How to care for your skin with shingles

Ms YY, a 35-year-old woman, initially noticed small rashes around her lips, which she assumed were cold sores. Despite applying topical antiviral creams, her condition worsened. By the third day, the rash had spread to her face, neck, and arms, causing severe pain that made it difficult for her to eat or drink.

When she was admitted to the hospital and referred to Dermatologist, Dr Kok Wai Leong, the diagnosis was clear: severe shingles, also known as disseminated herpes zoster. The virus, which had remained dormant in her body since childhood chickenpox, had reactivated, triggering a painful rash. Shingles is caused by the varicella-zoster virus, the same virus responsible for chickenpox. It follows nerve pathways and typically appears on one side of the body, manifesting as painful blisters that eventually scab over.

Anyone who has had chickenpox can later develop shingles. In Singapore, as many as 30,000 people contract shingles annually. It is more common in older adults and individuals with weakened immune systems, like Ms YY, who was undergoing treatment for rheumatoid arthritis. Her compromised immune system not only made her more vulnerable to shingles but also led to a more severe episode requiring intravenous antiviral medication, potent painkillers, and specialised eye care due to blisters near her eyes.

Shingles often begins with pain or tingling in a specific area of the skin, followed by flu-like symptoms such as fever and headache. A rash then appears in the affected area, forming blisters that dry up, crust over, and eventually heal. However, some patients experience lingering nerve pain, known as post-herpetic neuralgia, which can persist long after the rash disappears. Others may develop skin infections from bacteria, requiring antibiotics to aid in healing.

During the early stages, applying cool compresses can help dry the blisters. Dermatologists may also prescribe topical creams to support healing. Adequate rest, hydration, and pain management are essential for recovery. Most healthy individuals recover fully, but severe cases—like Ms YY’s—may require hospitalization, especially if complications such as vision loss or brain inflammation arise.

Simple tips for the skin you can perform at home:

• Use a gentle fragrance-free cleanser to cleanse the skin daily
• Apply a thin layer of prescribed topical creams
• If there are fluid-filled blisters, cover the rash with a sterile, non-sticky (adherent) bandage or dressing
• Wear loose, comfortable clothing
• Wash your hands regularly after you come into contact with the skin
• Avoid picking at the scabs when the skin starts to heal, to avoid scarring
• Rest and hydrate adequately to help your skin recover

To increase access to the costly vaccination, Singapore’s Ministry of Health (MOH) has announced that from September 2025, the shingles vaccine will be subsidized. This initiative aims to encourage vaccination, particularly among older adults and immunocompromised individuals, to reduce the risk of severe cases like Ms YY’s.

Patients with conditions that weaken immunity must be especially cautious. Ms YY’s case serves as a reminder of the importance of early diagnosis, timely treatment, and preventive measures to minimize the impact of shingles on skin health and overall well-being. If you suspect you may have shingles, consult our dermatologist, Dr Kok Wai Leong, promptly to prevent complications and ensure a smoother recovery.