Adult Shingles Treatment (Herpes Zoster)
Fast MD-only shingles care by secure online video visit, $49 flat-fee, no insurance required.
Shingles (herpes zoster) is a painful viral reactivation of the varicella-zoster virus that causes a band-like, blistering rash on one side of the body or face. Our board-certified MDs use guideline-based evaluation to confirm a typical shingles pattern, start timely antiviral treatment when appropriate, and identify red flags that require urgent in-person or emergency care.
- $49 flat-fee adult visit
- MD-only care (no mid-levels)
- No insurance required
- Secure video visits in 25+ states
Online MD-Only Shingles Care
- Adult-only evaluation of painful, band-like blistering rash
- Assessment of timing to decide if antivirals are likely to help
- Non-opioid pain strategies and skin-care guidance
- Clear criteria for eye involvement, neurologic issues, or immunocompromise
Adults 18+ only. TeleDirectMD does not prescribe opioids, gabapentinoids, or controlled substances for shingles and does not manage ophthalmic or disseminated herpes zoster solely by telehealth.
What Is Adult Shingles (Herpes Zoster)?
Shingles (herpes zoster) occurs when the varicella-zoster virus, which causes chickenpox, reactivates years later in a nerve root. It produces burning or tingling pain followed by a stripe of grouped blisters on one side of the body or face. The rash typically follows a single dermatome and does not cross the midline.
Shingles is a viral condition, not a bacterial skin infection, but it can sometimes be complicated by bacterial superinfection or nerve pain (postherpetic neuralgia). Antiviral medications work best when started within the first 72 hours of rash onset, though treatment may still be considered later in some adults. Telehealth is often appropriate for typical, limited shingles in otherwise stable adults, as long as there are no signs of eye involvement, neurologic symptoms, or widespread disease.
Symptoms and Red Flags in Adult Shingles
Many shingles cases can be managed through a virtual visit, especially when the pattern is classic and the patient is otherwise well. Certain symptoms, however, suggest higher-risk herpes zoster (such as eye involvement, neurologic complications, or immunocompromise) that require in-person or emergency evaluation.
| Symptom | What it suggests | Telehealth appropriate? | Red flag requiring urgent in-person care |
|---|---|---|---|
| Burning or tingling pain followed by a band of blisters on one side | Typical localized shingles in a single dermatome | Yes, often well-suited for telehealth if limited area | Not a red flag alone if patient otherwise stable |
| Blistering rash on one side of chest, back, or abdomen | Localized trunk shingles | Often appropriate for telehealth antiviral start | Severe pain, rapid spreading, or systemic symptoms |
| Rash on one side of face, scalp, or ear with pain | Cranial nerve involvement; risk of eye or ear complications | Telehealth may help triage quickly | Eye redness, vision changes, severe ear pain, or facial weakness |
| Blisters on tip of nose, around eye, or on eyelids | Possible herpes zoster ophthalmicus | No for definitive management | Requires urgent in-person ophthalmology or emergency evaluation |
| Facial weakness, trouble closing eye, or hearing changes | Possible Ramsay Hunt syndrome or other neurologic involvement | No | Urgent in-person or emergency evaluation is required |
| Rash in more than 1 non-adjacent area or widespread lesions | Disseminated zoster or immune compromise | No | Needs in-person or hospital assessment and IV therapy |
| High fever, confusion, severe headache, or neck stiffness | Possible CNS involvement or serious systemic infection | No | Emergency evaluation is required |
| Persistent or worsening pain after rash heals | Possible postherpetic neuralgia | Telehealth can help discuss options and referrals | Not a red flag alone but may warrant in-person pain or neurology care |
| Immunocompromised state (e.g., chemotherapy, high-dose steroids) | Higher risk of severe or disseminated shingles | Telehealth may triage but not definitive | Extensive rash, fever, or systemic symptoms require urgent in-person care |
Differential Diagnosis: Shingles vs Other Painful Rashes
Several conditions can mimic shingles, especially in early stages before blisters are obvious. During your TeleDirectMD visit, the MD will review the pain pattern, distribution, timing, and appearance to distinguish localized herpes zoster from other diagnoses that may need different treatment or in-person evaluation.
Herpes Zoster (Typical Shingles Pattern)
- Burning or tingling pain followed by grouped blisters
- Rash limited to 1 dermatome and 1 side of the body or face
- Intact or mildly ill systemic status in most localized cases
- Improves with timely antivirals and supportive care
Other Conditions That Can Mimic Shingles
- Herpes simplex: Recurrent grouped blisters, often around mouth or genitals, sometimes without classic dermatomal stripe.
- Contact dermatitis: Itchy, sometimes blistering rash at a site of exposure, usually not associated with burning nerve pain.
- Impetigo or bacterial skin infection: Honey-colored crusted lesions or spreading redness with more surface involvement.
