Shingles symptoms and treatment in Costa Rica

Dermatóloga evaluando una erupción compatible con herpes zóster en el torso de un paciente durante una consulta médica.

By Dr. Rodolfo SuárezSeptember 18, 202611 min read

A clear guide to shingles, its symptoms, treatment, and warning signs

Before you read: At Skinpaths, we distinguish between opinion and evidence. To write this content, we prioritized indexed medical sources and recommendations from scientific societies. You’ll find the complete bibliography at the end for your reference.
Important: This article is for informational purposes only and does not replace medical advice. If you have any questions, persistent symptoms, or your condition worsens, consult a healthcare professional.

Summary in 60 seconds

Shingles, also called herpes zoster, is a reactivation of the varicella-zoster virus, the same virus that causes chickenpox.
It usually produces pain, burning, tingling or sensitivity in an area of the skin, followed by clustered blisters.
It often appears on only one side of the body, such as a stripe on the chest, abdomen, back, or face.
It is not the same as genital herpes or oral herpes, which are related to the herpes simplex virus.
Antiviral treatment works best when started early, ideally within the first 72 hours of the outbreak.
The most well-known complication is postherpetic neuralgia: pain that persists after the skin has healed.
If it affects the face, eye, ear, appears in an immunosuppressed person, or the pain is intense, you should consult a doctor urgently.
The recombinant vaccine against herpes zoster reduces the risk of shingles and its complications in the groups for which it is indicated.
Covering lesions, avoiding scratching, and keeping skin clean helps reduce discomfort and the risk of virus transmission.

What is shingles?

Shingles is an infection caused by the reactivation of the varicella-zoster virus. After having had chickenpox—even many years before—the virus can remain dormant in the nerves and reactivate later. This reactivation causes pain along the path of a nerve and a blistering rash on the skin. CDC 2025

Although the word “herpes” can be confusing, shingles is not a sexually transmitted infection and is not the same as genital or oral herpes. It is a different disease, caused by a different virus: the varicella-zoster virus. AAD 2024

Why does it appear?

The direct cause is the reactivation of the varicella-zoster virus. This can occur when immunity to the virus decreases with age, certain illnesses, or treatments that weaken the immune system. Lim 2024

It is more common in older adults, but it can also occur in younger people. The risk increases in those with weakened immune systems, cancer, organ transplants, HIV infection, prolonged treatment with corticosteroids, biological therapies, or immunosuppressant drugs.

Based on the available scientific evidence, it cannot be definitively stated that «stress causes shingles.» Clinical opinion and some studies suggest that periods of intense stress may coincide with outbreaks in certain individuals, but the central mechanism remains the reactivation of the virus in a context of reduced immune control.

What does it look like and what symptoms does it cause?

In many patients, the first symptom is not a blister, but an abnormal sensation in the skin: pain, burning, stinging, tingling, itching, or tenderness to the touch. One or two days later, a reddish rash with small, clustered blisters may appear. AAD 2024

The typical distribution is unilateral: it affects only one side of the body and follows a band or strip corresponding to the path of a nerve. It can appear on the chest, back, abdomen, neck, face, scalp, buttocks, or genitals. In some cases, there is fever, fatigue, headache, or general malaise. WHO 2025

The blisters usually break, crust over, and heal gradually. In many people, the outbreak lasts two to four weeks, although the pain may persist longer. When pain continues after the skin has healed, it is called postherpetic neuralgia, the most recognized chronic complication of shingles. Gruver 2023

What can you do today?

If you suspect shingles, the most important thing is to consult a doctor as soon as possible. Antiviral medications such as acyclovir, valacyclovir, or famciclovir can reduce the duration and severity of the illness, especially if started early. The usual recommendation is to consider treatment within the first 72 hours of the rash appearing, although there are situations in which it may be indicated later, for example, if lesions continue to appear, if there is eye involvement, or if the person has a weakened immune system.

While you are receiving medical guidance, some safe steps may help:

Keep the area clean and dry.
Wear loose, soft clothing to avoid chafing.
Cover the injuries with a clean gauze if they are in an exposed area.
Wash your hands after touching the affected skin.
Avoid scratching or removing scabs.
Consult before applying creams, home remedies, or irritating products.

Shingles itself is not «contagious» from person to person. However, the virus present in the blisters can be transmitted to someone who has never had chickenpox or been vaccinated against it; that person could develop chickenpox, not shingles. WHO 2025

Until all lesions have crusted over, it is advisable to avoid direct contact with newborns, pregnant women without known immunity to chickenpox, and immunocompromised individuals.

What NOT to do?

Do not puncture blisters, pick at scabs, or cover the area with irritants. Alcohol, lemon, toothpaste, concentrated essential oils, or homemade mixtures can further inflame the skin and lead to irritant dermatitis or secondary infection.

It is also unwise to wait several days “to see if it goes away” when the pain is intense, the outbreak is on the face, there are lesions near the eye, or the person has a weakened immune system. Early treatment can be important to reduce the severity of the condition and the risk of complications. AAD 2024

Do not stop taking immunosuppressant medications, anticoagulants, corticosteroids, or chronic treatments without medical advice.

