An outbreak of shingles usually follows the following course:

• Blisters and pimples appear on your skin and cause pain.
• A crust forms over the blisters and pimples.
• In 2 to 4 weeks, the blisters and pimples heal. They rarely come back.
• Pain from shingles lasts for 2 to 4 weeks. You may have tingling or a pins-and-needles feeling, itching, burning, and a deep pain. Your skin may be very painful when it is touched.
• You may have a fever.
• You may have short-term weakness of certain muscles. This is rarely long term.

To treat shingles, your health care provider may prescribe:

• A medicine called an antiviral to fight the virus
• A medicine called a corticosteroid, such as prednisone
• Medicines to treat your pain

You may have postherpetic neuralgia (PHN) pain. This is pain that lasts longer than a month after symptoms of shingles start.

To relieve itching and discomfort, try:

• A cool, wet compresses on the affected skin
• Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or calamine lotion
• Zostrix, a cream that contains capsaicin (an extract of pepper)
• Antihistamines to reduce itching (taken by mouth or applied to the skin)

Keep your skin clean. Throw away bandages you use to cover your skin sores. Throw away or wash in hot water clothing that has contact with your skin sores. Wash your sheets and towels in hot water.

While your skin sores are still open and oozing, avoid all contact with anyone who has never had chickenpox, especially pregnant women.

Rest in bed until your fever goes down.

For pain, you can take a type of medicine called nonsteroidal anti-inflammatory drugs (NSAIDs). You do not need a prescription for some NSAIDs.

• Examples of NSAIDs are ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve or Naprosyn).
• If you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or bleeding, talk with your provider before using these medicines.

You may also take acetaminophen (such as Tylenol) for pain relief. If you have liver disease, talk with your provider before using it.

You may be given a narcotic pain reliever. Take it only as directed. These medicines can:

• Make you sleepy and confused. When you are taking a narcotic, do not drink alcohol or use heavy machinery.
• Make your skin feel itchy.
• Cause constipation (not being able to have a bowel movement easily). Try to drink more fluids, eat high-fiber foods, or use stool softeners.
• Make you feel sick to your stomach. Try taking the medicine with food.

Contact your provider if:

• You get a rash that looks or feels like shingles
• Your shingles pain is not well-managed
• Your pain symptoms do not go away after 3 to 4 weeks

Herpes zoster - treatment

Cohen J. Varicella-zoster virus (chickenpox, shingles). In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 346.

Dinulos JGH. Warts, herpes simplex, and other viral infections. In: Dinulos JGH, ed. Habif's Clinical Dermatology: A Color Guide in Diagnosis and Therapy. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 12.

Whitley RJ. Chickenpox and herpes zoster (varicella-zoster virus). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 136.

Updated by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.