Shingles / Herpes Zoster

Who Gets Shingles?

Anyone who had chickenpox can develop shingles. Risk increases with age (most common after 50), immunosuppression, stress, and certain medical conditions. About 1 in 3 people in the US will develop shingles in their lifetime.

Recognizing Shingles

1. Prodrome: burning, tingling, or shooting pain on one side of the body (days before rash)
2. Rash: red patches that evolve into clusters of fluid-filled vesicles in a dermatomal band
3. Crusting: blisters dry and crust within 7–10 days; rash typically resolves in 2–4 weeks

Zoster ophthalmicus (eye involvement) is an emergency — rash on the forehead/nose tip (Hutchinson's sign) requires immediate ophthalmology referral.

Treatment

• Antivirals: valacyclovir 1g TID × 7 days (preferred); famciclovir or acyclovir as alternatives
• Pain management: analgesics, tricyclic antidepressants, gabapentin, or pregabalin for acute pain
• Wound care: gentle cleansing; avoid popping blisters

Prevention: Shingrix Vaccine

The recombinant zoster vaccine (Shingrix) is 90%+ effective at preventing shingles and is recommended for all adults ≥ 50 years (2-dose series). Ask us about vaccination.

Postherpetic Neuralgia (PHN)

PHN develops in ~10–15% of patients (higher with age). Treated with gabapentinoids, tricyclics, topical lidocaine, or capsaicin. Our dermatologists coordinate care to minimize this complication.