What are the main symptoms of shingles. How long does shingles typically last. What treatments are available for shingles. How can you manage shingles pain at home. When should you seek medical attention for shingles. How can you prevent spreading shingles to others. What are the potential complications of shingles.

Understanding Shingles: Causes and Symptoms

Shingles, also known as herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus (VZV), the same virus responsible for chickenpox. This condition typically manifests as a painful rash that can appear anywhere on the body, though it most commonly affects a single stripe on one side of the torso.

What are the primary symptoms of shingles? The most common signs include:

• A painful, blistering rash
• Tingling or burning sensations
• Itching
• Fever
• Sensitivity to touch
• Fatigue

How long does a typical shingles outbreak last? The duration of a shingles episode can vary, but it generally follows this timeline:

1. Blisters and pimples appear, causing pain (1-5 days after initial symptoms)
2. A crust forms over the blisters (7-10 days after they appear)
3. The blisters and pimples heal completely (2-4 weeks from onset)

It’s important to note that while the rash typically heals within a month, some individuals may experience lingering pain, known as postherpetic neuralgia (PHN), for weeks or even months after the rash has cleared.

Effective Treatment Options for Shingles

When it comes to treating shingles, early intervention is key. What are the primary treatment options available for managing shingles? Healthcare providers typically prescribe a combination of medications to address various aspects of the condition:

Antiviral Medications

Antiviral drugs are the cornerstone of shingles treatment. These medications work by fighting the virus and can help shorten the duration of the outbreak and reduce its severity. Common antiviral medications prescribed for shingles include:

• Acyclovir
• Valacyclovir
• Famciclovir

For optimal results, antiviral treatment should be started within 72 hours of the rash’s appearance.

Pain Management

Pain is a significant component of shingles, and managing it effectively is crucial for patient comfort. What pain relief options are available for shingles sufferers? Healthcare providers may recommend or prescribe:

• Over-the-counter pain relievers (e.g., acetaminophen, ibuprofen)
• Prescription pain medications for severe cases
• Topical anesthetics or capsaicin cream
• Nerve blocks in some cases

Corticosteroids

In some cases, particularly for older adults or those with severe pain, a corticosteroid such as prednisone may be prescribed. These medications can help reduce inflammation and alleviate pain.

Home Care and Symptom Management for Shingles

While medical treatment is essential, there are several steps you can take at home to manage symptoms and promote healing. How can you care for shingles at home?

Skin Care and Itch Relief

To soothe the affected skin and reduce itching, try the following:

• Apply cool, wet compresses to the rash
• Take soothing baths with colloidal oatmeal or baking soda
• Use calamine lotion to relieve itching
• Consider over-the-counter antihistamines for itch relief

Keeping the affected area clean is crucial. Gently wash the rash with mild soap and water, and pat dry. Avoid scratching or picking at the blisters to prevent infection and scarring.

Pain Management Techniques

In addition to prescribed medications, you can try these strategies to manage pain:

• Use cold packs or ice wrapped in a towel to numb the area
• Wear loose-fitting, cotton clothing to reduce friction on the skin
• Practice relaxation techniques such as deep breathing or meditation
• Get plenty of rest to support your body’s healing process

Preventing the Spread of Shingles

While shingles itself isn’t contagious, the varicella-zoster virus can be transmitted to individuals who haven’t had chickenpox or been vaccinated against it. How can you prevent spreading the virus to others?

• Keep the rash covered with loose, non-stick bandages
• Avoid touching or scratching the rash
• Wash your hands frequently, especially after touching the affected area
• Avoid contact with high-risk individuals (pregnant women, newborns, and immunocompromised people) until the rash has crusted over

It’s important to note that once the rash has crusted over, you are no longer contagious.

Potential Complications of Shingles

While most cases of shingles resolve without significant complications, some individuals may experience long-term effects. What are the potential complications of shingles?

Postherpetic Neuralgia (PHN)

PHN is the most common complication of shingles, characterized by persistent pain in the affected area long after the rash has healed. This condition can last for months or even years and is more common in older adults.

