Shingles is a manifestation of the varicella-zoster virus — the same virus that causes chickenpox. While chickenpox is usually isolated to young children, shingles typically happens to people over age 50.

When the herpes zoster virus is triggered by a stressful event, shingles begins as a painful, itchy sensation in the skin followed by a blistery, fluid-filled rash isolated to one side of the body.

What are the Symptoms of Shingles?

The herpes zoster virus is trapped in the roots of the nerve and can lie dormant for many years. Once it becomes reactivated by a stressful event, it travels up the nerve, from the dorsal root in the spinal cord, out into the nerves in the skin (the dermatome).

Once it reaches the skin, you start to see the virus. It begins with a pins and needles sensation or a burning, painful sensation. A few days later, a red rash starts to form with fluid-filled blisters on top. These blisters can rupture and form a crust. The rash may appear on your face, trunk, arms, legs, back, or chest, but it always stays on one side of the body — the telltale sign it’s shingles.

Although the rash affects only one side of the body, the range of the rash varies by person. One or two days after the symptoms appear, you may see only one area of the rash, or you may see a rash that wraps from front to back and stops at the midline of the body. In this redness, you’ll see vesicles (the small fluid-filled blisters) or the crusty red bumps that are healing over from being scratched off.

By the time patients visit the dermatologist for shingles, we typically see crusty, red bumps that have already ruptured or that the patient has scratched off in the affected areas.

What Causes Shingles?

The virus that causes shingles lies dormant for years, so there’s not usually a clear connection to where you contracted the virus itself. However, stressful events are known to activate the symptoms of the virus. We see the symptoms of shingles blisters pop up when your immune system is decreased, your stress levels have increased, or you’ve had exposure to sun that you’re not used to.

Is Treatment for Shingles Necessary?

If you notice shingles’ symptoms, visit your dermatologist for shingles treatment immediately. The quicker it’s treated, the less chance your symptoms will escalate.

Our first goal in treatment is to help the lesions crust over as fast as possible. This will provide shingles itch relief as well as quicker healing.

Our second goal of treatment is to try to prevent postherpetic neuralgia. If a dermatologist can treat shingles within 72 hours of the rash appearing, you may have a chance to prevent the occurrence of the painful, burning sensation that can occur weeks or months after the rash has disappeared. If you receive treatment early, you can potentially avoid postherpetic neuralgia entirely.

We also want to treat shingles to prevent its spread. If the virus becomes aerosolized (fluid carried in the air), it can spread to people with weaker immune systems including pregnant women, infants, or immunosuppressed patients. For example, if an exposed blister ruptures and gets in the air, at-risk people can contract the virus and later show symptoms of shingles. Shingles also spreads through direct contact with the liquid with the blisters.

Visiting your dermatologist for shingles treatment works to protect others, provide quicker healing of your current symptoms, and prevent future symptoms from occurring.

How to Get Rid of Shingles with Treatment

We treat all shingles patients to minimize long-term effects and the spread of the virus, even if it’s been longer than 72 hours since symptoms appeared.

We begin treatment by prescribing the oral antiviral medication Valacyclovir (or Valtrex) for most cases of the herpes zoster virus. This helps decrease the amount of time the patient has virus manifestations and lowers the likelihood of postherpetic neuralgia.

We also recommend patients use topical therapy to ease their symptoms. We prescribe a steroid lotion for shingles and recommend the use of vinegar-soaked dressings to calm the rash quickly. Patients can soak cotton cloths or pajamas in a mixture of vinegar and water. After applying their steroid lotion for shingles, they should cover it with the vinegar-soaked cloth. The cloth will stick to the skin and help the steroid penetrate the rash. Topical therapy does not treat the virus itself but helps ease the severity of the symptoms.

For patients with postherpetic neuralgia, we offer other treatment options to help manage the pain. These can be prescribed by the dermatologist or the dermatologist may work with your primary care doctor or a neurologist to help alleviate the pain. We typically prescribe Neurontin (also called Gabapentin) to address the nerve pain. This does not treat the rash or the virus itself, but it will help with pain management.

Because shingles is a form of a virus, we cannot cure it. After symptoms disappear, the herpes zoster virus will go back to being dormant in the nerve. If the patient has a recurrence, we will treat it the same way to lessen its severity as soon as possible.

FAQs About Shingles

Can you get shingles if you’ve had the vaccine?

Yes, but it’s less common for people who have received the vaccine to see symptoms of this virus.

Can you get shingles if you’ve had it before?

Yes, shingles can reappear. It’s not common for shingles to occur multiple times, but it can happen. Shingles comes from the herpes zoster virus that lies dormant in the nerves. When symptoms disappear, the virus still lingers and can be reactivated at a later time.

Is it contagious?

Yes, shingles is contagious, especially while the blisters are open. Once the shingles blisters pop and have crusted over, shingles is typically no longer contagious. If you are living with someone who is pregnant or immunosuppressed, you’ll need to avoid being around them for the first few days until the blisters are no longer fluid-filled. The virus spreads through direct or airborne contact with the fluid. Once the fluid gone, it’s typically no longer contagious.

Is shingles on my face more dangerous?

If shingles appears on the face or ear, it should be closely monitored to prevent long-term damage to vision and hearing.

If a rash appears on the tip of the nose, seek treatment immediately from both your dermatologist and an ophthalmologist. Shingles on the tip of the nose indicates that the eye may be infected with the virus as well. You need to start treatment immediately. The ophthalmologist will test to see if the virus is in the cornea and work to protect your eyes from long-term effects.

If the ear is involved, you may also experience tinnitus — a ringing or noise perception in the ear. We need to address that quickly to avoid potential auditory problems that can follow. Your dermatologist will likely refer you to an ear, nose, and throat doctor to treat the ear appropriately.

When the herpes zoster virus shows any sign of affecting the eye or ear, we consider these dermatological emergencies that need to be addressed by a dermatologist as well as an ophthalmologist or ENT immediately.

Should you pop shingles blisters?

No, never pop a shingles blister. Your shingles blister may pop or rupture naturally, but do not expedite this process. Your dermatologist may opt to do a shingles blister pop in office for a culture check of the virus if the rash is not an obvious sign of singles. In these cases, they may conduct a biopsy, culture, or viral PCR to check the diagnosis. If they have a clinical suspicion of shingles, they’ll likely start treatment immediately and confirm their diagnosis with the biopsy when it is complete.

Should I get the shingles vaccine if I am immunosuppressed?

Shingles vaccine guidelines change frequently and depend on individual cases. If you have immunosuppression through HIV, check with your infectious disease doctor for their recommendation. This is a live vaccine and there can be a supposed reactivation of the virus.

For patients about to begin biologic medications for psoriasis or other dermatologic conditions, it’s ideal if you can get the vaccine prior to starting the medication.

If you are dealing with any type of immunosuppression, check with your doctor about the best choice for your condition.

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