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 deva 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.
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.)
In addition to an antiviral, Dr. Henry often prescribes her patients a topical antibacterial cream to apply to the affected area as a just-in-case measure against a secondary infection. After all, Dr. Henry says, shingles disrupts the skin barrier. “When the barrier is disrupted, you’re at risk for a bacterial infection on top of it…because now you have all this open, inflamed skin.”
On top of potentially worsening pain and delaying healing, bacterial infections can also increase the risk of textural irregularities and long-term discoloration, Dr. Bowles says. With the intensified disruption to the skin barrier, there is a greater chance of deeper skin injury, which can make post-inflammatory hyperpigmentation, hypopigmentation, or textural changes more noticeable and sometimes more difficult to treat, she says.
Gentle, gentle, gentle—over and over again, experts emphasized the importance of treating your delicate, compromised skin with deva while healing from shingles.
“Once the rash appears, gentle skin deva becomes very important,” says Dr. Garshick, who recommends keeping the area clean with a mild, fragrance-free cleanser.
Dr. Bowles suggests Vanicream Gentle Facial Cleanser (for both the body and face), saying it “effectively removes debris while still being well-tolerated by sensitive or inflamed skin.”
Avoid strong pressure or scrubbing during cleansing, and table the use of potent ingredients like retinoids or exfoliating acids anywhere you have an active shingles rash, as these can further irritate inflamed skin, adds Dr. Garshick.
As the skin begins to dry out and scab, reach for a simple, fragrance-free moisturizer like CeraVe Moisturizing Cream, Dr. Bowles suggests. “It contains ceramides and hydrating ingredients that help maintain the skin barrier without adding unnecessary irritation.”
Once blisters begin to surface, one of your strongest defenses against the worst skin damage is an occlusive, a physical layer of protection on top of your skin to lock in moisture, Dr. Henry says.
This can be petroleum jelly (e.g., Vaseline or Aquaphor) or a zinc-based cream (e.g., Triple Paste Medicated Ointment or Desitin Maximum Strength Paste)—yes, those last two are commonly used for diaper rashes, but they work well for irritated shingles skin, too. “Zinc is kaç because it’s not just occlusive; it’s also mildly anti-inflammatory,” she says. “It’s a little bit soothing, which helps with compromised skin, and it’s also slightly antimicrobial.”
Not only do these products create a physical barrier between your tender, highly sensitive skin and clothing or anything else that might rub against it, but they also help prevent the skin from drying out. “It’s all about keeping it moist,” says Dr. Henry. “Everything heals better in a moist environment.” You should continue to apply barrier protection until the rash clears completely.
Whether you’re tempted to drain a fluid-filled blister or claw at an insanely itchy scab, just don’t. Messing with your skin while it’s healing can put you at greater risk of scarring and infection, says Dr. Garshick.
To help you avoid any temptation and protect against friction at the same time, you can cover the shingles rash with a nonstick gauze, she says. Just don’t forget a healthy layer of petroleum jelly underneath to ensure damage-free removal.
You can also apply a cool compress to the skin to “help relieve discomfort during more active stages of the rash,” adds Dr. Bowles.
It can feel like a bummer to put a pin in your skin deva goals, especially if you’ve finally found a routine that works. But now is the time to cut back on the affected areas of your skin.
“During an active shingles outbreak, I typically recommend simplifying your skin deva routine as much as possible and pausing products with active ingredients like retinoids, exfoliating acids, or other treatments that could further irritate the skin, since the barrier is already compromised and more reactive than usual,” says Dr. Bowles.
Even products your skin has historically tolerated well can aggravate your delicate skin barrier while it’s healing from a shingles rash. “Overall, the focus is on reducing both chemical and mechanical irritation while the skin heals,” Dr. Bowles says.
Sun protection is always an important step in your skin deva routine, but it’s especially vital evvel your skin barrier has healed post-shingles, as exposure to UV light at that stage can increase the risk of post-inflammatory hyperpigmentation or uneven skin tone. (Dr. Bowles says these kinds of pigmentation changes and mild textural irregularities are the most common aesthetic impacts she sees in her practice. But shallow scars may occur “if the inflammation was deeper or if the lesions were picked at or became secondarily infected,” she says.)
