Shingles: why the first 72 hours are decisive

One of the sentences I read most often in comments is: "The illness was diagnosed late, and the pain did not go away for months." With shingles, time really matters. In this article I explain what to watch for, when to hurry and why.

Where this illness comes from

After a person has chickenpox in childhood, the virus does not disappear completely; it stays quiet in the nerve roots. Years later, especially with age or weakened immunity, the virus wakes up and travels along a nerve to the skin. The risk rises noticeably after the age of 50.

How it starts

• Pain, burning or tingling on one side of the body only, sometimes a few days before the rash
• Then fluid-filled blisters on red skin in a band across the same area
• Sometimes fever, headache and tiredness
• The blisters usually crust over in 7-10 days; full healing can take several weeks

Why the first 72 hours

International recommendations advise starting antiviral treatment within 72 hours of the rash appearing: the rash then heals faster and acute pain is reduced. Even after 72 hours, treatment may still be needed if new blisters keep appearing or the eye is affected. So if you are late, come anyway.

Seek help without waiting if

• The rash is on the forehead, around the eye or on the tip of the nose: the eye can be affected, and an eye doctor should also examine you
• Your immunity is weakened, or you are on chemotherapy or immunosuppressive medicines
• The rash has spread to several areas of the body
• The pain is very severe or there is a high fever

Is it contagious

Shingles itself is not passed on, but the fluid in the blisters can give chickenpox to someone who has not had chickenpox or the vaccine. Keep the blisters covered until they crust over, and avoid close contact with pregnant women, babies and people with weak immunity.

The rash has gone, the pain has not

Pain lasting more than three months after the rash heals is called postherpetic neuralgia. It is more common in older patients and seriously affects quality of life. This pain is not something you have to "endure": there are specific medicines and topical treatments that reduce it, chosen individually.

Can it come back, and can it be prevented

Yes, shingles can recur: in a large observational study it returned within a few years in about 5 percent of patients. A recombinant vaccine exists for people over 50. In large clinical trials it reduced the risk by 97 percent in people over 50 and by about 90 percent in those over 70. Discuss with your doctor whether the vaccine is right for you.