. This increases the likelihood of avoiding serious complications and long-term nerve pain. Starting treatment after three days is still beneficial, so don’t delay.

Seeing a rash or blister appear on your skin can be concerning. It’s easy to search the internet for clues and wonder if you have a fungal infection, atopic dermatitis, or even skin cancer. If you have symptoms of psoriasis, shingles, or another skin disease, schedule an appointment with your doctor immediately.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis and their loved ones. On MyPsoriasisTeam, more than 116,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis and psoriatic arthritis.

Do you have psoriasis or shingles? Did you have trouble telling one type of rash from the other? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on April 18, 2023
All updates must be accompanied by text or a picture.

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Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here
Suzanne Mooney writes about people, pets, health and wellness, and travel. Learn more about her here

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