From the Guidelines
Isolation for shingles is necessary until all lesions have crusted over, which is typically indicated by the presence of a firm, adherent crust and no new lesions cropping up at the time of practice or competition, as recommended by the American Academy of Pediatrics 1. The duration of isolation can vary, but it is generally recommended to avoid direct contact with people who have never had chickenpox, pregnant women, newborns, and individuals with weakened immune systems during this period.
- The varicella-zoster virus can cause chickenpox in susceptible individuals who come into contact with the fluid from the lesions.
- Once the lesions have dried and formed crusts, the individual is no longer contagious. Some key points to consider during isolation include:
- Covering the rash with clean, dry bandages to reduce the risk of transmission.
- Washing hands frequently.
- Avoiding sharing personal items like towels or clothing. If it is necessary to be around others before the lesions have crusted, it is essential to keep the rash completely covered. According to the Advisory Committee on Immunization Practices (ACIP), for localized herpes zoster in immunocompetent individuals, it is recommended to cover the lesions and restrict contact with high-risk patients until all lesions dry and crust 1. Antiviral medications like acyclovir, valacyclovir, or famciclovir, started within 72 hours of rash appearance, can help reduce the duration of the outbreak and may shorten the contagious period. It is crucial to follow the guidelines and recommendations from reputable sources, such as the American Academy of Pediatrics and the Advisory Committee on Immunization Practices, to ensure the best possible outcome and minimize the risk of transmission.
From the Research
Isolation Period for Shingles
- The cutaneous manifestations of shingles usually resolve in approximately 4 weeks 2
- The rash is usually unilateral, confined to a single dermatome, and typically progresses to clear vesicles that become cloudy and crust over in seven to 10 days 3
- Postherpetic neuralgia is the most common complication, occurring in about one in five patients, and is defined as pain in a dermatomal distribution sustained for at least 90 days after acute herpes zoster 3
- The pain following healing of the skin, termed post-herpetic neuralgia (PHN), can persist for several months, or even years in the untreated patient 2
- Postherpetic neuralgia in the cutaneous nerve distribution may last from 30 days to more than six months after the lesions have healed 4
Treatment and Management
- Treatment with acyclovir, famciclovir, or valacyclovir decreases the duration of the rash 4, 5, 3, 6
- Antiviral therapy during the acute phase may reduce the incidence and severity of complications but does not reliably prevent PHN 6
- Adjunct medications, including opioid analgesics, tricyclic antidepressants, or corticosteroids, may relieve the pain associated with acute herpes zoster 4
- Evidence supports treating postherpetic neuralgia with tricyclic antidepressants, gabapentin, pregabalin, long-acting opioids, or tramadol 4