Shingles: symptoms, early treatment and when to be seen in person

Shingles symptoms and stages

A few days before the rash, many people feel pain, tingling or itching in one area of skin, and sometimes a fever. Then a painful, usually itchy rash appears on one side of the face or body, often as a band or strip. If you are not sure what your rash is, see skin rash.

The blisters scab over in 7 to 10 days and the rash clears within 2 to 4 weeks. Other possible symptoms are headache, chills and an upset stomach.

Why timing matters: antivirals

Antiviral medicines (acyclovir, valacyclovir and famciclovir) shorten how long shingles lasts and how severe it is. The CDC says they should be started as soon as possible after the rash appears.

So it is worth getting seen as soon as you notice the rash. In a US$79 online doctor visit, with good light on your skin, the doctor will assess whether the rash looks like shingles and tell you if you need to be seen in person. If appropriate, the doctor can prescribe medication. We do not prescribe controlled substances.

When you need to be seen in person

Shingles cannot always be handled by video. Get in-person care if you have:

• A rash on the face near the eye or on the tip of the nose: shingles can affect the eye and cause vision loss. You need an in-person evaluation the same day.
• A weakened immune system from leukemia, lymphoma, HIV or medicines that suppress immunity: the risk of complications is higher.
• A rash spread across several parts of the body.
• Confusion, a severe headache, weakness or changes in hearing.
• Blisters with pus, spreading redness or a high fever, which can mean a bacterial infection.

Pain relief and care at home

Over-the-counter or prescription pain relievers help with the pain. For itching, the CDC suggests wet compresses, calamine lotion and warm oatmeal baths. Keep the rash clean and covered.

We do not prescribe opioids or other controlled substances for pain. If the pain is severe or not improving, the doctor will suggest options or where to get more help. See what we do not do by telehealth.

Postherpetic neuralgia: pain that stays

The most common complication is nerve pain that continues after the rash heals, called postherpetic neuralgia. According to the CDC, about 10% to 18% of people with shingles get it, and the risk rises with age. If the pain continues after your skin has healed, tell the doctor.

Is shingles contagious?

You cannot catch shingles from someone. But a person who never had chickenpox or the chickenpox vaccine can pick up the virus through direct contact with fluid from the blisters or by breathing in virus particles from them, and would get chickenpox, not shingles.

The virus stops spreading once the blisters scab over. Until then, cover the rash and avoid contact with pregnant people who have not had chickenpox or the vaccine, premature or low-birth-weight babies, and people with weakened immune systems.

The shingles vaccine in Puerto Rico

The CDC recommends 2 doses of the recombinant shingles vaccine for adults 50 and older, and for adults 19 and older with weakened immune systems. It is recommended even if you have already had shingles.

We do not give vaccines. The vaccine is available at doctors' offices and pharmacies; ask at your local pharmacy.

Shingles in children

Children can get shingles, but it is not common. If your child has a blistering rash, especially with fever or near the eye, get them seen. We see children from 6 months old, with a parent or legal guardian on camera, and the doctor is not a pediatrician. A baby under 3 months with a temperature of 100.4 °F (38 °C) or higher needs medical care right away. For other rashes, see rashes in children.

Frequently asked questions

Is shingles contagious?

You cannot pass on shingles as such, but fluid from the blisters can spread the virus to someone who never had chickenpox or the vaccine, and that person would get chickenpox. It stops spreading once the blisters crust over.

How long does shingles last?

The blisters scab over in 7 to 10 days and the rash usually clears within 2 to 4 weeks. In some people the pain continues afterwards.

Can I get shingles medication online?

If the doctor judges during the video visit that it is shingles and that it is safe to treat you this way, she can prescribe an antiviral. If the rash is near your eye or your immune system is weakened, she will direct you to in-person care.

Should I get the vaccine if I already had shingles?

Yes. The CDC recommends the vaccine even after shingles, to help prevent it coming back. We do not vaccinate; you can get it at doctors' offices and pharmacies.

Related pages

• Skin rash
• Rashes in children
• Eczema and dermatitis
• Online doctor visit
• What we don't do
• Pricing