Shingles is a painful, blistering rash that follows one nerve on one side of the body. It is caused by the chickenpox virus waking up years later. Antiviral tablets help most when they are started within three days of the rash appearing. Cold sores are small clusters of blisters on or around the lip, caused by the herpes simplex virus. The virus stays in the body for life, but episodes get shorter when treatment starts early, and for most people they become less frequent over the years.
The same eight facts on every condition comparison.
It is a reactivated virus.
The chickenpox virus can lie dormant in nerves and later reactivate.
It follows a nerve.
Inflammation follows a nerve band and causes a skin eruption.
Risk rises with weaker immunity.
Age and immune-lowering treatment increase risk, but younger people can get it.
Care has several parts.
Antivirals, pain control and checking for complications are each addressed.
They are caused by herpes simplex.
The virus stays latent for life after the first exposure.
They recur in the same place.
Reactivation produces small blisters near the lip border.
A first infection can differ.
It may cause painful mouth and gum inflammation with fever.
Unusual sores need review.
A persistent ulcer should be reassessed, not treated repeatedly.
Truncal shingles A band around one side of the chest or back.
Facial and ocular shingles Forehead, scalp or around the eye.
Disseminated shingles Widespread; in weakened immunity.
Blister cluster Small blisters on the lip edge.
Crusting Yellow crust as it heals.
Near the nose Can appear around the nostrils.
Varicella-zoster virus remains dormant in sensory nerves after chickenpox. When it reactivates, it travels toward the skin and can cause pain and grouped blisters in a one-sided nerve distribution.
Herpes simplex virus remains in sensory nerves after the initial infection. Reactivation brings the virus back to nearby skin, where local viral activity can produce grouped blisters.
Shingles. Risk rises with age, particularly after age 50, but younger people can be affected.
Cold Sores. The first infection often occurs early in life; recurrent episodes can occur at any age afterward.
Shingles is caused by the chickenpox virus waking up years after it first infected you. The virus stays dormant in nerves and can reactivate later.
Cold sores are caused by the herpes simplex virus. After the first infection, the virus stays in nerves and can reactivate.
Evidence labels come from each condition’s own treatment list.
The first step for shingles pain, and enough on their own for a milder episode. They work better taken regularly than only when the pain peaks. Shingles pain is nerve pain, so if these are not holding it, that is a reason to ring your doctor rather than to take more.
Dabbed on while the blisters are present, it cools the skin and takes the edge off the itching. A cool compress does much the same thing. Neither shortens the episode, and neither should be rubbed in, because breaking the blisters spreads virus and can leave scars.
An oatmeal soak can settle itching while the rash is blistering, in cool rather than hot water. It is comfort only. It does not change how long shingles lasts or whether nerve pain follows.
A thin layer of plain petroleum jelly on broken or crusting areas stops them drying and cracking, which lowers the risk of bacteria getting in. It has no effect on the virus itself. Use it under a loose, non-stick dressing rather than an adhesive one, which tears blisters when it comes off.
Plain ointment dabbed over the crust keeps it soft so it does not split each time you talk or eat, which hurts less and leaves less of a mark. Drying the sore out does the opposite of what people expect. Apply it with a clean fingertip or a cotton bud and wash your hands afterwards - it does nothing to the virus itself.
The only over-the-counter cream shown to shorten an episode, and only by about half a day. It has to go on at the first tingle and be reapplied five times a day. It is a reasonable thing to keep in a bag, but antiviral tablets started at the same moment do considerably more.
Strong sun on the lips is one of the most reliable triggers there is, so for anyone whose episodes follow skiing, a beach holiday or long days outdoors, a daily SPF lip balm is genuine prevention rather than lip care. Use it every day rather than only when an episode is due, and keep using it while the mark left behind fades, since sun makes that darker and slower.
A thin gel patch worn over the sore. It keeps the area moist so the crust splits less, it stops fingers reaching the sore, and it contains the fluid that spreads the virus. It does not shorten the episode itself, and it is easier to use once the blisters have opened than at the tingle stage.
A popular supplement for preventing episodes, but the studies behind it are small, old and inconsistent. It is not dangerous and some people are convinced by it. It is not a substitute for an antiviral, and it is not something to rely on if your episodes are frequent.
A numbing patch worn over the area for pain that carries on after the rash has healed. It goes only on intact skin, never on blisters or open areas. It helps some people a great deal and others hardly at all, so it is worth a proper trial before deciding.
A high-strength patch applied in a clinic for lasting nerve pain, with one treatment lasting up to three months. It burns while it is on, so the skin is numbed first. It is used after simpler options, and only once the skin has fully healed.
An antibiotic ointment used only if the crusts turn hot, swollen or start oozing pus, which means bacteria have moved in on top. It does nothing to the shingles virus. If the infection is spreading, antibiotic tablets are needed instead.
Penciclovir cream. A prescription antiviral cream applied every two hours while awake for four days. It shortens an episode by around half a day to a day, so a little more than the over-the-counter cream and a lot less than tablets. It is a reasonable option for someone who cannot take the tablets.
Acyclovir cream. The cream version of the tablet, five times a day for four days. The virus is multiplying deep in the skin cells and traveling in a nerve, so a cream only reaches part of the problem, and the benefit is measured in hours rather than days. If you can take the tablets, take the tablets.
The usual first choice for shingles: three doses a day for seven days. Started within 72 hours of the rash it shortens the episode and lowers the chance of lasting nerve pain. It does not clear the virus from the body, and it does much less once everything has crusted over.
An equally effective alternative to valacyclovir, taken three times a day for seven days. It is used when valacyclovir does not suit. The same 72-hour clock applies, and it is usually the more expensive option.
