Prodrome (1–3 days before rash)

• Burning, tingling, or sharp pain in a band on one side
• Skin sensitivity, mild fever, headache, or fatigue

Rash phase (7–10 days)

• Red patches → clusters of fluid-filled blisters on one side
• Blisters crust over in 7–10 days; pain can be significant

Healing & nerve pain

• Crusts fall off over 2–4 weeks
• Some develop postherpetic neuralgia (PHN)—nerve pain that lasts after the rash clears

• Shingles can spread the chickenpox virus to someone who has never had chickenpox or the vaccine—through direct contact with blister fluid.
• Cover the rash; avoid touching/scratching; wash hands often.
• Avoid close contact with pregnant people, newborns, and people with weak immunity until all blisters have crusted.

Antivirals (start ASAP)

• Valacyclovir, acyclovir, or famciclovir ideally within 72 hours of rash onset
• May still help later if new blisters are appearing or if eye/ear is involved

Pain control

• Cool compresses, acetaminophen/NSAIDs if appropriate
• For stronger pain: consider clinician-guided options (e.g., gabapentin/pregabalin, short course of certain agents)
• Topicals: lidocaine gel/patch after crusting; avoid irritating creams on open blisters

When to recheck

• No improvement in 48–72 hours on antivirals
• New spreading redness, pus, fever, or confusion
• Any face/eye/ear symptoms—same-day care

• Keep rash clean, dry, and covered; loose cotton clothing
• Cool wet compresses 15–20 minutes a few times daily
• Non-stick dressings if blisters weep; change gently
• Avoid thick ointments on fresh blisters; after crusting, light moisturizers can ease itch

What it is

• Nerve pain that persists for ≥90 days after the rash
• More common with older age and severe acute pain

Options that help

• Gabapentin / pregabalin (dose cautiously; watch for dizziness/sedation)
• Duloxetine or certain TCAs (e.g., nortriptyline at night) when appropriate
• Topical 5% lidocaine patches; capsaicin patch/cream in select cases
• Sleep routine, gentle movement, stress reduction techniques

• Shingrix (recombinant zoster vaccine) is recommended for most adults 50+, including many who previously had shingles.
• Two doses, 2–6 months apart. Ask your clinician about timing after an acute episode.
• Helps prevent shingles and postherpetic neuralgia.

How long am I contagious?

From the start of blisters until they all crust and dry. Keep them covered and avoid high-risk contacts during this period.

Can shingles happen more than once?

Yes. Recurrence is possible. Vaccination reduces the chance and severity of future episodes.

Do antivirals help after 72 hours?

They work best early, but may still help if new blisters are appearing or if the face/eye/ear is involved—seek care.

Which pain treatment is safest for me?

It depends on your health and medicines. Options include acetaminophen/NSAIDs (if safe), gabapentin/pregabalin, duloxetine, TCAs, and topical lidocaine. Start low, go slow.