Discharge Instructions - Shingles

As discussed in the Emergency Department prior to discharge, you have been diagnosed with shingles.  If you have been diagnosed with shingles, you likely had chicken pox when you were a child.  The virus that caused chicken pox never actually leaves the body; it hides, or "sleeps" inside the spinal cord.  For most people, the virus stays quiet inside the spinal cord and never reactivates or "wakes up."  However, for 1 in 5 people (about 20 percent of people), the virus does reactivate.  It travels down one of the nerves from the spinal cord, causing the rash to appear along the path of that nerve.  This usually causes a burning pain to the area, then a skin rash appears a few days later.

To control your pain, start with Ibuprofen (also known as Advil or Motrin) or Naproxen (also known as Aleve).  An hour after you’ve taken one of them, if it still hurts too much to take a deep breath, you can add a stronger pain medication.  You may have been prescribed a stronger pain medication such as Hydrocodone (Norco) or Oxycodone (Percocet).  These stronger medications can make you drowsy, so DO NOT DRIVE OR OPERATE MACHINERY WITHIN 8 HOURS OF TAKING THEM.  These medications usually also cause constipation, so take an over-the-counter medicine for constipation, such as Metamucil or Docusate, at the same time as taking these medications.

For a small number of patients, the pain lasts more than a month (even after the rash is gone).  This is called “post-herpetic neuralgia.”  See your primary care provider if this is the case for you.

If you have been prescribed an anti-viral medication, start it as soon as possible and complete the entire course (do not stop taking it early).  If you have been prescribed a steroid medication, start it as soon as possible and complete the entire course (do not stop taking it early).

Remember that you are contagious while you have the skin rash.  The risk is that you can give another person chicken pox if they haven’t had chicken pox before; however, you can’t give them shingles.

Specifically avoid contact with the following people:

    -Pregnant women

    -People who are taking chemotherapy

    -Anyone who has not had chicken pox or has not been vaccinated against chicken pox

The skin rash is no longer contagious when the bubbles have popped and dried over.  You can put a bandage and/or lots of layers of clothing on top of the bubbles to try to prevent spreading the virus.

If the rash is itchy, you can apply chamomile lotion or try oatmeal baths.  Keep the skin rash clean and dry as best as you can.  It usually lasts 2-4 weeks.

Monitor your rash daily.  If the rash is getting redder in the surrounding skin, it may be becoming infected.  If so, you will need to get antibiotics from your primary care provider or the Emergency Department.

See your primary care provider within 1-2 weeks.  If the rash is on your forehead, you will need to follow-up with an Ophthalmologist (an eye doctor) as well, as the eye can be affected in this area, particularly if the rash is also on the end of the nose.

Return to the Emergency Department for rash spreading to the other side of the body, or to another area of the body, fever (≥38.0 °C or 100.4 °F), confusion, or any new or concerning symptoms.