Long-term Shingles: Prevent and Treat | As Seen in Glamour
Shingles can leave long-term effects on your skin, ranging from changes in the overall texture to hyperpigmentation. Using the right products and treatment practices, can decrease the amount of discoloration and patches. Dr. Alexandra Bowles thoroughly provides the best tips and tricks, as well as product recommendation to protect your skin throughout its natural healing process, featured in Glamour.
What is the typical timeline and progression of a shingles rash?
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 in a specific area of the skin, usually on one side of the body. 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.
While progression is often similar, 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 the possible short and long-term risks 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. This is particularly seen 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.
Furthermore, if an individual were to get a secondary bacterial infection from a shingles rash, it could increase the risk of both scarring and long-term discoloration. When the skin barrier becomes more disrupted and inflamed, there is a greater chance of deeper skin injury. As a result, it can make post-inflammatory hyperpigmentation, hypopigmentation, or textural scarring more noticeable and difficult to treat. From a medical standpoint, bacterial infections are important because they can worsen pain, delay healing, and occasionally require antibiotics. That’s one reason why I emphasize avoiding picking or scratching the area and keeping the skin clean during healing.
What are the best practices for maintaining the health of your skin during each phase?
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.
What are common, but avoidable mistakes people make dealing with long-term shingles?
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.
Are there specific products, ingredients, or items recommended during a shingles outbreak?
I usually recommend focusing on gentle, soothing products that support the skin barrier during an 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 on sensitive or inflamed skin. Adding on, it can be used on both the face and body due to its mild and non-irritating composition. For larger body areas, I recommend gentle fragrance-free body washes such as Dove Sensitive Skin Body Wash or Vanicream Body Wash.
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. The goal is to keep the routine simple and supportive while the skin heals. The recommendations to avoid harsh active ingredients such as retinoids, exfoliating acids, or scrubs apply specifically to the area affected by shingles. If someone has shingles on their back, for example, there is generally no reason they cannot continue using their normal skincare routine on unaffected areas like the face, assuming the skin there is otherwise healthy and tolerating those products well.
What advice is there for individuals with more melanated or fair skin?
While shingles is often described as causing a “red” rash, the appearance can vary significantly depending on skin tone. In lighter skin tones, the rash may appear bright red or pink, while in deeper skin tones it can look more violaceous, grayish, dark brown, or subtly inflamed rather than obviously red. 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.
For individuals with more melanated skin, I pay particular attention to the risk of post-inflammatory hyperpigmentation, which can persist after the rash has healed. I usually emphasize strict sun protection and gentle skincare to help minimize long-term discoloration. For those with very fair skin, redness and irritation may be more visible, and the skin can be more prone to sensitivity during healing. In both cases, avoiding picking, minimizing irritation, and supporting the skin barrier are key. I also remind patients that healing can take time, and gradual improvement is expected. Tailoring care to the individual’s skin type can help improve overall outcomes.
How do you deal specifically with the hyper- and hypo- pigmentation from long-term shingles?
Hypopigmentation after shingles is often related to inflammation disrupting normal pigment production during healing. In many cases, some repigmentation can gradually occur over time, although it may take several months. I usually recommend focusing on gentle skincare, avoiding additional irritation, and maintaining good sun protection while the skin recovers. If pigment changes are persistent, it’s reasonable to see a dermatologist. There you can discuss whether treatments such as topical anti-inflammatory medications, light-based therapies, or other targeted approaches may be appropriate.
Additionally, SPF is especially important to minimize and prevent worsening of post-inflammatory hyperpigmentation. It can also be helpful towards the overall healing process. UV exposure can make uneven pigmentation more noticeable in general. While sunscreen will not directly “fix” hypopigmentation, reduced sun exposure can help decrease contrast between lighter and surrounding skin of long-term shingles.
What type of scarring appears during healing, and how do you treat them?
The most common changes I see after shingles are post-inflammatory pigmentation changes and mild textural irregularities.. Some patients can develop shallow atrophic scarring if the inflammation was deeper, the lesions were picked at, or became secondarily infected. In certain cases, especially with prolonged inflammation, there can also be persistent discoloration or areas of altered skin texture.
Many of the same recommendations mentioned above are important for minimizing scarring. More specifically, avoiding picking, minimizing friction, gentle moisturizers, and protecting the area from sun exposure. Sunscreen is especially helpful for reducing worsening pigmentation changes associated with scars and helping scars heal with less noticeable discoloration. It is particularly important for post-inflammatory hyperpigmentation, although it will not necessarily change scar texture itself. Preventing additional inflammation during healing is one of the biggest factors in reducing more noticeable scarring overall.
What are in-office treatments for stubborn discoloration and scars?
Treatment really depends on whether the primary issue is pigmentation, redness, or textural scarring, as well as the patient’s skin tone and sensitivity. For persistent hyperpigmentation, I may consider topical lightening agents, chemical peels, or certain lasers. However, caution is important in more melanated skin tones because aggressive treatments can worsen pigmentation. For redness, vascular lasers may sometimes help. For textural scarring, treatments such as microneedling, fractional laser resurfacing, or radiofrequency-based procedures can sometimes improve skin texture over time. I usually recommend a personalized approach because the safest and most effective treatment can vary significantly. This depends on the patient’s skin type, healing pattern, and the severity of the residual changes.
What are signals that the skin barrier is healed?
In general, I consider the skin barrier more fully healed once there are no longer any open lesions, crusting, active blisters, or significant tenderness in the area. The skin should feel more intact and less reactive overall. If the area is still stinging easily, irritated with simple products, or showing active inflammation, I usually recommend continuing a gentle, barrier-focused approach.
