Shingles is more than just a painful rash. Without the right care, it can leave behind lasting skin damage including scarring, hyperpigmentation, and chronic sensitivity. Dr. Alexandra Bowles, walks through the full progression of a shingles outbreak, what it means for your skin at each stage, and exactly how to care for it to reduce the risk of long-term damage. Whether you’re in the early tingling phase or deep in recovery, learn more in Glamour’s full article.

What does the typical timeline and progression of a shingles rash look like?

Shingles typically follows a fairly predictable progression, although it can vary somewhat from person to person. It often starts with a tingling, burning, or sensitive feeling. Within a few days, a red rash begins to appear, followed by clusters of small, fluid-filled blisters. These blisters can become painful and may continue to develop over several days before they eventually begin to dry out and form scabs. Over time, the scabs heal, although the skin may still appear discolored or sensitive for a period afterward. I usually think of it as moving from nerve-related symptoms to visible skin changes and then into a healing phase.

What are some of the risks or things that can happen to your skin from an episode of shingles? 

In the short term, shingles can cause significant inflammation, redness, and discomfort in the affected area. As the skin heals, some patients may experience post-inflammatory hyperpigmentation or changes in skin tone, particularly if the rash was more severe. In some cases, there can also be textural changes or mild scarring, especially if the blisters were disrupted. One of the more well-known long-term complications is postherpetic neuralgia, which involves lingering nerve pain even after the skin has healed. I also see patients who notice ongoing sensitivity or dryness in the affected area. The degree of these changes can vary depending on how early the condition is treated and how the skin is cared for during the healing process.

What are best practices for maintaining the health of your skin, lessening symptoms, and reducing the risk of skin damage?

During the early tingling phase, the most important step is seeking medical evaluation, as antiviral treatment can help reduce the severity and duration of the outbreak. Once the rash appears, I usually recommend keeping the area clean, avoiding friction, and using gentle, non-irritating skincare. During the blister phase, it’s important not to pick or pop the lesions, as this can increase the risk of infection and scarring. As the skin begins to scab and heal, keeping the area lightly moisturized can help support the skin barrier. Sun protection is also very important once the rash has healed, since the skin can be more prone to discoloration at that stage. Overall, gentle care and avoiding unnecessary irritation are key throughout the process.

Does the progression always look the same? 

The progression is often similar, but it doesn’t look exactly the same for everyone. Some people may have a milder rash, while others experience more extensive blistering or discomfort. Catching shingles early is important because starting antiviral treatment can help reduce inflammation and limit how severe the rash becomes. From a skin perspective, this can lower the risk of prolonged discoloration, scarring, and ongoing sensitivity. I usually emphasize that earlier treatment tends to lead to better overall outcomes, both for the skin and for symptom control.

What are some skin mistakes people can make when they have shingles, and why are these important to avoid?

One of the most common mistakes is picking or scratching the affected area, which can increase the risk of infection and scarring. I also see patients use overly harsh products or try to “treat” the rash with strong active ingredients, which can further irritate already inflamed skin. Another issue is not keeping the area clean and protected, especially if blisters are present. It’s also important to avoid excessive sun exposure during healing, as this can worsen discoloration. In general, I recommend keeping the routine simple and focused on supporting the skin rather than aggressively treating it.

What products are recommended for a shingles outbreak?

I usually recommend focusing on gentle, soothing products that support the skin barrier during a shingles outbreak. A simple, fragrance-free moisturizer can be very helpful, especially as the skin begins to dry out or scab. For example, I often suggest something like CeraVe Moisturizing Cream because it contains ceramides and hydrating ingredients that help maintain the skin barrier without adding unnecessary irritation. For cleansing, I recommend using a very gentle, non-stripping cleanser that won’t disrupt the skin while it’s healing. A product like Vanicream Gentle Facial Cleanser is a good option because it effectively removes debris while still being well-tolerated by sensitive or inflamed skin. In addition to basic skincare, cool compresses can help relieve discomfort during more active stages of the rash. I also recommend avoiding strong active ingredients such as exfoliants or retinoids until the skin has fully recovered. Overall, the goal is to keep the routine simple and supportive while the skin heals.

A worn or dirty hairbrush can contribute to breakage, scalp irritation, and dull-looking hair. Regularly cleaning and replacing your brush can help keep both hair and scalp healthy! Learn more about how this can affect your hair and scalp health with Dr. Alexandra Bowles, featured in HuffPost’s article.

How often should you replace your hairbrush?

