COLD SORES & SHINGLES

OVERVIEW

Cold sores and shingles are viral skin infections caused by members of the herpesvirus family. Following initial infection, these viruses remain latent within nerve tissue and can reactivate later.

Both conditions can produce painful skin lesions and neurologic symptoms, although their clinical behavior, transmission, and potential complications differ. Early recognition is important because antiviral treatment is most effective when started early in the course of active disease.

COLD SORES (HERPES SIMPLEX VIRUS)

Cold sores are most commonly caused by Herpes Simplex Virus type 1 (HSV-1), although HSV-2 can also cause oral infection. After initial infection, the virus remains latent in sensory nerve tissue and can reactivate periodically.

CLINICAL FEATURES

Reactivation is often preceded by prodromal symptoms, including:

Tingling
Burning
Tenderness or pain
Itching or altered sensation

These symptoms can begin before visible lesions appear.

Active cold sores typically develop as clusters of small fluid-filled blisters that subsequently rupture, erode, crust, and heal. The lips and surrounding skin are common sites.

IMPORTANCE OF EARLY TREATMENT

Antiviral therapy is most effective when started during the prodrome or as early as possible after lesions appear.

Early treatment can:

Reduce the duration of an outbreak
Reduce lesion severity
Shorten the duration of pain and discomfort

Patients with recurrent cold sores who are planning ablative or non-ablative facial laser procedures should inform the treating physician before treatment. Preventive oral antiviral therapy can be used around facial procedures to reduce the risk of HSV reactivation.

SHINGLES (HERPES ZOSTER)

Herpes zoster, commonly known as shingles, results from reactivation of the varicella-zoster virus (VZV), the virus that causes chickenpox.

After the initial infection, VZV remains latent within sensory nerve ganglia and can reactivate later in life.

CLINICAL PRESENTATION

Shingles commonly begins with pain, burning, tingling, itching, or increased skin sensitivity in the affected area before the rash becomes apparent.

The eruption typically consists of:

Grouped vesicles or blisters on an erythematous base
Distribution along a single dermatome or adjacent dermatomes
Involvement predominantly on one side of the body or face
Pain, burning, tenderness, or altered sensation in the affected area

Fever, headache, fatigue, or malaise can accompany the eruption.

IMPORTANCE OF EARLY TREATMENT

Antiviral medication is the mainstay of treatment for herpes zoster. Treatment is most effective when initiated early, particularly within the first 72 hours after the rash appears.

Antiviral therapy can reduce the severity and duration of the acute infection and associated pain.

Treatment can still be appropriate beyond the initial 72-hour period in patients with continued development of new lesions, significant disease, or complications.

SHINGLES INVOLVING THE FACE OR EYE

Shingles affecting the forehead, eyelid, nose, or area around the eye requires prompt medical attention because varicella-zoster virus can involve the eye and threaten vision.

Eye pain, redness, light sensitivity, visual changes, or shingles involving the ophthalmic distribution requires urgent ophthalmologic evaluation.

Neurologic symptoms, extensive or disseminated lesions, or severe illness also require prompt medical assessment.

CONTAGIOUSNESS

A person with shingles does not transmit shingles directly to another person. However, virus from active shingles lesions can transmit varicella-zoster virus to a susceptible person, who can then develop chickenpox.

Transmission risk continues while active vesicles are present and decreases once all lesions have dried and crusted.

During the active blistering phase:

Keep lesions covered when possible
Avoid touching or scratching the lesions
Practice careful hand hygiene
Avoid direct contact between the lesions and people at increased risk from varicella infection, particularly pregnant individuals without immunity, newborns, and immunocompromised individuals

RECURRENCE

Having shingles once does not guarantee lifelong protection against another episode. Herpes zoster can recur.

The risk of shingles increases particularly with advancing age and impaired cell-mediated immunity.

COMPLICATIONS OF HERPES ZOSTER

POSTHERPETIC NEURALGIA (PHN)

Postherpetic neuralgia is the most common complication of herpes zoster and consists of persistent neuropathic pain in the area affected by shingles after the skin eruption has resolved.

Symptoms can include:

Persistent burning, aching, or stabbing pain
Extreme sensitivity to light touch
Tingling, numbness, or altered sensation

The risk of postherpetic neuralgia increases substantially with age and can persist for months or longer.

OTHER POTENTIAL COMPLICATIONS

Herpes zoster can also produce less common but serious complications involving the eye, cranial or peripheral nerves, central nervous system, or other organs.

Prompt evaluation is particularly important for facial or ocular involvement, neurologic symptoms, disseminated disease, or severe systemic illness.

Seek Medical Evaluation for Cold Sores or Shingles

Early recognition of herpes simplex and herpes zoster allows timely antiviral treatment and appropriate management of symptoms and complications.

📞 Call (847) 518-9999 to schedule a dermatology evaluation.

Medical Disclaimer
This information is provided for educational purposes only and does not replace individualized medical evaluation. Treatment recommendations depend on clinical findings, diagnostic requirements, and patient-specific factors. Outcomes may vary, and no specific medical result can be guaranteed.

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