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Shingles
Herpes zoster: pain and blisters along a strip of skin, always on one side only.
Shingles is the reactivation of the chickenpox virus, which after childhood infection stays dormant in the nerve ganglia for decades. When it wakes it travels along the nerve to the skin: this is why the lesions are not randomly distributed but follow a strip along that nerve's territory, stopping sharply at the midline. A rash occupying only one side of the trunk, with a precise border at the centre, is the signature of this condition.
The pain often comes first. Burning, stabbing, exaggerated sensitivity to touch over an area of apparently normal skin, for several days: this is the phase that leads many people to think of a muscular problem, until the grouped blisters appear.
Here time matters more than in most dermatological conditions. Antiviral therapy is most effective if started within the first 72 hours of the lesions appearing, and one of its aims is to reduce the risk of the most feared complication: pain persisting for months after the skin has healed. A painful band-like rash on one side only is therefore not something to watch for a week — it is a reason to be seen straight away.
The first 72 hours are not a detail
This is why this page insists on timeliness more than any other. Antiviral therapy gives maximum benefit if started within the first three days of the blisters appearing, and its purpose is not only to shorten the episode: it is to reduce the likelihood of pain continuing long after the skin has healed, a complication that can be disabling and far harder to treat than the initial infection. If a painful band-like eruption appears on one side only, the appointment is today, not next week. And if the face is involved, particularly around the eye, assessment is urgent.
How it shows
- Pain, burning or stabbing in an area, even before any sign
- Grouped blisters on a reddened base
- Band-like distribution along one side of the body only
- Sharp border at the midline: it does not cross to the other side
- Exaggerated sensitivity to contact with clothing
- Sometimes fatigue or fever in the first days
How we proceed
- 1Rapid assessment: distribution, side, time since onset
- 2Clinical confirmation and evaluation of the pain
- 3Antiviral therapy, the more useful the sooner it is started
- 4Specific attention if the face or eye region is involved
- 5Management of pain even after the skin has healed
Available treatments
- Dermatology visit
- Antiviral therapy
- Pain management
- Scheduled follow-up
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Frequently asked questions
Can I infect someone?+
It is not transmitted as shingles, but the blisters contain the chickenpox virus: someone who has never had chickenpox and is not vaccinated can catch chickenpox from direct contact with the lesions. Until crusts have formed it is therefore wise to cover them and avoid contact with pregnant women, newborns and people with reduced immune defences.
Why does it hurt so much when the skin looks so mild?+
Because the problem is not in the skin but in the nerve: the virus reactivates along a nerve pathway, and the pain reflects that inflammation more than the extent of the blisters. This is why pain can precede the eruption by days and why its intensity is not proportional to what is visible. It is not patient exaggeration: it is the nature of the condition.
Can it come back?+
It is possible, although in most people it remains a single episode. Reactivations are favoured by age and by situations in which immune defences are reduced. A vaccination exists that is indicated for certain population groups: this is a discussion to have with your own doctor, and one of the reasonable things to ask about after an episode.
Related reading
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