In many cases, replacing a hairbrush every six to twelve months is a good general guideline. It can vary depending on how often the brush is used and how well it is maintained. Over time, the bristles can become worn, bent, or damaged, which can make the brush less effective and potentially rougher on the hair and scalp. If the brush begins to accumulate buildup that is difficult to clean or if the bristles lose their shape, it’s usually a good sign that it’s time for a replacement. Regularly replacing or maintaining your hairbrush helps ensure it continues to detangle and style the hair without causing unnecessary stress to the strands.

Why is it important to replace your hairbrush often enough?

Hairbrushes collect quite a bit over time, including shed hair, natural oils from the scalp, dust, and residue from styling products. If a brush is not cleaned or replaced periodically, that buildup can be redistributed back onto the hair and scalp during brushing. Worn bristles may also tug on the hair more than they should, which can contribute to breakage or unnecessary tension on the strands. Replacing a brush when it becomes worn helps maintain both scalp hygiene and overall hair health.

How could an old hairbrush with the ball tips worn off mess up your hair or scalp?

Many brushes have small, rounded tips at the end of the bristles that are designed to help protect the scalp and glide through the hair more gently. When those tips wear off, the exposed bristles can become sharper or rougher against the scalp. This may lead to increased friction, minor scalp irritation, or unnecessary pulling on the hair. Over time, that extra tension can contribute to breakage, especially in individuals with fragile or chemically treated hair. A brush that no longer has intact tips may not distribute pressure evenly across the scalp.

How could an old hairbrush that’s dirty mess up your hair or scalp?

If you don’t clean your hairbrush regularly, it collects oils, dead skin cells, styling products, and environmental debris. Every time you use the brush, it transfers that buildup back onto your hair and scalp. In some cases, this may contribute to scalp irritation, itching, or a greasy appearance even after washing. Dirty brushes can also make the hair feel heavier or dull because of the residue being redistributed. Keeping brushes clean helps maintain a healthier scalp environment.

Should you be cleaning your hairbrushes? If so, how?

Yes, hairbrushes should be cleaned regularly. I typically recommend removing trapped hair after each use or at least every few days. Every one to two weeks, the brush can be washed with warm water and a gentle shampoo to remove oils and product buildup. Using a small brush or toothbrush can help clean between the bristles if necessary. After washing, it’s best to allow the brush to air dry completely before using it again. This simple routine can help extend the lifespan of the brush and keep it more hygienic.

Do you have a hairbrush you recommend? 

One brush that I often recommend is the Wet Brush Original Detangler. It’s designed with flexible bristles that help detangle hair with less pulling or tension on the strands. I find it  helpful for those with fragile, fine, or easily tangled hair because it glides through the hair gently. It can also be used on both wet and dry hair, which makes it a versatile option for daily use.

How can it affect your overall scalp health?

Many people often overlook hairbrushes when thinking about hair and scalp care, but they play an important role in keeping hair healthy. Cleaning and maintaining your brush helps reduce unnecessary tension and breakage and prevents buildup from spreading back onto your scalp. In general, I recommend choosing brushes that are gentle on the hair and replacing them when they show signs of wear. Small habits like cleaning and maintaining your brush can make a noticeable difference in overall hair health over time.

Dandruff affects millions of people and can be frustrating to manage, but it’s usually caused by a combination of factors like scalp yeast, oil imbalance, and environmental stressors. Understanding the root causes and choosing the right treatment can help restore a healthy, flake-free scalp. Dr. Alexandra Bowles dives deeper into this topic in HuffPost’s article.

What are some of the main causes of dandruff?

Dandruff is incredibly common, and it often stems from a combination of factors rather than one single cause. One of the biggest contributors is an overgrowth of Malassezia, a yeast that naturally lives on the scalp but can become irritating when it multiplies. This irritation leads to flaking, itching, and inflammation. Dry skin, especially in colder months, can also make dandruff worse, as can excess oil production, which creates an environment where yeast thrives. Some hair products may trigger sensitivity or buildup, leading to even more irritation. Stress and changes in hormones can also play a role, which is why dandruff can flare during busy or stressful periods. Overall, dandruff is rarely about “poor hygiene.” It’s usually about how your scalp responds to oils, yeast, and environmental factors.

Are there key ingredients that people should look for when trying to treat their dandruff?

Yes. Several ingredients do a wonderful job at calming dandruff and restoring balance to the scalp. Pyrithione zinc and selenium sulfide help reduce scalp yeast, which is often the root cause of flaking and itching. Ketoconazole is another powerful antifungal option, especially for more stubborn cases. If inflammation is a big issue, salicylic acid can gently exfoliate flakes while helping other active ingredients penetrate better. And for people with sensitive skin, formulas containing tea tree oil can offer natural antimicrobial and soothing benefits. The key is choosing a shampoo that directly addresses your type of dandruff and using it consistently to keep symptoms under control.

