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.

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.