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.