Shingles: Why the First Few Days Matter

Shingles is a painful, blistering rash caused by the chickenpox virus waking back up, and the first few days matter because antiviral treatment works best when it starts early, ideally within about three days of the rash appearing. If you notice a band of pain, tingling or blisters on one side of your body, it's worth getting it looked at soon rather than waiting to see what happens.

What is shingles?

After you've had chickenpox, the virus (varicella-zoster) stays quietly in nerve cells for life. Years later it can reactivate and travel along a single nerve to the skin, which is why shingles shows up in a stripe or patch on one side of the body. It's more common after 50 and in people whose immune system is weakened by illness, medication or stress, but younger adults and even children can get it.

What does early shingles look like?

Shingles often starts before there's anything to see. The usual sequence:

• First, a strange feeling in one area: burning, tingling, itching, stabbing pain or extreme sensitivity to touch, usually on one side of the chest, back, belly or face. Some people also feel tired, achy or feverish.
• One to five days later, the rash: red patches that turn into clusters of small fluid-filled blisters, in a band or strip that stops at the midline of the body.
• Over the next week to ten days: the blisters break and crust over. The rash usually heals within two to four weeks.

That early pain can be mistaken for a pulled muscle, a kidney problem or even heart trouble, depending on where it is. The one-sided pattern is the clue, but a clinician should sort out chest pain rather than assuming it's shingles.

Why does early shingles treatment matter?

Antiviral medicines can't cure shingles, but when they're started early they can help the rash heal faster and may make it less severe. They tend to help most within about 72 hours of the rash appearing, so the first few days are the window to act. A clinician may still recommend treatment after that, especially if new blisters are forming, the rash is near the eye, or you're older or have a weakened immune system.

The other reason to be seen is pain. Shingles pain can be intense, and some people have nerve pain that lingers after the rash heals (postherpetic neuralgia). A clinician can discuss options to manage pain now.

Is shingles contagious?

You can't catch shingles from someone with shingles. But the fluid in the blisters can spread the virus to someone who has never had chickenpox or the chickenpox vaccine, and they could develop chickenpox. Until the blisters have crusted over:

• Keep the rash loosely covered and avoid scratching.
• Wash your hands often.
• Stay away from pregnant people who haven't had chickenpox, newborns and premature babies, and anyone with a weakened immune system.

Can you prevent shingles?

There is a shingles vaccine, generally recommended for adults 50 and older and for some younger adults with weakened immune systems. Ask your primary care doctor or pharmacist whether it's right for you, including if you've had shingles before.

Getting a shingles rash checked

Shingles is usually recognized from how the rash looks and where it is. At an urgent care, a clinician can examine you and discuss treatment the same day. A telehealth video visit can also be an option for a rash, and the clinician will tell you if you need to come in.

A standard in-clinic visit is $175 self-pay, and telehealth is $75 self-pay. We contract with all major commercial and government plans, including Colorado Medicaid and Medicare; we can't guarantee a particular commercial plan has us in network, and if it's out of network or denies the visit, we drop you to the self-pay rates. See our cost and insurance page.

Call 911 or go to the ER if… you have chest pain, pressure or shortness of breath (don't assume it's shingles); the rash is on your face near an eye or on the tip of your nose, or you have eye pain or vision changes; you have a severe headache, stiff neck, confusion or drowsiness; one side of your face droops or feels weak; the rash is spreading widely over your body; or you have a weakened immune system and develop a high fever.

Where to find us

Four clinics across metro Denver, all ages welcome, se habla español:

• Hampden (Southeast Denver): 8 AM–11 PM daily
• Littleton: 8 AM–11 PM daily
• Thornton: 8 AM–11 PM daily
• Highlands: Mon–Fri 5–11 PM, Sat–Sun 8 AM–11 PM

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