From the Research
Patients with shingles should be isolated until all lesions have crusted over, typically 7-10 days after the rash appears, to prevent the spread of the varicella-zoster virus to individuals who have never had chickenpox or the varicella vaccine. This isolation is particularly important when around pregnant women who haven't had chickenpox, newborns, immunocompromised individuals, and people who haven't had chickenpox or the varicella vaccine. During isolation, the affected person should keep the rash covered, avoid touching or scratching lesions, practice good hand hygiene, and use separate towels and bedding. Isolation is necessary because shingles is caused by the varicella-zoster virus, which can spread through direct contact with fluid from the blisters. While someone with shingles cannot give another person shingles directly, they can transmit the virus to someone who has never had chickenpox, potentially causing chickenpox in that person.
For pain management during isolation, acetaminophen or ibuprofen can be used, along with prescribed antivirals like acyclovir, valacyclovir, or famciclovir, which are most effective when started within 72 hours of rash appearance 1, 2. According to a study published in 2020, valacyclovir has been shown to be more effective than famciclovir in reducing the duration and intensity of zoster-associated pain 1. Another study published in 2012 found that valacyclovir and famciclovir are superior to acyclovir in reducing the risk of pain associated with herpes zoster 2.
Key considerations for isolation and pain management include:
- Keeping the rash covered to prevent direct contact with the blisters
- Practicing good hand hygiene to prevent the spread of the virus
- Using separate towels and bedding to prevent the spread of the virus
- Starting antiviral therapy within 72 hours of rash appearance to maximize effectiveness
- Using valacyclovir or famciclovir as the preferred treatment options for herpes zoster due to their superior efficacy and pharmacokinetics 1, 2.