Shingles and scabies can both cause inflamed, blistered skin rashes, but their causes, symptom patterns, and treatment are very different.

The primary symptom of both shingles and scabies is a skin rash.

Shingles, also known as herpes zoster, is caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. After you have had chickenpox, the virus remains dormant in your body. Later in life, typically after age 50, it may reactivate in some people, leading to the characteristic blistering rash of shingles.

Scabies isn’t caused by a virus but usually by an infestation of the Sarcoptes scabiei mite, an ectoparasite that burrows into your skin to lay eggs and causes the skin rash.

Shingles and scabies rashes can look like clusters of blisters, but how and where they appear on your body helps differentiate the two conditions.

Shingles

If you have shingles, a rash will usually develop and stay on one side of your body, most commonly on the chest or upper back, though it can affect any area of your body.

The varicella-zoster virus lies dormant in nerve roots, typically on one side of your spinal cord. When it reactivates, it almost always follows the path of a single spinal nerve called a dermatome.

Typically, 1 to 2 days before a shingles rash develops, you may experience intense tingling, pain, burning, or an “electrical sensation” in the same area where the rash will appear, according to the American Academy of Dermatology Association. These sensations occur as the virus travels along your nerve and causes inflammation.

A shingles rash looks like blisters over a band of discolored and irritated skin. If you have a dark skin tone, you may notice the rash has a pinkish, grayish, dark brown, or purplish hue.

Because shingles compromises nerves, a shingles rash can be extremely painful. Unlike other rashes, shingles doesn’t usually cause intense itching.

Shingles may also lead to symptoms beyond your skin, such as:

  • light sensitivity
  • headache
  • a general feeling of illness or being sick
  • fever
  • muscle aches
  • vomiting

Scabies

A scabies rash develops after Sarcoptes scabiei mites burrow into your skin. While you can develop a scabies rash anywhere on your body, the mites tend to prefer:

  • skin folds or areas where skin rubs together
  • armpits
  • belly button
  • between fingers and toes
  • beltline
  • nipples
  • buttocks
  • inside of the wrists
  • penile shaft

A scabies rash looks like little pimple-like bumps over lines of red, discolored, or irritated skin. For some people, it can resemble eczema if it develops with scaly patches. In severe mite infestations, known as crusted scabies (formerly known as Norwegian scabies), thick crusts can also form.

A scabies rash is incredibly itchy, and the itch tends to worsen at night when the mites become more active. Scabies can be so itchy that excessive scratching may lead to the development of sores and secondary skin infections.

Shingles and scabies have distinct causes and risk factors.

Shingles

If you’ve had chickenpox before, you’re at an increased risk for shingles.

However, not everyone who has had chickenpox develops shingles later in life. Why the virus reactivates in some people and not in others isn’t fully understood, but your risk for shingles goes up with age and with factors that weaken your immune system.

The virus that causes shingles is contagious through direct person-to-person contact. If it passes to someone who has never had chickenpox or been vaccinated against chickenpox, it can cause chickenpox.

Scabies

Scabies is highly contagious. The mite is very hardy, meaning it can survive in the environment for a few days without a host. For example, it can survive on sheets and towels.

Being around someone who has scabies — even if you don’t touch them directly — is how the mite passes from one person to another.

Shingles and scabies have very different treatments and prevention strategies.

Treatment

Shingles can resolve on its own for most people within 2 to 4 weeks, but treatment can help the rash clear faster and can help relieve the intense pain associated with this condition. Doctors treat shingles with antiviral medications, such as:

  • famciclovir
  • valacyclovir
  • acyclovir

To help manage pain, a doctor may recommend prescription or over-the-counter anti-inflammatory medications.

Scabies treatment mainly relies on topical skin products to kill mites and relieve skin irritation. Common prescriptions include:

  • permethrin cream
  • crotamiton cream or lotion
  • spinosad liquid

If scabies is widespread throughout your body, a doctor may prescribe ivermectin, an antiparasitic medication that’s typically taken by mouth every 2 weeks. Some people may only need one dose, while others may need up to 3 doses.

Antibiotics, antihistamines, and steroid creams may also be part of your treatment routine.

Prevention

It’s not always possible to prevent shingles, but getting the shingles vaccine can help reduce your chances of developing shingles as you age.

Preventing scabies means avoiding contact with anyone or any objects that may have mites.

If you’ve come in contact with someone with scabies, wash all your clothes and other linens in hot water and dry on high heat as soon as possible. Thoroughly vacuum carpets and furniture. Contact a doctor right away to discuss the exposure and your treatment options.

Shingles and scabies are dermatological conditions that cause rashes.

While they can share certain features, such as red, blistered skin, they have very different causes, symptom patterns, and treatments.

If you’re not certain if you’re experiencing shingles or scabies, a dermatologist can help determine the underlying cause of your rash.