Shingles
The chickenpox virus waking up along one nerve: a painful, blistering stripe on one side of the body. See a doctor early, because antivirals work best within 72 hours.
The shingles ladder
Speed matters more than strength. Get seen early, treat the pain properly, and watch the eyes.
- Step 1 · Self-careKeep the rash clean, cool and coveredCool compresses, loose cotton clothes, and a dressing over blisters until they crust.
- Works
- Not tested in trials; sensible and low risk. Eases discomfort and stops spread to people who haven’t had chickenpox
- Cost
- Free to a few dollars for dressings
- How long
- Until all blisters crust, usually 7–10 days
- Watch for
- Keep away from pregnant women, newborns and people with weak immunity until crusted.
Pop the blisters for science? No. Science says scarring and infection.
- Step 2 · PharmacyPain relief (paracetamol, ibuprofen)Regular doses while the rash is active.
- Works
- Not well tested in shingles; takes the edge off mild to moderate pain
- Cost
- About $5–15
- How long
- Days to a couple of weeks
- Watch for
- Ibuprofen: stomach and kidney cautions. If pain stops sleep, see your GP; stronger options exist.
Taking it regularly beats chasing the pain after it’s already won.
- Step 3 · PrescriptionAntiviral tablets (valaciclovir, famciclovir)Slow the virus. Best started within 72 hours of the rash appearing.
- Works
- Rash heals a day or two faster and pain settles sooner (weeks sooner in some trials); doesn’t clearly prevent long-term nerve pain
- Cost
- $25 on the PBS ($7.70 concession)
- How long
- 7 days
- Watch for
- Headache, nausea. Doses are adjusted for kidney problems.
Day 1 rash, day 1 appointment. Day 6 is too late for the best results.
- Step 4 · PrescriptionNerve pain medicines (amitriptyline, pregabalin, gabapentin)For burning, electric or lingering pain, including pain after the rash (post-herpetic neuralgia).
- Works
- About 1 in 3 get at least half their pain relieved vs 1 in 5 on a dummy treatment; reduces rather than removes pain
- Cost
- Amitriptyline: under the $25 PBS co-payment. Others: $25 or less on the PBS when eligible.
- How long
- Weeks to months, adjusted slowly
- Watch for
- Drowsiness, dizziness and falls, especially in older people. Don’t stop pregabalin or gabapentin suddenly.
Start low, go slow. These are marathons, not sprints.
- Step 5 · SpecialistEye doctor or pain clinicSame-day eye review for shingles near the eye; pain clinic for nerve pain that won’t settle.
- Works
- Not tested as a step in trials; urgent eye review protects sight. Pain clinics offer patches, creams and procedures
- Cost
- Specialist fees vary; Medicare rebates with a referral; public clinics have waits
- How long
- Depends on the problem
- Watch for
- A rash on the tip or side of the nose can mean the eye is involved.
Your eyes are not a wait-and-see organ.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Antiviral creamsCold sore creams don’t treat shingles. The antiviral that works is a tablet.
- Steroid tablets to prevent nerve painReviews show they don’t prevent pain after shingles, and they have side effects. Not routinely recommended.
- Lysine supplementsNo good evidence for shingles. The vaccine is the thing that actually prevents it.
- AntibioticsShingles is a virus, so antibiotics don’t help unless the skin gets a bacterial infection.
What you can do
- Get the vaccine if you’re eligible: free for people 65 and over, First Nations people 50 and over, and some adults with very weak immunity.
- Not eligible but 50 or over? It’s available privately, and it cuts your risk of shingles by about 9 in 10.
- See your GP within 3 days of the rash for the best antiviral results.
- Cover the rash and wash your hands. It can give chickenpox (not shingles) to people who haven’t had it.
- Use pain relief regularly. Under-treated pain is miserable and doesn’t earn medals.
See your GP if
- You think you have shingles, ideally within 72 hours of the rash
- Pain is stopping you sleeping or keeps going after the rash heals
- The rash is widespread or you have weak immunity (chemotherapy, transplant, high-dose steroids)
- You’re pregnant and have the rash, or are pregnant, not immune to chickenpox and have been near someone with shingles
See a doctor the same day for shingles on the forehead, around the eye or on the nose, eye pain, redness or blurred vision. For confusion, a severe headache, weakness or face drooping, or feeling very unwell, call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.
Common questions
Is shingles contagious?
You can’t catch shingles from someone, but the fluid in the blisters can give chickenpox to a person who has never had it or the vaccine. Cover it until the blisters crust.
Can I get shingles more than once?
Yes, though it’s uncommon. The vaccine lowers the risk, even if you’ve had shingles before.
How long does shingles last?
The rash usually crusts in 7 to 10 days and heals in 2 to 4 weeks. About 1 in 10 people, more often older people, have nerve pain for months afterwards.
Who can get the shingles vaccine for free?
In Australia, people aged 65 and over, First Nations people aged 50 and over, and adults 18 and over with certain conditions that seriously weaken immunity. Two doses are needed.
Helpful resources
- healthdirect helpline: 1800 022 222Free 24/7 advice from a registered nurse if you’re not sure whether a rash needs seeing today. Australia (NURSE-ON-CALL in Victoria).
- Shingles vaccine: who can get it freeOne-page government fact sheet on free Shingrix eligibility. Free PDF, Australia.
Evidence and more information
- Healthdirect: Shingles
- Australian Government: Shield yourself from shingles
- Cochrane: Antivirals for preventing post-herpetic neuralgia
- Cochrane: Gabapentin for chronic neuropathic pain
maladywise.com/shingles/