Shingles: the early signs, and why you shouldn't wait

Urgent Care / Skin / Shingles

What is shingles?

Shingles is caused by the same virus as chickenpox, called varicella-zoster. After you have chickenpox, the virus stays asleep in your nerves for life. Years later, it can wake up and travel along a nerve to the skin, causing a painful rash.

Anyone who has had chickenpox can get shingles. The risk goes up with age, especially after 50, and in people whose immune system is weakened by illness or medication. About one in three people in the United States will get shingles in their lifetime.

What are the early signs of shingles?

Compare your symptoms to this list:

• Pain, burning, tingling, itching or numbness in one area of skin, often several days before any rash
• The area is on one side of the body only, often a stripe around the chest, back or waist, or on one side of the face
• A red rash appears in that same area
• The rash turns into clusters of fluid-filled blisters
• The blisters crust over and scab as they heal
• Some people also have fever, headache, chills, tiredness or an upset stomach

The early pain can be confusing. Before the rash appears, shingles on the chest can be mistaken for a heart or lung problem, and on the back for a pulled muscle. If you have chest pain, don't assume it's shingles. Call 911.

Why shouldn't you wait?

• Antiviral medicine works best when started early. It's most helpful when it begins as soon as possible after the rash appears, ideally within about three days.
• Pain can last after the rash heals. Some people, especially older adults, develop long-lasting nerve pain called postherpetic neuralgia. Treating shingles promptly is part of lowering that risk.
• Shingles near the eye can affect your vision. This needs same-day, in-person care.

Who is more at risk?

• Adults 50 and older, with risk rising with age
• People with a weakened immune system, from conditions like cancer or HIV, or medicines such as steroids, chemotherapy or drugs taken after an organ transplant
• People under significant stress or recovering from another illness

Is shingles contagious?

You can't give someone shingles. But fluid from shingles blisters can spread the virus to someone who has never had chickenpox or the chickenpox vaccine, and they could get chickenpox.

Until your blisters have all crusted over:

• Keep the rash covered
• Wash your hands often, and don't touch or scratch the blisters
• Avoid contact with pregnant women who haven't had chickenpox or the vaccine, newborns and premature babies, and people with weakened immune systems

What can you do at home?

These steps can make you more comfortable alongside treatment:

• Keep the rash clean and dry
• Use cool, damp compresses to soothe the skin
• Try calamine lotion or a colloidal oatmeal bath for itching
• Wear loose, soft clothing over the area
• Rest, and drink plenty of fluids

Over-the-counter pain relievers help some people. Ask a clinician or pharmacist first if you have kidney, liver, stomach or heart problems, or take a blood thinner.

How is shingles treated?

Your clinician will decide what's right for you, based on how long you've had the rash, where it is, your age and your other health conditions. Treatment may include:

• Antiviral medicine, if appropriate, to help the body fight the virus
• Pain medicine suited to your health and your other prescriptions
• Medicine for nerve pain, if pain is severe or lingers
• Prescription creams or other measures for itching and skin care
• A plan for follow-up, especially if pain continues after the rash heals

What does a video visit at MD Care look like for shingles?

Shingles is often recognized from its pattern, which shows up well on camera. Your clinician will:

• Ask when the pain or tingling started and when the rash appeared
• Look closely at the rash: where it is, whether it stays on one side, and whether there are blisters
• Check the area around your eyes, nose and ears if the rash is on your face
• Ask about your immune system, your vaccines and your other medicines
• Recommend treatment and, when appropriate, send a prescription to your pharmacy

Good light helps, and clear photos are useful for hard-to-see places like your back. Read more about rashes and skin infections.

A video visit is $50 without insurance, with no membership. A $20 message visit with photos may work for some follow-ups, when your clinician agrees it's appropriate. If you have Medicare, we confirm your coverage before your visit, and you pay your plan's share. Most patients are seen within three hours, and you need to be in Florida at the time of your visit. See pricing and Medicare.

When should shingles be seen in person?

Get in-person care the same day, at an eye doctor, an urgent care or an emergency room, if:

• The rash is on your forehead, near your eye or on the tip or side of your nose
• You have eye pain, redness, blurred vision or sensitivity to light
• The rash is in or around your ear with ear pain, dizziness, hearing loss or weakness on one side of your face
• You have a weakened immune system
• The rash is spreading widely over your body
• The rash looks infected: increasing redness, warmth, swelling or pus