The oldest of the three antiviral tablets and the cheapest. It works just as well, but it has to be taken five times a day for seven days, which is harder to keep up. The dose is lowered if your kidneys are not working well.
Nerve pain medicines rather than ordinary painkillers. They are the main treatment for pain that carries on after the rash heals, and they are often started during the episode when pain is severe. The dose is built up slowly, and they can make you drowsy or unsteady at first.
A low dose of an old antidepressant, taken at night for nerve pain. It suits people whose shingles pain is keeping them awake. It takes a few weeks before you can judge it, and it is used carefully in older adults because of dry mouth, dizziness and confusion.
A short course of steroid tablets is sometimes added to antivirals for severe pain or when the facial nerve is involved. It can speed up rash healing and early pain a little. Studies have not shown that it prevents lasting nerve pain, and it is never given on its own for shingles.
The usual first choice, and for a cold sore it is a single day of treatment - two large doses twelve hours apart, started at the first tingle. Taken then, it shortens the episode and can stop a blister forming at all. Started after the blister is out it does much less, which is the whole argument for keeping a course at home.
An equally effective alternative, taken as a single dose at the first tingle, which suits people who will not manage a second dose later in the day. It is used where valacyclovir does not suit or is not available. It is usually the more expensive of the two.
The oldest of the antiviral tablets and the cheapest. It works, but it has to be taken five times a day for five days, which is a lot of doses for something that lasts a week anyway. The dose is lowered if your kidneys are not working well.
A low dose of the same antiviral taken every day, rather than only during an episode, for people getting roughly six or more a year. It reduces how often they happen substantially and lowers the amount of virus shed in between. The effect stops when the tablets stop, and doctors usually review it after six to twelve months.
Two injections a few months apart, more than 90 percent effective at preventing shingles in adults 50 and over. It prevents rather than treats, so it is not used during an episode. It is still recommended once an episode has cleared, because having had shingles does not protect you from having it again.
An episode runs two to four weeks, the pain sometimes longer. Most people get it once, though it can recur if the immune system is suppressed.
Most episodes run a week to ten days. People settle into a rhythm - one or two a year, or several, and some have one episode and never another. Frequency drops with age.
Postherpetic neuralgia
Nerve pain that carries on after the skin has healed, because the virus damaged the nerve it traveled down. It is the most common complication of shingles, and the risk climbs steeply with age. Starting antiviral tablets within 72 hours and controlling the pain properly from day one both lower the chance of it. It is treatable, so it is worth going back rather than waiting for it to fade.
Shingles in the eye
When the affected nerve serves the forehead and eye, blisters appear on the forehead, the eyelid or the tip and side of the nose, and the eye itself can be involved. It can cause lasting damage to sight. Blisters anywhere in this area are a same-day problem, and often need an eye specialist as well as antiviral tablets.
Shingles in the ear
Blisters in or around one ear, together with weakness on that side of the face, and sometimes a change in hearing, ringing or dizziness. It is uncommon. It needs urgent treatment, because the facial nerve recovers better the sooner antiviral tablets and steroids are started.
Herpes can occasionally spread to the eye or extensively through eczema-affected skin. Eye pain, widespread painful blisters, or exposure of a newborn requires prompt medical advice.
Seek prompt care when shingles is suspected because antivirals work best early. Eye or ear involvement, widespread blisters or weakened immunity needs urgent assessment.
Seek care for severe, frequent or persistent episodes. Eye pain or redness, widespread blisters with eczema, or illness in a newborn needs urgent assessment.
Not with shingles - nobody catches shingles from you. But the blister fluid can give chickenpox to someone who has never had chickenpox and never been vaccinated. Keep the rash covered, wash your hands, and stay away from newborns, pregnant people who are not immune, and anyone immunosuppressed until it crusts.
Possibly not. The evidence is strongest inside 72 hours, but treatment is often still given if new blisters are forming, if you are older, if the rash involves the face or eye, or if you are immunosuppressed. Being late is a reason to be seen today.
Nerve pain that continues after the rash heals, from damage to the nerve the virus traveled down. Much more common in older adults, and it can last months. It is treatable with different drugs from ordinary painkillers, so go back rather than waiting it out.
Generally yes. One episode does not protect you from another, and vaccination is recommended once an episode has cleared. Ask your doctor about timing.
The virus travels down a single sensory nerve, and each nerve supplies a strip of skin on one side. That is also why the rash stops abruptly at the midline - one of the clearest clues.
Yes, though most people do not. Recurrence is more likely if your immune system is suppressed. If it has happened more than once, ask whether anything underlying should be looked into.
Almost certainly in childhood, from ordinary contact with someone who carried the virus - a kiss, a shared cup or spoon. Most people have no memory of it, because the first infection often causes nothing. It is not about hygiene or anything you did.
Most easily passed on from when blisters appear until the sore has fully crusted - roughly the first four to five days. Small amounts are shed when nothing is visible. Precautions matter most around newborns, eczema and anyone immune-suppressed.
Because the virus lives in one nerve, which supplies one small patch of skin. When it reactivates it travels down to that patch. Some people have two or three usual spots.
The virus stays in the body permanently, so there is no cure. But episodes usually become less frequent over the years, and daily suppressive treatment can reduce them a great deal. Plenty of people effectively stop having them.
Not while you have an active sore. Herpes simplex is dangerous in newborns in a way it is not in older children or adults. Do not kiss the baby, wash your hands before handling them, and cover the sore. If a newborn develops blisters or a fever, or becomes unusually sleepy or floppy, that is an emergency.
Less well. Antiviral tablets stop the virus multiplying, and by the time blisters are out most of that has happened. Still worth taking for a severe episode, but the benefit is in the first 24 hours.
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