Red flags & when to go in person for Shingles (Herpes Zoster) - Triage

Audience: adult

Shingles, also known as herpes zoster, is a viral infection that causes a painful rash, usually on one side of the body. It happens when the chickenpox virus reactivates in your nerves. Most people can manage shingles symptoms at home with rest, pain relief, and sometimes antiviral medicines prescribed by a healthcare provider. However, some signs mean you should seek in-person medical care quickly. These include severe pain that does not improve, rash spreading near the eyes, high fever, or symptoms affecting your vision or balance. Telemedicine can help assess your symptoms, provide advice, and guide treatment, but it cannot replace hands-on exams or urgent care when serious complications arise. Knowing when to see a healthcare provider in person can help prevent complications like nerve damage or eye problems. This guide helps you recognize red flags and understand what telemedicine can and cannot do for shingles.

Red flags — go in person / ER

• Rash or pain near or in the eyes — seek emergency care to prevent vision loss.
• Severe headache, confusion, weakness, or difficulty moving parts of the body — urgent evaluation needed.
• High fever not improving or signs of infection like increased redness, swelling, or pus — see a healthcare provider in person.

What telemedicine can do

• Initial symptom assessment and advice
• Guidance on pain management and rash care
• Prescribing antiviral medications when appropriate
• Determining if in-person care is needed

What telemedicine cannot do

• Physical examination for complications
• Emergency treatment for eye or neurological involvement
• Management of severe pain not responding to initial treatments

What is Shingles?

Shingles is caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. After chickenpox, the virus stays dormant in nerve tissues and can reactivate years later as shingles. It usually causes a painful rash with blisters on one side of the body or face. The rash often lasts 2 to 4 weeks and may be accompanied by itching, burning, or tingling sensations.

Common Symptoms of Shingles

Typical symptoms include:

Symptoms usually appear on one side of the body, often on the torso, but can also affect the face or eyes.

When to Seek In-Person Medical Care (Red Flags)

Certain signs mean you should get medical help in person right away:

These may indicate serious complications needing urgent care.

How Telemedicine Can Help with Shingles

Telemedicine can:

It is a convenient first step, especially if you cannot visit a clinic easily.

Limitations of Telemedicine for Shingles

Telemedicine cannot:

If you experience red flags, you should seek in-person medical evaluation promptly.

How to prepare for your tele-visit

• Note when symptoms started and how they have changed.
• Have a clear view of the rash area for video consultation.
• List any medications you are currently taking.
• Prepare to describe your pain and other symptoms in detail.
• Have a thermometer to check your temperature if possible.

After your tele-visit

• Follow the treatment plan given by your healthcare provider.
• Keep the rash clean and dry to prevent infection.
• Use pain relief methods as advised, such as over-the-counter medicines.
• Monitor for any worsening symptoms or new red flags.
• Schedule follow-up visits if recommended or if symptoms persist or worsen.

FAQs

Can shingles be contagious?

Shingles itself is not contagious, but the varicella-zoster virus can spread to people who have never had chickenpox or the vaccine, causing chickenpox in them. Avoid direct contact with the rash until it has crusted over.

How long does shingles usually last?

Shingles rash and pain typically last 2 to 4 weeks. Some people may experience lingering pain called postherpetic neuralgia, which can last longer.

Can I treat shingles at home?

Many people can manage shingles at home with rest, pain relief, and antiviral medications if prescribed. However, you should seek medical advice to confirm diagnosis and treatment.

Why is eye involvement in shingles serious?

Shingles near or in the eyes can cause serious complications, including vision loss, so it requires urgent medical evaluation and treatment.

Is there a vaccine to prevent shingles?

Yes, vaccines exist that can reduce the risk of developing shingles and its complications. Discuss vaccination options with your healthcare provider.

Sources

1. Shingles (Herpes Zoster) — MedlinePlus, U.S. National Library of Medicine.
2. Shingles (Herpes Zoster) — Centers for Disease Control and Prevention (CDC).
3. Herpes Zoster (Shingles) — Mayo Clinic.
4. Herpes Zoster (Shingles) — Merck Manuals Consumer Version.

This telemedicine guidance is for educational and triage purposes only and is not a substitute for in-person medical care. If you experience any red flags or worsening symptoms, seek prompt evaluation by a healthcare provider in person or emergency services as needed.