Vision Problems

If shingles affects the eye area (ophthalmic shingles), it can lead to vision problems, including temporary or permanent blindness. Prompt treatment is crucial to prevent eye damage.

Bacterial Skin Infections

Open blisters are susceptible to bacterial infections. Proper skin care and hygiene can help prevent this complication.

Neurological Complications

In rare cases, shingles can lead to inflammation of the brain (encephalitis) or other neurological issues.

When to Seek Medical Attention for Shingles

While many cases of shingles can be managed at home with prescribed treatments, certain situations warrant immediate medical attention. When should you contact your healthcare provider about shingles?

• If you suspect you have shingles, especially if you’re over 60 or have a weakened immune system
• If the rash is near your eye, as this can lead to serious complications
• If the pain is severe and not responding to prescribed medications
• If you develop a high fever or signs of infection (increased redness, warmth, or swelling)
• If your symptoms persist or worsen after 3-4 weeks

Early intervention can help prevent complications and reduce the severity of symptoms, so don’t hesitate to reach out to your healthcare provider if you have concerns.

Shingles Prevention: Vaccination and Risk Reduction

While it’s not always possible to prevent shingles, there are steps you can take to reduce your risk or lessen the severity of an outbreak. What can you do to prevent shingles?

Vaccination

The most effective way to prevent shingles is through vaccination. There are two vaccines available:

• Shingrix: Recommended for adults 50 and older, this vaccine is more than 90% effective at preventing shingles.
• Zostavax: While no longer available for use in the United States as of November 18, 2020, some individuals may have received this vaccine previously.

These vaccines can significantly reduce your risk of developing shingles and can also help lessen the severity and duration of the illness if you do develop it.

Lifestyle Factors

While not guaranteed to prevent shingles, maintaining a healthy lifestyle can help support your immune system, potentially reducing your risk of reactivation of the varicella-zoster virus. Consider the following:

• Manage stress through relaxation techniques, exercise, or therapy
• Eat a balanced diet rich in fruits, vegetables, and whole grains
• Get regular exercise to boost your immune system
• Ensure you’re getting adequate sleep
• Avoid excessive alcohol consumption
• Quit smoking if you currently smoke

Remember, while these lifestyle factors can support overall health, they are not a substitute for vaccination in preventing shingles.

Living with Shingles: Long-term Management and Support

For some individuals, the effects of shingles can persist long after the rash has healed. How can you manage the long-term impacts of shingles?

Managing Postherpetic Neuralgia (PHN)

If you’re experiencing ongoing pain due to PHN, several treatment options are available:

• Topical treatments such as lidocaine patches or capsaicin cream
• Anticonvulsant medications like gabapentin or pregabalin
• Tricyclic antidepressants, which can help with nerve pain
• Opioid pain medications for severe cases
• Non-drug therapies such as transcutaneous electrical nerve stimulation (TENS)

Working closely with your healthcare provider to find the most effective pain management strategy is crucial.

Emotional and Psychological Support

The persistent pain and discomfort associated with shingles and PHN can take a toll on mental health. Consider seeking support through:

• Counseling or therapy
• Support groups for individuals with chronic pain
• Mindfulness and meditation practices
• Regular communication with friends and family about your experiences

Remember, managing the psychological aspects of chronic pain is just as important as addressing the physical symptoms.

Ongoing Monitoring

If you’ve had shingles, it’s important to maintain regular check-ups with your healthcare provider. They can monitor for any lingering effects or complications and adjust your treatment plan as needed.

Living with shingles or its after-effects can be challenging, but with proper medical care, self-management strategies, and support, many individuals successfully navigate this condition and maintain a good quality of life.

