What should I do if I suspect I have shingles, especially if I am over 50 years old or have a weakened immune system?

What to Do If You Suspect Shingles

If you suspect shingles, especially if you're over 50 or immunocompromised, seek immediate medical evaluation to start antiviral therapy within 72 hours of rash onset—this is critical for reducing complications and preventing postherpetic neuralgia. 1, 2, 3

Immediate Actions

Seek Medical Care Urgently

• Contact your healthcare provider immediately if you notice a painful, unilateral rash with vesicles (fluid-filled blisters) in a dermatomal pattern, particularly if you're over 50 years old 2, 4
• Treatment is most effective when started within 48-72 hours of rash onset, though antiviral therapy can still provide benefit if started later 2, 3, 5
• If facial involvement is present (forehead, eyelid, or nose), arrange urgent ophthalmology evaluation within 24 hours due to risk of vision-threatening complications 2

Antiviral Treatment

For immunocompetent adults over 50:

• Valacyclovir 1000 mg three times daily for 7-10 days is the preferred first-line treatment due to superior bioavailability and less frequent dosing compared to acyclovir 2, 3, 5
• Alternative: Acyclovir 800 mg five times daily for 7-10 days 3, 5, 6
• Continue treatment until all lesions have completely scabbed, not just for an arbitrary 7-day period—this is the key clinical endpoint 3

For immunocompromised patients:

• Intravenous acyclovir 10 mg/kg every 8 hours is required for severe disease, disseminated infection, or significant immunosuppression 2, 3
• Treatment duration extends beyond 7-10 days as lesions develop over longer periods (7-14 days) and heal more slowly 3

Infection Control Measures

Contagiousness Timeline

• You are contagious from 1-2 days before rash onset until all lesions have dried and crusted, typically 4-7 days after rash appears 1
• Avoid contact with high-risk individuals including pregnant women, premature infants, immunocompromised persons, and anyone without history of chickenpox or varicella vaccination 1
• Cover all lesions completely and practice frequent handwashing with soap and water 1

Practical Prevention

• Use separate towels and pillows from household members 1
• Maintain at least 6 feet physical separation from others when possible 1
• If you work in healthcare, you must be restricted from caring for high-risk patients until all lesions have crusted 1

Special Considerations

Facial Shingles Requires Extra Vigilance

• Daily ophthalmological review is mandatory during acute illness if any part of the rash involves the forehead, eyelid, or nose 2
• Use non-preserved ocular lubricants (hyaluronate or carmellose drops) every 2 hours throughout acute illness 2
• Risk of vision loss, keratitis, and other ocular complications is significant without prompt treatment 2

Immunocompromised Patients

• Risk of dissemination is 10-20% without prompt antiviral therapy, with potential for viral pneumonia, encephalitis, and hepatitis 2
• May develop chronic ulcerations with persistent viral replication 2, 3
• Require airborne and contact precautions with negative air-flow rooms until all lesions are dry and crusted 1

Common Pitfalls to Avoid

• Do not assume antiviral therapy immediately makes you non-contagious—viral shedding continues until lesions are fully crusted 1
• Do not stop treatment at exactly 7 days if lesions are still forming or have not completely scabbed 3
• Do not use topical antivirals—they are substantially less effective than systemic therapy 3
• Do not delay treatment waiting for "confirmation"—clinical diagnosis is sufficient to start therapy, and the 72-hour window is critical 2, 3

Post-Recovery Vaccination

• Once acute symptoms resolve (typically waiting at least 2 months), get the recombinant zoster vaccine (Shingrix) 2, 3
• Having shingles once does not provide reliable protection—10-year cumulative recurrence risk is 10.3% 2
• Shingrix provides 97.2% efficacy in preventing future episodes with a two-dose series given 2-6 months apart 2
• The CDC recommends Shingrix for all adults 50 years and older, regardless of prior herpes zoster episodes 7, 3