- Insect bites: Localized red, itchy bumps or welts, often multiple and symmetric rather than a single dermatomal band.
Telehealth can often distinguish these patterns based on images and detailed history. When the diagnosis remains uncertain, the rash is near the eye or ear, or the patient is very ill or immunocompromised, in-person evaluation is recommended for definitive examination and testing.
When Is a Video Visit Appropriate for Adult Shingles?
When a Video Visit Is Appropriate
- Adult 18+ with a classic band of blisters on one side of trunk or limb
- Rash started within the past 72 hours or is still evolving
- No eye redness, vision changes, or blisters on the tip of the nose
- No facial weakness, trouble closing an eye, or severe ear pain
- No high fever, confusion, or rapidly worsening systemic symptoms
- Patient is not severely immunocompromised and can take oral antivirals
- Can clearly show the rash on camera and follow home-care instructions
Red Flags Requiring In-Person or ER Care
- Blisters on eyelids, tip of nose, or any vision changes
- Facial paralysis, trouble closing one eye, or severe ear pain
- Rash involving more than 1 non-adjacent area or becoming widespread
- High fever, severe headache, neck stiffness, or confusion
- Severe immunosuppression with extensive rash or systemic illness
- Severe pain out of proportion to visible rash, especially with rapid progression
- Pregnancy with suspected shingles or exposure concerns
If any red-flag symptoms are present, seek in-person or emergency care immediately. TeleDirectMD is not an emergency service and does not manage ophthalmic, disseminated, or neurologic shingles solely by telehealth.
Treatment Options for Adult Shingles
Effective shingles management focuses on timely antiviral therapy, non-opioid pain control, and supportive skin care. Our MDs follow evidence-based guidelines and emphasize starting antivirals as early as reasonable, especially for adults over 50 or those with more significant pain or risk factors.
Supportive Care and Skin Measures
- Keep the rash clean and dry; gently wash with mild soap and water as needed.
- Avoid picking or scratching blisters to reduce risk of bacterial infection and scarring.
- Use loose, soft clothing to minimize friction over affected skin.
- Cool compresses or cool baths may provide temporary relief from burning or itching.
- Use over-the-counter pain relievers such as acetaminophen or ibuprofen when appropriate.
Antiviral and Pain Management (When Appropriate)
- Oral antiviral medications started as early as possible, ideally within 72 hours of rash onset.
- Scheduled non-opioid analgesics to help manage acute pain.
- Topical options such as lidocaine patches or gels may be discussed in selected adults.
- Referral back to primary care, pain management, or neurology for persistent postherpetic neuralgia.
TeleDirectMD does not prescribe opioids or controlled substances for shingles. Long-term neuropathic pain management with medications such as gabapentin or antidepressants is typically coordinated with in-person primary care or specialty care if needed.
Common Medications Used for Adult Shingles
The exact regimen is individualized based on age, kidney function, timing of rash, and other medical conditions. The table below shows typical examples your MD may consider for uncomplicated adult shingles appropriate for outpatient telehealth management.
| Medication | Dose | Duration | When it is used |
|---|---|---|---|
| Valacyclovir 1 g tablet | 1 g by mouth 3 times daily | 7 days | First-line antiviral for many adults with normal kidney function and rash onset within 72 hours |
| Acyclovir 800 mg tablet | 800 mg by mouth 5 times daily | 7–10 days | Alternative antiviral when valacyclovir is not suitable or available |
| Famciclovir 500 mg tablet | 500 mg by mouth 3 times daily | 7 days | Another antiviral option for uncomplicated shingles in adults when appropriate |
| Acetaminophen 500–1000 mg | 500–1000 mg by mouth every 6 hours as needed (do not exceed 3000 mg per day unless directed) | Short term, during acute pain phase | Baseline non-opioid analgesic for shingles pain when no contraindications |
| Ibuprofen 400–600 mg | 400–600 mg by mouth every 6 hours as needed with food | Short term, during acute pain phase | Nonsteroidal option for adults without kidney disease, GI bleeding history, or other contraindications |
| Lidocaine 5% topical patch or gel | Applied to intact skin over painful area as directed (patch typically up to 12 hours on, 12 hours off) | Short term, with periodic reassessment | Selected adults needing localized, non-opioid pain relief when skin is intact and not weeping |
These are example regimens only. Actual medications, strengths, and durations are determined by the MD after reviewing your history, kidney function considerations, other diagnoses, and current medications. TeleDirectMD does not prescribe opioids, gabapentinoids, or other controlled substances for shingles via telehealth.
Home Care, Expectations, and Return to Work
Shingles usually runs its course over 2–4 weeks. The goal of treatment is to shorten the duration of viral activity, reduce acute pain, and lower the risk of complications such as postherpetic neuralgia, especially in older adults.
- Start antivirals as prescribed as soon as possible and complete the full course.