Shingles – aftercare Information | Mount Sinai

Herpes zoster – treatment

What to Expect

An outbreak of shingles usually follows the following course:

• Blisters and pimples appear on your skin and cause pain.
• A crust forms over the blisters and pimples.
• In 2 to 4 weeks, the blisters and pimples heal. They rarely come back.
• Pain from shingles lasts for 2 to 4 weeks. You may have tingling or a pins-and-needles feeling, itching, burning, and a deep pain. Your skin may be very painful when it is touched.
• You may have a fever.
• You may have short-term weakness of certain muscles. This is rarely long term.

To treat shingles, your health care provider may prescribe:

• A medicine called an antiviral to fight the virus
• A medicine called a corticosteroid, such as prednisone
• Medicines to treat your pain

You may have postherpetic neuralgia (PHN) pain. This is pain that lasts longer than a month after symptoms of shingles start.

Skin Care and Itch Relief for Shingles

To relieve itching and discomfort, try:

• A cool, wet compresses on the affected skin
• Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or calamine lotion
• Zostrix, a cream that contains capsaicin (an extract of pepper)
• Antihistamines to reduce itching (taken by mouth or applied to the skin)

Keep your skin clean. Throw away bandages you use to cover your skin sores. Throw away or wash in hot water clothing that has contact with your skin sores. Wash your sheets and towels in hot water.

While your skin sores are still open and oozing, avoid all contact with anyone who has never had chickenpox, especially pregnant women.

Managing Pain

Rest in bed until your fever goes down.

For pain, you can take a type of medicine called NSAIDs. You do not need a prescription for NSAIDs.

• Examples of NSAIDs are ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve or Naprosyn).
• If you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or bleeding, talk with your provider before using these medicines.

You may also take acetaminophen (such as Tylenol) for pain relief. If you have liver disease, talk with your provider before using it.

You may be given a narcotic pain reliever. Take it only as directed. These medicines can:

• Make you sleepy and confused. When you are taking a narcotic, do not drink alcohol or use heavy machinery.
• Make your skin feel itchy.
• Cause constipation (not being able to have a bowel movement easily). Try to drink more fluids, eat high-fiber foods, or use stool softeners.
• Make you feel sick to your stomach. Try taking the medicine with food.

When to Call the Doctor

Call your provider if:

• You get a rash that looks or feels like shingles
• Your shingles pain is not well-managed
• Your pain symptoms do not go away after 3 to 4 weeks

Dinulos JGH. Warts, herpes simplex, and other viral infections. In: Dinulos JGH, ed. Habif’s Clinical Dermatology: A Color Guide in Diagnosis and Therapy. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 12.

Whitley RJ. Chickenpox and herpes zoster (varicella-zoster virus). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 136.

Last reviewed on: 5/12/2022

Reviewed by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Covering a shingles rash: Step-by-step

The varicella-zoster virus (VZV) causes shingles, a painful rash that can occur anywhere on the body but usually develops on one side of the torso. Covering a shingles rash is key to preventing the virus from spreading.

When someone has chickenpox and recovers, the virus remains dormant in the body. Later, it can reactivate and cause shingles. This occurs in about 1 in 3 people in the United States. Most people only develop shingles once, although it can occur more often.

Shingles usually appear as a patch of blisters on one side of the torso, between the neck and pelvis. However, the rash can appear on other parts of the body. The blisters usually weep, crust over, and clear in 7–10 days, while the rash clears completely in 2–4 weeks. However, some people can develop postherpetic neuralgia, causing pain that can last for months.

Preventing the transmission of shingles is important. Direct contact with fluid from the rash can spread the virus to people who have never had chickenpox or had the vaccine. They may develop chickenpox, as opposed to shingles, directly following the exposure. However, they could also develop shingles later in life.

Shingles spreads through direct contact with fluid from the blisters of the shingles rash. The VZV virus can spread through this fluid to someone who has never had chickenpox and can trigger an infection in them. However, individuals will not develop shingles at the time of exposure. If they develop chickenpox, they are prone to developing shingles later in life.

Shingles cannot spread before the rash is present or after the rash forms a crust. The risk of spreading shingles reduces greatly after covering the rash.

A caregiver who handles clothing or rash bandages that were in contact with the rash may have exposure to VZV.

