Shingles (Herpes Zoster) is a painful viral infection caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. This reactivation leads to a localized outbreak of lesions along a nerve pathway. During recovery, a common concern is whether the lesions turning dark or black is a normal part of healing. Understanding the expected progression helps manage the infection and recognize potential complications.
The Typical Shingles Healing Timeline
The shingles timeline begins with a prodromal phase, characterized by localized tingling, burning, or pain along the affected nerve. This can precede the visible rash by several days. The acute eruptive phase follows, where clusters of red spots appear and quickly develop into fluid-filled blisters (vesicles).
Within seven to ten days, these blisters rupture, dry out, and form scabs or crusts. A typical healing scab is usually brownish, yellowish, or pinkish as the body repairs the damaged skin underneath. The rash generally resolves completely within two to four weeks, though some discoloration may remain.
Understanding Dark or Black Lesions
The appearance of dark or black coloration in healing shingles lesions can be startling, but it often represents a deeper crusting process. This darkening is frequently due to hemorrhagic vesicles, where small blood vessels beneath the blister leak blood into the fluid. As this blood dries, the resulting scab or crust becomes dark brown or black, forming a tough, protective covering called eschar.
Lesions can look different depending on an individual’s skin tone. On darker skin, the rash may not show typical bright red inflammation, instead appearing purplish, dark pink, or dark brown from the outset. While dried blood is a normal part of deep scabbing, a true black color can also indicate a more serious condition: necrosis, or tissue death.
Necrosis occurs when severe inflammation affects the tiny blood vessels supplying the skin, compromising blood flow. This severe form of infection, sometimes called gangrenous shingles, is less common. It is seen more frequently in people who are elderly or have compromised immune systems. The resulting black coloration is dead tissue, not a simple scab, and requires immediate medical evaluation. Distinguishing between a dark, dried blood scab and an expanding area of black, non-healing tissue is crucial.
When to Seek Medical Attention
While a dark crust can be part of healing, certain signs require prompt medical consultation to prevent complications. Seek medical attention if the pain intensifies or persists after the lesions have crusted over, which may suggest postherpetic neuralgia. An immediate visit is warranted if the rash appears near an eye, as shingles can cause permanent vision loss if not treated quickly.
Watch for signs of a secondary bacterial infection, which can complicate healing and lead to deeper scarring. These signs include increased redness and swelling spreading beyond the rash, warmth around the lesions, or the presence of pus. If the black area appears to be expanding or deepening, or if you feel unwell with a high fever, this suggests severe tissue involvement or necrosis. Early intervention with antiviral medication, especially within 72 hours of rash onset, can significantly reduce the severity and duration of the infection.