Shingles initially may manifest in some people with symptoms such as fatigue, malaise, or poor appetite, followed by pain on the affected side, typically unilateral skin pain. The pain can be dull, but there may also be a burning sensation or stabbing pain, characteristic of unilateral neuralgia.

However, some patients experience both rash and pain simultaneously. For those who experience pain before the rash appears, diagnosing shingles can be difficult early on, as the neuralgia is present without any rash. Generally, within a few days, usually no longer than a week, erythema can occur in the area of the neuralgia. Subsequently, numerous vesicles emerge on the erythema, often clustering in a band-like distribution and typically limited to one side of the body.