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HealthConsider > Blog > Healthcare > Shingles (Herpes Zoster) — Symptoms, Treatment, Prevention, and When to Seek Care
Healthcare

Shingles (Herpes Zoster) — Symptoms, Treatment, Prevention, and When to Seek Care

Last updated: October 6, 2025 4:15 am
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Shingles (Herpes Zoster)

Shingles is a reactivation of varicella‑zoster virus (VZV), the virus that causes chickenpox. After chickenpox, VZV lies dormant in sensory ganglia and can reactivate years later. The rash is typically unilateral, in a single dermatome, and often very painful.

Contents
  • How Contagious Is It?
  • Symptoms and Course
  • When to Seek Urgent Care
  • Treatment
  • Skin Care and What to Avoid
  • Complications
  • Prevention — Vaccination
  • Return to Normal Activities

How Contagious Is It?

  • People with shingles can transmit VZV to those without immunity, causing chickenpox (not shingles). Transmission is mainly by direct contact with fluid from blisters; risk drops once lesions crust.
  • Cover the rash and avoid contact with pregnant people without immunity, newborns, and the immunocompromised until all lesions are crusted.

Symptoms and Course

  • Prodrome: localized burning/tingling/itching or pain.
  • Rash: clusters of clear vesicles on a red base along a dermatome; may involve face, trunk, or limbs; typically heals in 2–4 weeks.
  • Systemic symptoms (fever, malaise) may occur. Pain can persist after healing (postherpetic neuralgia, PHN), especially in older adults.

When to Seek Urgent Care

  • Eye involvement (forehead/eyelid lesions, eye pain, light sensitivity) — ophthalmology evaluation immediately.
  • Ear involvement with facial weakness, ear pain, or hearing changes (Ramsay Hunt syndrome).
  • Widespread/disseminated rash, severe immunosuppression, pregnancy, severe or escalating pain, or signs of bacterial infection (spreading redness, pus, high fever).

Treatment

Start antiviral therapy as soon as possible — ideally within 72 hours of rash onset (earlier is better). Treat later if new lesions are appearing or complications are present.

  • Antivirals (adults; typical examples):
    • Valacyclovir 1 g three times daily for 7 days.
    • Famciclovir 500 mg three times daily for 7 days.
    • Acyclovir 800 mg five times daily for 7–10 days.
  • Pain control:
    • Acetaminophen and/or NSAIDs for mild–moderate pain; short course of stronger analgesics if severe.
    • Neuropathic pain agents (e.g., gabapentin, pregabalin, or tricyclic antidepressants) if pain is significant or persistent.
    • Topical lidocaine 5% patches over painful intact skin; high‑concentration capsaicin is a clinic option once healed.
  • Corticosteroids: may reduce acute pain when used with antivirals in select adults; not for everyone and not as monotherapy. Avoid in immunocompromised unless specialist‑directed.

Skin Care and What to Avoid

  • Keep lesions clean and dry; use cool compresses for comfort. Calamine or Burow’s solution (aluminum acetate) soaks can help weeping areas.
  • Avoid picking/scratching; trim nails. Gentle bathing is fine; pat dry.
  • Do not apply alcohol, vinegar, herbal powders, or animal products to lesions; they can irritate and delay healing.
  • Sunlight can irritate active lesions — protect the area rather than sun‑exposing it.

Complications

  • Postherpetic neuralgia (PHN): pain persisting >90 days after rash onset; risk increases with age and severe acute pain.
  • Ophthalmic zoster: keratitis, uveitis, and vision loss if untreated.
  • Ramsay Hunt syndrome: facial nerve palsy with ear rash/pain and hearing issues.
  • Bacterial superinfection of skin lesions.

Prevention — Vaccination

  • Recombinant zoster vaccine (RZV, e.g., Shingrix) is recommended for adults ≥50 years and for immunocompromised adults ≥19 years, even if they’ve had shingles before. Two doses reduce the risk of shingles and PHN substantially.

Return to Normal Activities

  • Resume normal contact when all lesions are crusted and covered, and you feel well enough to participate.

Educational information only; not a substitute for medical advice. For diagnosis and prescriptions, consult a clinician.

The information provided on HealthConsider.com is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician or other qualified health provider with any questions you may have regarding a medical condition or treatment.

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