When is shingles considered healed in a patient with a typical infection?

When Shingles is Considered Healed

Shingles is considered healed when all lesions have completely crusted over, which marks the end of active viral replication and infectivity. 1, 2

Clinical Endpoint for Healing

The key clinical milestone that defines healing is complete crusting of all lesions—this is not an arbitrary timeframe but rather a specific physical finding that must be documented. 1, 3

• Patients remain contagious until all lesions are fully crusted over, making this the critical endpoint for both clinical management and infection control decisions. 2, 3
• Antiviral treatment must continue at least until all lesions have scabbed, not just for a predetermined number of days. 1
• Once all lesions are fully crusted, isolation precautions can be discontinued and the patient is no longer infectious to susceptible individuals. 1, 2

Timeline of Disease Progression to Healing

Immunocompetent Patients

• Total disease duration from initial symptoms to complete healing: 2-4 weeks 3
• New lesions continue to form for 4-6 days after the initial rash appears 2, 3
• The rash itself typically lasts approximately 2 weeks before complete crusting occurs 3
• Peak viral shedding occurs in the first 24 hours after lesion onset, with progressive decline as lesions convert to crusts 2

Immunocompromised Patients

• Significantly prolonged disease course: new lesions may continue to develop for 7-14 days or longer 1, 3
• Healing occurs much more slowly than in immunocompetent hosts 3
• Without adequate antiviral therapy, some immunocompromised patients develop chronic ulcerations with persistent viral replication 3
• These patients require treatment extension well beyond the standard 7-10 days until complete crusting is achieved 1, 3

Predictable Stages Before Healing

Understanding the progression helps identify when healing is approaching:

1. Prodromal phase: Pain, burning, tingling 24-72 hours before visible changes 2
2. Erythematous macules: First visible skin changes 2
3. Papules: Rapid progression from macules 2
4. Vesicles: Characteristic fluid-filled blisters in dermatomal distribution 2
5. Pustulation: Vesicles become cloudy 2
6. Crusting phase: Final stage before complete healing—this is the healing endpoint 2, 3

Clinical Implications

• Do not rely on calendar days alone—the physical finding of complete crusting is what matters, not whether 7,10, or 14 days have passed. 1
• If lesions are still forming or have not completely scabbed at the expected timeframe, continue antiviral therapy and maintain isolation precautions. 1
• The crusting phase represents substantially reduced viral shedding and marks the end of infectivity. 2
• Healthcare workers with shingles should be excluded from duty until all lesions dry and crust. 1

Common Pitfall to Avoid

Never discontinue antiviral therapy at exactly 7 days if lesions are still forming or have not completely scabbed—short-course therapy designed for genital herpes is inadequate for VZV infection. 1 The treatment endpoint is clinical (complete crusting), not temporal (a specific number of days). 1