After a battle with shingles, you probably just want to forget it ever happened.
However, while some folks may endure lingering nerve pain from a shingles complication called postherpetic neuralgia, that’s not the only stubborn side effect that can stick around after the painful, blistering rash subsides. Secondary bacterial infections, skin color changes, and even textural scarring is also a possibility, says Marisa Garshick, MD, FAAD, a board-certified dermatologist at MDCS Dermatology in New York City and New Jersey.
The good news is that getting familiar with a few important do’s and don’ts can help protect your skin. Here’s what you can expect during and after a shingles infection, along with tips and strategies to help limit discolored patches of skin and lingering marks after you recover.
The shingles rash timeline
Understanding the typical progression of a shingles outbreak can help you care for your skin as effectively as possible at every stage. While shingles infections can present differently on different people, the evolution of the illness tends to follow the same pattern, says Alexandra Bowles, DO, a board-certified dermatologist at MONA Dermatology in Cincinnati, Ohio.
A common early sign of shingles is an unidentified itching, tingling, or burning sensation that usually shows up on one side of the body, says Michelle Henry, MD, a board-certified dermatologist and Mohs micrographic, reconstructive, and cosmetic surgeon at Skin & Aesthetic Surgery of Manhattan. This can occur with or without skin markings, which may be mistaken for seemingly benign culprits like bug bites or an allergic reaction.
Within a few days a rash typically begins to appear, Dr. Bowles says. “While shingles is often described as causing a ‘red’ rash, the appearance can vary significantly depending on skin tone,” she explains. The affected area may appear bright red, dark pink, purplish, grayish, or dark brown, depending on your skin tone. Understanding “that variation is important because shingles can sometimes be more difficult to recognize early in more melanated skin if people are only expecting a classic bright red appearance,” Dr. Bowles says.
The rash develops into clusters of small, fluid-filled blisters called vesicles, which can be painful but will eventually dry out and form scabs. The blistering and scabbing phase generally lasts seven to 10 days. “Over time the scabs heal, although the skin may still appear discolored or sensitive for a period afterward,” Dr. Bowles says.
It’s during this healing process that you may notice dark or light patches of skin (hyperpigmentation and hypopigmentation, respectively). Those with very light and very dark skin are most susceptible to pronounced discoloration as well as redness, Dr. Henry says. These marks can last for weeks to months, Dr. Garshick says. Most pigment changes are temporary, but if the blisters are severe, it can be permanent, she adds.
How to protect and heal your skin
Unfortunately, you can’t fast-forward through a bout of shingles, but you can soften the blow to your skin by following these derm-approved guidelines.
Seek treatment ASAP.
One of the most meaningful ways you can protect yourself from the worst of a shingles infection is getting an early diagnosis, Dr. Bowles says.
“Catching shingles early is important because starting antiviral treatment can help reduce inflammation and limit how severe the rash becomes,” she says. From a skin perspective this can lower the risk of prolonged discoloration and ongoing sensitivity, Dr. Bowles adds.
Antiviral medications, which work best if given within three days of the onset of the rash, help fight the virus, therefore making it easier for your body to fight it into submission. (As a reminder the virus that causes shingles, which is also responsible for chickenpox, never fully leaves your body. Instead, it lies dormant until it’s reactivated.)
