Shingles is a painful skin condition caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. After an initial infection, VZV lies dormant in nerve tissue and can reawaken to cause a blistering rash typically confined to one side of the body. The primary goal of managing this rash is to reduce discomfort, prevent secondary infection, and minimize the risk of transmitting the virus.
Should Shingles Rashes Be Covered?
The fluid inside active shingles blisters contains the varicella-zoster virus, which is transmissible and can cause chickenpox in individuals who are not immune. For this reason, covering the rash is generally recommended, especially when the blisters are weeping or oozing fluid, to prevent the spread of the virus to vulnerable people. Those who have not had chickenpox or the chickenpox vaccine, such as pregnant women, premature infants, and people with compromised immune systems, are particularly at risk.
Standard cotton gauze should not be used directly on the lesions because it risks sticking to raw, open blisters and scabs. Removing regular gauze can tear away healing skin, which prolongs the healing process and increases the risk of bacterial infection. Instead, if a covering is necessary, use a loose, sterile, non-stick bandage or non-adhesive pad.
The covering should be changed daily to keep the area clean and dry, discouraging bacterial growth. Allowing the skin to air dry completely before applying a new dressing is good practice. If the blisters are dried out or crusted over, leaving the lesions uncovered may be acceptable, especially if the rash is not likely to contact others or clothing. However, consulting a healthcare provider for personalized advice is recommended.
Recommended Topical Treatments and Hygiene
Maintaining gentle hygiene is important for managing the shingles rash at home. The affected area should be washed daily with a mild, fragrance-free cleanser and water to reduce the bacterial load. After washing, gently pat the skin dry with a clean towel, avoiding any rubbing or scrubbing that could break the blisters.
To soothe discomfort and help dry out weeping blisters, cool, moist compresses can be applied to the rash for five to ten minutes several times a day. The compress should be a clean cloth soaked in cool water or a solution like Burow’s solution (aluminum acetate), which is known for its astringent properties. Directly applying ice is not recommended as it can cause further damage to the sensitive skin.
Calamine lotion, a traditional topical treatment, may be applied to relieve itching and act as a mild astringent for oozing lesions. However, some dermatologists advise waiting until the blisters have crusted over before using calamine lotion.
It is necessary to resist the urge to scratch or pick at the blisters. This action can introduce bacteria, lead to a secondary infection, and cause scarring.
Recognizing Signs of Infection and Complications
The shingles rash compromises the skin barrier, making it susceptible to secondary bacterial infections, most commonly caused by Staphylococcus aureus. Signs of a developing bacterial infection include increased or spreading redness, warmth, swelling, or tenderness extending beyond the rash boundaries. Pus drainage, yellow fluid from the blisters, or red streaks radiating from the lesion also signal a possible secondary infection requiring immediate medical attention.
A persistent fever that develops after the rash appears can also be a sign that the body is fighting a spreading infection. If any of these symptoms occur, a healthcare provider should be contacted promptly, as a course of oral antibiotics may be required to prevent the infection from worsening.
One concerning complication of shingles is postherpetic neuralgia (PHN), which involves nerve pain lasting three months or longer after the rash heals. This pain is often described as a deep ache, a sharp, jabbing sensation, or a constant burning, and the skin may become extremely sensitive to light touch. Older individuals and those who had a severe rash are at a higher risk of developing PHN.
Seeking medical consultation at the first sign of a rash is important because antiviral medications are most effective when started within 72 hours. Starting treatment early can reduce the duration and severity of the rash and lower the likelihood of developing long-term complications like PHN. If severe or lingering pain continues after the rash resolves, a doctor’s visit is necessary to discuss treatment options, including prescription nerve pain medications.