Shingles is a viral infection caused by the varicella-zoster virus, which also causes chickenpox. After chickenpox, the virus remains inactive in nerve tissue near the spinal cord and brain. Years later, it can reactivate, traveling along nerve pathways to the skin and causing a painful rash. Prompt medical attention for shingles is important for effective treatment, symptom management, and complication prevention.
Your First Stop: Primary Care
For most individuals experiencing shingles symptoms, a primary care physician (PCP) is the initial and most appropriate point of contact. These providers evaluate the characteristic rash and pain. They confirm a diagnosis based on visual examination and reported symptoms, which typically include tingling, burning, or itching followed by a painful, blistering rash usually on one side.
Upon diagnosis, your PCP can prescribe antiviral medications like acyclovir, valacyclovir, or famciclovir, most effective when started within 72 hours of rash onset. These medications inhibit virus replication, reducing the severity and duration of rash and pain. PCPs also manage pain symptoms, recommending over-the-counter or, in some cases, stronger pain relievers. They assess case severity and determine if a specialist referral is necessary for complex cases or complications.
Recognizing When a Specialist is Necessary
Certain situations, symptoms, or characteristics indicate a need for specialist consultation. If the rash or pain involves the eye or surrounding area, a specialist referral is important to prevent vision loss. Shingles affecting the eye, known as herpes zoster ophthalmicus, requires immediate attention to prevent serious ocular complications.
Severe or persistent pain, particularly if it suggests postherpetic neuralgia, warrants further evaluation. Postherpetic neuralgia is chronic nerve pain that can linger for months or years after the rash clears. Shingles affecting the ear, face, or presenting with nerve involvement like facial drooping or hearing changes also requires specialist input.
Individuals with compromised immune systems require specialized care due to their increased risk of severe infection and complications. A widespread rash, unusual presentation, or symptoms not improving with initial treatment are also indicators for a specialist consultation.
Key Specialists for Shingles
Different specialists may become involved based on specific complications or symptoms. A dermatologist, a skin specialist, is often consulted for unusual rashes, skin complications, or cases where the diagnosis is unclear. They provide expertise in managing skin lesions and any secondary infections. An ophthalmologist, an eye specialist, monitors eye health, manages inflammation, and addresses potential issues like glaucoma or corneal scarring when shingles affects the eye.
For nerve pain, particularly persistent postherpetic neuralgia, motor weakness, or other neurological complications, a neurologist is the specialist. They assess nerve function and recommend advanced pain management strategies or therapies for nerve damage.
A pain management specialist focuses on alleviating severe or chronic pain associated with shingles, especially when standard treatments are insufficient. They offer interventional procedures and medication regimens to improve a patient’s quality of life.
For immunocompromised patients or individuals with complex or recurrent cases, an infectious disease specialist provides expertise in managing the viral infection. They optimize antiviral therapy and address any systemic complications.