- Cover the rash with loose clothing or non-adherent dressings if weeping, especially in work settings.
- Avoid direct contact between open blisters and people who are pregnant, immunocompromised, or never had chickenpox or the varicella vaccine.
- Monitor for eye symptoms, new neurologic changes, or spreading rash and seek urgent care if they occur.
- Schedule follow-up if pain persists after rash healing, as long-term nerve pain may need additional in-person evaluation.
Many adults with localized shingles can continue working or return to work when pain is controlled and the rash can be covered, depending on job duties and contact with high-risk individuals. If a work note is needed, TeleDirectMD can generally provide documentation of evaluation and treatment rather than recommending prolonged time off unless there are complications or severe symptoms.
TeleDirectMD Telehealth Disclaimer
TeleDirectMD provides MD-only virtual urgent care for adults using secure video visits to evaluate conditions like shingles. Visits are $49 flat-fee with no insurance required and are available in 25+ states. Our physicians follow evidence-based guidelines, clarify what can be safely managed via telehealth, and explain when in-person primary care, ophthalmology, neurology, or emergency evaluation is more appropriate. TeleDirectMD is not an emergency service or a replacement for comprehensive in-person care.
Adult Shingles Treatment FAQs
Shingles occurs when the varicella-zoster virus, which causes chickenpox, reactivates years later in a nerve. After a chickenpox infection or varicella vaccination, the virus stays dormant in nerve roots. For reasons that are not fully understood, it can reactivate and travel along the nerve to the skin, causing a painful, band-like blistering rash on one side of the body or face.
Many adults with a classic shingles pattern on the trunk or limbs and no eye or neurologic symptoms can be safely evaluated via secure video. We review your symptoms, medical history, and photos of the rash and, when appropriate, start antiviral therapy and give clear home-care instructions. If we see signs of eye involvement, severe illness, or disseminated rash, we will direct you to in-person or emergency care instead of managing it fully online.
Antivirals such as valacyclovir or acyclovir work best when started as early as possible, ideally within 72 hours of rash onset. In some cases, especially in older adults or those with higher risk of complications, treatment may still be considered beyond 72 hours if new lesions continue to appear. During your TeleDirectMD visit, the MD will review the timing of your symptoms and discuss whether antivirals are likely to help you.
The fluid in shingles blisters contains varicella-zoster virus. Until the blisters crust over, direct contact with the rash can transmit the virus to people who have never had chickenpox or the varicella vaccine, causing chickenpox, not shingles. You should keep the rash covered and avoid direct skin contact with pregnant people, newborns, and anyone who is significantly immunocompromised while lesions are open or weeping.
TeleDirectMD focuses on non-opioid strategies such as acetaminophen, nonsteroidal anti-inflammatory drugs, cool compresses, and topical options like lidocaine patches when appropriate. For persistent or complex nerve pain after the rash heals, we may recommend in-person follow-up with your primary care clinician or a pain or neurology specialist to discuss additional options that are not managed solely by telehealth through our service.
Postherpetic neuralgia is nerve pain that persists after the shingles rash has healed. It can feel like burning, stabbing, or sensitivity to light touch in the affected area. Shingles antivirals reduce but do not eliminate this risk. TeleDirectMD can help recognize postherpetic neuralgia, provide initial guidance, and recommend follow-up with primary care or pain specialists for longer-term management and medications that require ongoing monitoring or in-person assessment.
Any blisters on the tip of your nose, eyelid, or around the eye, new eye redness or vision changes, severe ear pain, hearing changes, or facial weakness (trouble closing one eye, crooked smile) are red flags. These findings can signal herpes zoster ophthalmicus or Ramsay Hunt syndrome and require urgent in-person evaluation, often in an emergency department or by an ophthalmologist or ENT specialist. Telehealth should not be your only source of care in those situations.
Yes. Most people have only 1 episode of shingles, but recurrent episodes can occur, especially in older adults or those with weakened immune systems. If you have repeated episodes, it is important to discuss your overall health, immune status, and vaccination options with your in-person clinician. Telehealth can help triage and treat episodes, but recurrent disease may warrant a broader in-person evaluation and discussion of preventive strategies such as vaccination when appropriate for you.
Prior shingles does not guarantee you will never have it again. Vaccination recommendations depend on your age, health conditions, and prior vaccine history. TeleDirectMD can provide general education, but the decision and timing for shingles vaccination are best finalized with your in-person primary care clinician or pharmacist, who can administer the vaccine and track your overall preventive care plan.
TeleDirectMD offers MD-only, guideline-based shingles care through secure video visits with a transparent $49 flat-fee model and no insurance required in 25+ states. We emphasize early antiviral treatment when indicated, non-opioid pain control, clear education on contagiousness and red flags, and explicit instructions on when in-person ophthalmology, neurology, urgent care, or emergency evaluation is safer than telehealth alone.