When should I consult?

Consult a healthcare professional if a painful rash with blisters appears, especially if it’s on only one side of the body. Consulting a doctor is even more important if the outbreak started less than 72 hours ago, as this may be the best time to start antiviral treatment.

Warning signs: seek urgent medical attention if there are

Injuries to the face, forehead, eyelid, tip of the nose or near the eye.
Eye pain, red eye, blurred vision, or sensitivity to light.
Severe ear pain, facial weakness, vertigo, or hearing loss.
High fever, confusion, stiff neck, or severe headache.
Extensive outbreak, many affected areas, or lesions on both sides of the body.
Pregnancy.
Low defenses due to illness or medication.
Very intense, progressive, or difficult-to-control pain.
Signs of bacterial infection: pus, marked increase in redness, heat, swelling, or foul odor.

Ophthalmic herpes zoster can affect eye structures and requires prompt specialist evaluation. Therefore, any lesion consistent with herpes zoster on the forehead, eyelid, or around the eye deserves priority attention.

What does a dermatologist usually do?

The diagnosis is usually clinical: the dermatologist examines the distribution of the pain, the appearance of the blisters, and whether the rash follows the path of a nerve. In typical cases, additional tests are not always necessary.

When the clinical picture is unclear, a laboratory test, such as PCR for varicella-zoster virus taken from a lesion, may be ordered. This can be helpful if the lesions are atypical, or if there is doubt about herpes simplex, impetigo, contact dermatitis, drug reactions, or other blistering diseases. Lim 2024

The dermatologist also assesses the severity, the need for antiviral treatment, pain management, and the risk of complications. If eye involvement is suspected, they may refer the patient to ophthalmology. If pain persists after the skin has healed, they may consider managing postherpetic neuralgia with specific medications for neuropathic pain, depending on the case.

Biopsy is not routinely performed in typical herpes zoster. It is reserved for atypical cases, persistent lesions, or differential diagnoses that cannot be resolved with clinical evaluation and viral testing.

Treatment: realistic expectations

Antiviral drugs do not immediately «erase» the outbreak. Their goal is to limit viral replication, reduce the duration of the episode, and decrease its severity when prescribed early.

In some patients, especially older adults or those with severe pain, the pain may take longer than the skin to heal. Postherpetic neuralgia can last for weeks, months, or longer and requires a targeted approach to pain management. Gruver 2023

Pain management is a central part of treatment. It may require common analgesics, anti-inflammatories if they are safe for the patient, or medications for neuropathic pain when the pain is burning, electric, or persistent. The choice depends on age, kidney function, liver function, other medications, and medical history.

Evidence supports the use of antivirals in acute herpes zoster, especially in high-risk patients. Classic studies compared valacyclovir with acyclovir and observed benefits in resolving shingles-related pain. (Beutner 1995)

Shingles vaccine

The recombinant shingles vaccine is an important preventive tool for older adults and immunocompromised individuals for whom it is indicated. The CDC recommends two doses of recombinant shingles vaccine for adults 50 years of age and older, and also for adults 19 years of age and older with immunodeficiency or immunosuppression due to illness or treatment. CDC 2024

Clinical trials of the recombinant vaccine showed high efficacy in reducing herpes zoster in older adults, including people aged 70 and over. Lal 2015 , Cunningham 2016

The specific indication may vary depending on the country, availability, age, medical history, and healthcare system. Therefore, the decision should be reviewed with a healthcare professional, especially if there is immunosuppression, pregnancy, severe allergies, or acute illness.

Frequently Asked Questions

Is shingles contagious?

It is not transmitted from person to person like shingles. However, the fluid from the blisters can transmit the varicella-zoster virus to someone without immunity, who could then develop chickenpox. The risk decreases when all the lesions have crusted over.

Is it the same as genital herpes?

No. Genital herpes is usually caused by herpes simplex virus type 1 or type 2. Shingles is caused by the varicella-zoster virus. They are different viruses and different diseases.

How long does it last?

The skin usually improves within two to four weeks. The pain may resolve sooner or persist longer. If the pain continues for weeks or months after the skin has healed, it may be postherpetic neuralgia.

Can I take a bath?

Yes. In general, you can bathe gently, pat the area dry without rubbing, and keep it clean. Avoid exfoliants, perfumes, or irritating products on the lesions.

Should I isolate myself?

Strict isolation at home is not usually required, but it is important to cover the lesions and avoid direct contact with high-risk individuals until all blisters have crusted over: pregnant women without known immunity, newborns, and immunocompromised individuals.

Can it be repeated?

Yes, although many people only have one episode. Recurrence is possible, especially in older people or those with immune system disorders.

Is the vaccine effective if I’ve already had shingles?

In many cases, it can be considered after an episode, depending on age, immune status, and local recommendations. It is not used to treat an active outbreak; it is used for future prevention. The decision should be discussed with a doctor.