Should shingles be covered with a dressing?

Management of Shingles Lesions: To Cover or Not to Cover

Shingles lesions should be covered with a clean, non-adherent dressing until the lesions are completely dry and covered by a firm, adherent crust. 1

Understanding Shingles and Its Transmission

Shingles (herpes zoster) is caused by the reactivation of the varicella-zoster virus that remains dormant in nerve cells after a chickenpox infection. The virus typically affects a single dermatome, causing a painful, blistering rash 2. The management of these lesions is important both for patient comfort and to prevent transmission.

Covering Recommendations Based on Lesion Stage

1. Active, Moist Lesions:

   • Cover with a clean, non-adherent dressing 1
   • This helps prevent viral transmission and secondary infection
   • Particularly important in settings where contact with others is likely

2. Healing Lesions:

   • Continue covering until lesions are completely dry and have a firm, adherent crust 1
   • Once crusted over, the risk of transmission is significantly reduced

3. Fully Crusted Lesions:

   • May not require covering if completely dry with firm, adherent crusts 1
   • No new lesions should have appeared for at least 72 hours 1

Dressing Selection and Application

Recommended Dressings:

• Non-adherent dressings (such as Telfa™) for direct contact with lesions 1
• Clean cloth or sterile gauze secured with medical tape 1
• Hydrocolloid dressings may help with pain management in severe cases 3

Application Guidelines:

1. Gently cleanse the area with warm sterile water or saline 1
2. Apply a greasy emollient such as petroleum jelly to prevent dressing adherence to lesions 1, 4
3. Cover with a non-adherent dressing 1
4. Secure with medical tape, avoiding excessive pressure

Special Considerations

For Athletes and Sports Participation:

• Active, moist shingles lesions are contraindicated for sports participation 1
• Return to sports only when:
  • All systemic symptoms have resolved
  • No new lesions for at least 72 hours
  • All lesions are dry and covered by firm, adherent crusts
  • Patient has completed at least 5 days of appropriate antiviral therapy 1

For Severe or Extensive Cases:

• More frequent dressing changes may be needed if there is significant exudate
• Consider pain management strategies alongside dressing selection 3
• Consult healthcare provider for signs of secondary infection or complications

Wound Care Principles

• Avoid changing dressings too frequently as this can disrupt the healing process 4
• Do not apply ice directly to shingles lesions as it can cause tissue damage 1
• Leave blisters intact as this improves healing and reduces pain 1

When to Seek Medical Attention

• If lesions show signs of secondary infection (increased redness, swelling, purulent discharge)
• If new lesions continue to appear after 72 hours
• If pain is severe or not adequately controlled
• If lesions involve the face, particularly near the eyes

By following these guidelines, patients can manage shingles lesions effectively while minimizing the risk of transmission and complications.