According to the American Academy of Dermatology (AAD), people need to care for their shingles rash daily. They must also cover it to prevent spreading shingles to others. To cover a rash, people can follow these steps:

1. Wash the rash with a gentle, fragrance-free cleanser.
2. Pat the rash dry and avoid rubbing it. Be sure to keep towels separate from other people’s towels and clothing.
3. Apply a thin layer of clean, pure petroleum jelly to the rash area.
4. Cover the rash with a fresh, sterile, nonstick bandage.
5. Wash hands thoroughly with soap and hot water.

Covering a shingles rash is key to preventing transmission of ZVZ. To prevent the spread of the virus, people can also avoid:

• sharing clothing, towels, or personal hygiene products
• letting other people touch gauze or bandages that have covered the rash without wearing gloves or thoroughly washing their hands afterward
• scratching the rash to prevent the blisters from weeping fluid and transferring the virus to the hands

Anyone over 50 years of age or those aged 19 or older with a weakened immune system is eligible for the shingles vaccine. According to the Centers for Disease Control and Prevention (CDC), the shingles vaccination, Shingrix, is over 90% effective at preventing shingles and its complications in healthy adults. In adults with weakened immune systems, it is 68–91% effective, depending on the condition that weakened the person’s immune system.

People typically receive Shingrix in two doses 2–6 months apart, though individuals may receive a second dose sooner if they have immune system issues. Those with shingles should also get the vaccine once the rash has resolved completely to prevent future reoccurrence.

If an individual is caring for someone with shingles, the best way to avoid getting shingles is to not touch the rash or any items that come in contact with it.

They need to use gloves where possible and wash their hands thoroughly with soap and hot water after handling any garments, wound dressings, towels, or bedsheets that touch the rash.

Learn more about how shingles spreads.

Shingles appears as a rash on the skin’s surface, but it can also affect the nerves and be itchy, painful, and uncomfortable.

Some potential ways to relieve a shingle rash include:

• wearing loose-fitting, lightweight, natural-fiber clothing
• applying calamine lotion to the rash area
• taking an oatmeal bath
• placing a cool, clean, damp washcloth over the rash several times per day for 5–10 minutes

The CDC also suggests using over-the-counter pain relief, such as acetaminophen, when necessary. If the pain is persistent, a person can talk with a doctor who may suggest alternative treatments.

It can take several weeks for a shingles rash to clear up. Practicing self-care may help people feel better.

Individuals can:

• Participate in enjoyable activities that refocus the mind from itching or pain. This could include reading, watching movies or TV, spending time with friends, music, gardening, or gaming.
• Eat a nutritious, well-balanced diet.
• Get plenty of rest.
• Do some gentle exercise such as yoga or walking.
• Try to reduce stress, which can worsen the pain.
• Find help and support from family or friends.

Learn about home remedies for shingles.

The AAD recommends contacting a doctor within the first 3 days of the rash appearing. A doctor can prescribe antiviral medications that may lessen symptoms, shorten their duration, and reduce the risk of complications.

Some people can develop other health problems following shingles. People need to contact a doctor if they:

• have signs of other infection, such as swelling or pus, or the rash is not clearing
• experience ongoing pain after the rash clears
• feel unwell after the rash has cleared

Learn more about some after-effects of shingles.

For most people, shingles clears in 7–10 days, and the rash clears completely in 2–4 weeks.

Postherpetic neuralgia (PHN) is a fairly common complication of shingles, and 10–18% of people who have shingles will develop it. PHN causes nerve pain that can be severe and interfere with daily life. It can last for months or years after the rash clears.

Learn more about postherpetic neuralgia.

VZV, the same virus that causes chickenpox, causes shingles. When a person gets chickenpox and recovers, the virus lies dormant in their body. Later in life, it may reactivate and cause shingles.

The virus spreads through the fluid that seeps from the rash’s blisters. Covering the shingles rash with a sterile, clean gauze or bandage reduces the risk of a person transmitting the virus to others.