What are some dandruff shampoos that you recommend?

Nizoral A-D (1% ketoconazole): This is one of my top recommendations for more persistent dandruff because ketoconazole is a strong antifungal ingredient that helps control yeast on the scalp. You have to let it sit on the scalp for it to work!

Head & Shoulders Clinical Strength (selenium sulfide): A great option for moderate to severe flaking, and it also helps calm itching and redness while restoring moisture balance.

Neutrogena T/Sal (salicylic acid): Perfect for people with thicker scale or buildup because the salicylic acid breaks up flakes without being too harsh.

Selsun Blue (selenium sulfide): Another reliable choice that reduces inflammation and helps regulate oil production, which is especially helpful for oily or irritated scalps.

Is there anything else people should be doing to address their dandruff?

Consistency is key when treating dandruff. Most people see the best results when they use their medicated shampoo several times a week and allow it to sit on the scalp for five minutes before rinsing. Avoiding heavy styling products can also help, since buildup can worsen flaking and irritation. If your scalp feels dry, pairing your dandruff shampoo with a gentle, hydrating conditioner on the ends of your hair, not the scalp, can keep hair soft without disrupting treatment. Managing stress, getting adequate sleep, and maintaining a healthy diet can also support overall scalp health. And if your flaking doesn’t improve after a few weeks, or if you notice redness, pain, or hair shedding, it’s a good idea to see a dermatologist to rule out another condition. My biggest message is that dandruff is very treatable. You just need the right approach and a little patience.

Hair changes can be confusing, especially when you’re noticing more strands in your brush or a gradual thinning over time. While many people use the terms interchangeably, hair shedding and hair loss are actually two different conditions with different causes and treatment approaches. Understanding the difference is the first step toward finding the right solution, and Dr. Alexandra Bowles helps to explain how to in NBC Select’s article.

What are the main differences between hair loss and hair shedding?

Hair shedding and hair loss are often confused, but they’re not the same thing. Shedding refers to increased hair fall from the scalp, usually as part of a temporary disruption in the hair growth cycle. Hair loss, on the other hand, occurs when hair follicles stop producing new hairs or gradually shrink over time. With shedding, the follicle is still healthy and capable of regrowth, whereas hair loss may involve follicle damage or miniaturization. Shedding typically feels sudden and diffuse, while hair loss often appears more gradual and patterned. Understanding this distinction is important because the causes, treatments, and long-term outlook can be very different.

What causes hair loss versus shedding?

Hair shedding is most commonly triggered by stressors such as illness, surgery, childbirth, hormonal shifts, nutritional deficiencies, or significant emotional stress. These events push more hairs than usual into the shedding phase, leading to noticeable shedding weeks to months later. Hair loss is often driven by genetics, hormonal changes, autoimmune conditions, or chronic inflammatory scalp disorders. Androgenetic alopecia, for example, is influenced by genetics and hormones and tends to progress slowly over time. Certain medications and medical conditions can contribute to both shedding and hair loss. Identifying the underlying cause is key to determining the most effective treatment approach.

How can you tell which one you’re experiencing?

One helpful clue is how the hair loss looks and feels. Shedding often presents as large amounts of hair coming out in the shower, on pillows, or in brushes, but without obvious bald patches. Hair loss tends to show up as thinning in specific areas, widening of the part, recession at the temples, or visible scalp over time. Another indicator is timing. Shedding usually starts a few months after a triggering event and often improves within several months. Hair loss is typically more gradual and persistent. If the pattern or timeline feels unclear, a dermatologist can help clarify what’s happening.

Is hair shedding the same as thinning hair?

Hair shedding and thinning are related, but they’re not identical. Shedding refers to hair falling out, while thinning describes a visible decrease in hair density. Temporary shedding can sometimes make hair appear thinner, but the hair often regrows once the trigger resolves. Thinning hair is more commonly associated with ongoing hair loss conditions, such as androgenetic alopecia, where regrowth may be slower or incomplete. In thinning hair, individual strands may also become finer over time. The key difference is whether new, healthy hairs are growing back at the same rate they’re being lost.

Do both require medical care? 

Not all cases of hair shedding require medical treatment, especially if the cause is temporary and identifiable. Many shedding episodes resolve on their own with time, stress reduction, and proper nutrition. Hair loss, however, often benefits from medical evaluation because early treatment can help slow progression and preserve existing hair. Certain types of shedding may also need medical attention if they’re severe, prolonged, or associated with other symptoms. A dermatologist can help determine whether reassurance, monitoring, or treatment is appropriate. Getting the correct diagnosis helps prevent unnecessary treatments and anxiety.

When should you see a doctor?

