Shingles usually begins with pain, burning or tingling in one area of skin — before anything appears. A few days later, blisters come up in exactly that spot, in a band on one side of the body. The thing to know straight away: shingles medicine is of most benefit when it is started very early, so being seen early decides whether the episode is mild or difficult later on.
Recognising shingles
According to CDC, many people have pain, itching or tingling in the exact area of skin where the rash is about to appear, and this can start several days before the rash itself. At that stage the skin still looks normal, so the pain is often put down to a pulled muscle or to nerve pain in the ribs. Then the rash comes up, with several characteristic features:
- In a band on one side of the body, left or right, almost never crossing the midline; most often on the flank, back or chest, and it can appear on one side of the face
- Blisters on a background of red skin; burning and aching more deeply than it itches, and worse than the rash looks — a light touch or clothing rubbing against it hurts
- There may also be fever, headache, chills and an upset stomach
- The blisters crust over after about one to two weeks, and the rash fades over the following few weeks
What it is mistaken for
| Mistaken for | The difference you can see |
|---|---|
| Rove beetle dermatitis (kiến ba khoang, common in Vietnam) | A red streak following the direction a hand brushed across the skin, possibly on both sides of the body; stinging on the surface rather than aching deeply, with no days of warning pain beforehand |
| Chickenpox | The same virus, but chickenpox comes up all over the body in several waves and itching is the main feature; shingles stays in one band and pain is the main feature |
Why shingles needs seeing early rather than waiting to see how it goes
According to CDC, shingles is treated with antiviral medicines — acyclovir, valacyclovir, famciclovir — and these shorten the illness and reduce how severe it is, but they work best when started as soon as the rash appears. The names are given so you recognise what you have been prescribed; which one and how to use it is the doctor's decision. The window of greatest benefit is those first few days, so waiting a few days to see whether it eases is the commonest way to miss it — while the complication CDC mentions most often is nerve pain that lasts long after the rash has gone.
What to do now
None of the following needs a prescription; do it alongside getting seen.
- Note down the date the pain started and the date the first blisters appeared, then photograph the area. Those are the two dates the doctor will ask about.
- Keep the area clean and dry; carry on washing in cool water, do not scrub, pat dry gently with a towel kept for that purpose only.
- Cover the rash with clean gauze or loose, soft clothing: less painful rubbing, and less risk of passing the virus on.
- Cool compresses with a clean cloth to settle the burning; no hot compresses, no warming balms.
- If you need pain relief while waiting to be seen, ask a pharmacist: paracetamol (acetaminophen) is the usual choice, but how it is used is for the doctor or pharmacist to decide.
What not to do
- Do not prick, squeeze or burst the blisters; do not pick off scabs before they come away on their own — that is how infection gets in
- Do not put traditional remedies on the rash: crushed leaves, chewed glutinous rice or mung bean, toothpaste, lime, ink, turmeric. They do not heal the rash any faster, they make infection more likely, and they make it harder for the doctor to assess
- Do not use medicine left over from someone else's illness, corticosteroids especially; do not buy antibiotics over the counter, because shingles is caused by a virus
Who you can infect, and how
This is the most commonly misunderstood part. According to CDC, you cannot give anyone else shingles. But the virus in the blisters can give chickenpox to someone who has never had chickenpox and has not been vaccinated — it is the same virus: it causes chickenpox the first time, lies dormant, then reactivates years later as shingles.
- You are infectious from when the blisters appear until the rash has crusted over; according to CDC, before and after that period you are not. It spreads through contact with the blister fluid or by breathing in virus particles from it — unlike chickenpox, shingles does not spread through coughing or sneezing
- Keep the rash covered, do not share towels, and avoid close contact with pregnant women who have never had chickenpox, with newborns, and with anyone whose immune system is weakened
When you must go to hospital
Be seen NOW, do not wait overnight, if: the rash or the pain is on one side of the face, around the eye or on the tip of the nose; the eye is red, painful, vision is blurred, or light hurts — according to CDC, shingles on the face can affect the eye and cause loss of vision. Also go now if: the rash appears on both sides of the body or spreads over several areas; there is a severe headache, a stiff neck, confusion, drowsiness or seizures; the mouth is pulled to one side, there is weakness on one side of the face, hearing loss, ringing in the ears or dizziness; the area of rash is swelling and reddening fast, feels hot, is oozing pus and there is a fever; or the patient is having cancer treatment, taking medicines that suppress the immune system, has had a transplant, or has HIV. Call 115 (the emergency number in Vietnam) if there is difficulty breathing, rapidly increasing confusion or seizures.
Be seen within 24–72 hours, even with none of the above:
- Blisters have just appeared, even if there are only a few and it does not hurt much yet — this is when the medicine is of most benefit
- Pain on one side of the body for several days with no clear cause, particularly in anyone over 50
- Older people, pregnant women, anyone with a weakened immune system or an underlying condition; or pain bad enough to prevent sleep
- A rash in the genital area or around the anus, or one accompanied by difficulty passing urine; or you are not sure whether this is shingles or rove beetle dermatitis
At home and at a medical facility
Most cases of shingles in otherwise healthy people are treated as an outpatient: an examination, prescribed medicine, then monitoring at home — and that care and monitoring is something Y Te Xanh (GreenCare) nurses can do. But the first appointment, to get the antiviral prescription, has to be with a doctor, and for anything involving the eye we will tell you plainly that it needs a medical facility.
The information above follows publicly available US CDC material on shingles and does not replace being examined. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.
Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.