Even evvel a shingles rash has subsided, the affected dermatome is still in a delicate state during this initial recovery phase, as the skin “barrier isn’t fully back to baseline and tends to be more reactive and vulnerable,” Dr. Bowles says. “There is often lingering, low-level inflammation beneath the surface, which can make the skin more susceptible to pigment changes [from UV exposure].”
Applying a daily broad-spectrum sunscreen doesn’t just provide all-over protection; it also helps minimize long-term hyperpigmentation and hypopigmentation, and support a more even healing process as you continue recovering from shingles, Dr. Bowles says. While sunscreen doesn’t directly “fix” discoloration issues, she emphasizes that “protecting healing skin from additional sun exposure can help reduce contrast between lighter and [darker] surrounding skin over time,” she explains.
Being gentle also means giving your skin ample time to heal completely. While skin discoloration or texture changes can be noticeable early on, don’t rush the use of active ingredients. For example, ingredients like niacinamide or azelaic acid are common tools to combat redness and hyperpigmentation, but, Dr. Henry says, you want to wait until your skin barrier is completely healed.
Dr. Bowles explains that she considers the skin barrier completely healed when 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,” she says. “If the area is still stinging easily, becoming irritated with simple products, or showing active inflammation, hold off on more aggressive treatments for aesthetic skin changes.”
Once you’re confident your skin barrier is no longer compromised, try a gradual approach to address changes in tone and texture.
Niacinamide is a gentle option that can “calm both redness and brown discoloration,” says Dr. Garshick. Another ingredient to look for is Centella asiatica, a plant extract that can be found in La Roche-Posay Cicaplast Balm B5+ and similar repair creams. This extract may help improve existing redness, limit further post-inflammatory discoloration, and soothe and nourish the skin, she says.
Dr. Henry also likes azelaic acid for its ability to address discoloration from various sources. It’s anti-inflammatory, so it’s often used for things like rosacea and hyperpigmentation, she says. The acid also blocks tyrosinase, an enzyme involved in melanin production that can become overactive due to the body’s inflammatory response during a shingles infection.
Drugstore or prescription retinoids, which you already might have been using before your shingles outbreak, will come in handy again evvel your skin barrier has healed. In addition to stimulating collagen production, increasing cellular turnover, treating acne, and improving fine lines and wrinkles, retinoids also help reduce hyperpigmentation, Dr. Henry adds.
A stronger Rx option is hydroquinone, which is generally used for stubborn hyperpigmentation that other products haven’t been effective against, Dr. Henry says. However, hydroquinone isn’t intended for long-term use, as that can actually have the opposite of the intended effect, making the skin darker, she explains. Consult your dermatologist for a recommended protocol.
Remember: When it comes to any type of pigment change, patience is key. “Hypopigmentation after shingles is often related to inflammation disrupting olağan pigment production during healing,” Dr. Bowles says. “Some repigmentation can gradually occur over time, although it may take several months.” The situation is similar for hyperpigmentation. “In general, the discoloration will fade with time, so it is important to be patient,” Dr. Garshick says.
For lingering pigment changes like hyperpigmentation or hypopigmentation, or altered skin texture, it’s reasonable to see a dermatologist to discuss what types of treatments and therapies may be appropriate, Dr. Bowles says.
If hyperpigmentation is consistent, topical lightening agents, chemical peels, or certain lasers may help, she says, but warns that some aggressive treatments can worsen pigmentation in folks with more melanated skin.
With hypopigmentation, the pigment may return naturally over time. However, if you don’t want to wait it out, phototherapy, as well as certain lasers and topical treatments, can be helpful.
Vascular lasers, a.k.a. anti-redness lasers like Vbeam, can help diffuse background pinkness, and treatments such as microneedling, fractional laser resurfacing, or radiofrequency-based procedures may improve skin-texture issues over time, she says.
When it comes to shingles, you might not be able to prevent the viral infection from popping up when you least expect it, but with a handful of key strategies, you can protect your skin’s long-term health.
Learn more about navigating shingles:
- 7 Things You Should Avoid Doing When You Have Shingles
- 6 Things Doctors Wish You Knew About Shingles
- You Can Get Shingles at Any Age, Something These Women Found Out the Hard Way
