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[Sticky] Shingles


Michael Gray MD JD
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Yes — early shingles (herpes zoster) can often be evaluated and treated through telemedicine, and prompt treatment is especially helpful in the first 48–72 hours after rash onset.

A virtual clinician can frequently diagnose shingles based on symptoms and photos, and — when appropriate — start antivirals to reduce pain and complications.


👍 Telemedicine is usually appropriate for early, uncomplicated cases

Typical features providers can assess virtually:

  • Pain, burning, or tingling on one side of the body

  • Followed by a band-like rash or clusters of blisters

  • Rash limited to a single dermatome (not crossing midline)

  • Mild–moderate pain without severe swelling or fever

During a telehealth visit, the clinician may:

  • Review timing of pain + rash onset

  • Examine clear, well-lit photos or video of the rash

  • Start antivirals (acyclovir, valacyclovir, famciclovir) when indicated

  • Recommend pain relief and skin-care measures

  • Provide guidance on contagion and wound protection

  • Arrange follow-up

Treatment works best when started as soon as possible, ideally within 72 hours of rash appearance.

Sharing photos from multiple angles and distances is very helpful.


🟡 Telemedicine may be appropriate but likely needs close follow-up if:

  • You are immunocompromised, pregnant, or age > 60

  • Rash involves multiple body areas

  • Pain is severe or rapidly worsening

  • There’s significant swelling or drainage

  • You’re unsure whether the rash is shingles

The clinician may recommend:

  • In-person exam, labs, or culture

  • Dermatology or primary-care follow-up


🔴 Seek urgent in-person or emergency care — not telemedicine — if the rash is:

  • On or near the eye, forehead, or nose (possible eye involvement)

  • Inside the ear or associated with facial weakness

  • Widespread or crossing the midline

  • Accompanied by high fever, confusion, or severe headache

  • In a child, infant, or someone with very weak immunity

Eye or facial shingles can threaten vision and require same-day care.


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