You should consider seeing a dermatologist if hair shedding lasts longer than six months, worsens over time, or occurs without an obvious trigger. It’s also important to seek care if you notice patchy hair loss, scalp redness, pain, or itching. Sudden hair loss involving the eyebrows, eyelashes, or body hair should always be evaluated. If hair changes are accompanied by fatigue, weight changes, or hormonal symptoms, further workup may be needed. Early evaluation allows for more treatment options and often better outcomes. Most importantly, if hair changes are causing distress, it’s absolutely appropriate to seek professional guidance.

What are the best treatments for hair loss versus shedding? 

Treatment depends heavily on whether someone is dealing with true hair loss or temporary shedding. Hair loss conditions, such as androgenetic alopecia or alopecia areata, often benefit from targeted therapies like topical minoxidil, prescription medications, or in-office treatments that address follicle health and inflammation. Hair shedding is usually managed by identifying and correcting the underlying trigger, such as stress, illness, hormonal changes, or nutritional deficiencies. There is some overlap, as treatments that support scalp health and follicle function can benefit both. However, shedding often improves with time and supportive care, whereas hair loss typically requires ongoing treatment to slow progression. This is why an accurate diagnosis is so important before starting any regimen.

What should you consider when shopping for a treatment for hair loss?

When choosing a treatment for hair loss, it’s important to look for products with clinical evidence supporting their effectiveness. Ingredients like minoxidil have strong data behind them and remain a cornerstone of treatment for many types of hair loss. Patients should also consider consistency and long-term use, since most hair loss treatments require ongoing application to maintain results. Scalp tolerance is another key factor, especially for those with sensitive skin or underlying scalp conditions. It’s also wise to be cautious of products that promise rapid or dramatic regrowth, as these claims are often unrealistic. Consulting a dermatologist can help tailor treatment choices to the specific type of hair loss.

What should you consider when shopping for a treatment for hair shedding?

With hair shedding, the focus should be on gentle, supportive products rather than aggressive growth stimulants. Look for formulations that promote scalp health, reduce inflammation, and support the hair growth cycle, such as those containing soothing botanicals or peptides. Since shedding is often temporary, the goal is to create an environment that allows hair to regrow naturally. Avoid harsh treatments or excessive product layering, which can further irritate the scalp. It’s also important to consider lifestyle factors, like nutrition and stress, alongside topical treatments. In many cases, patience and consistency are just as important as the product itself.

Are there any specific products recommended for hair loss or shedding?

For hair loss, topical minoxidil remains one of the most effective and accessible treatments, with decades of research supporting its use. Products like Rogaine 5% Minoxidil Foam or Keeps 5% Minoxidil Foam are well-studied options that can help slow progression and support regrowth when used consistently over several months. For hair shedding, the focus should be on calming and supporting the scalp rather than aggressively stimulating it. Gentle options such as PURA D’OR Original Gold Label Anti-Hair Thinning Shampoo or Nizoral A-D Shampoo can help address inflammation or scalp imbalance that may contribute to shedding. A lightweight topical like The Ordinary Multi-Peptide Serum for Hair Density can also support scalp health without adding buildup. Ultimately, choosing the right product depends on the underlying cause, scalp sensitivity, and individual lifestyle, which is why a proper diagnosis is so important.

Can scalp massages help?

Scalp massages can be a helpful, supportive practice, but they are not a standalone treatment for hair loss. A gentle massage may improve blood flow to the scalp and reduce tension, supporting overall scalp health. This can be particularly beneficial for people experiencing stress-related shedding. However, scalp massages alone are unlikely to reverse genetic or autoimmune hair loss. It’s also important not to massage too aggressively, as excessive traction can worsen shedding. When used appropriately, scalp massage can be a useful complement to other treatments, but it should not replace evidence-based therapies.

What else can you do to avoid hair loss or shedding?

Lifestyle factors play a significant role in hair health. Managing stress, maintaining a balanced diet with adequate protein and iron, and addressing underlying medical conditions are all essential. Gentle hair care practices, such as avoiding tight hairstyles and minimizing heat styling, can also help reduce breakage and shedding. Sleep quality and hormonal balance are often overlooked but can significantly impact the hair growth cycle. Regular scalp care and sun protection for thinning areas are also important. Taking a holistic approach often leads to better long-term outcomes.

Hair changes can be emotionally challenging, and it’s important for patients to know they’re not alone. Many cases of shedding are temporary and improve with time and proper care. Early evaluation can make a meaningful difference, especially when it comes to hair loss conditions that benefit from prompt treatment. I encourage patients to be cautious of trends or quick fixes and to focus on consistent, evidence-based approaches. Hair health is closely tied to overall health, so addressing the whole picture matters.