Medically reviewed by Dr. Ponlawat Pitsuwan, Physician, Takecare Clinic Phuket. Last reviewed: September 2026.
I often see shingles in older travellers who are run down after a long journey. The band of pain and rash on one side of the body is quite typical. Starting antiviral treatment within three days of the rash appearing makes a real difference to recovery and to the risk of lasting nerve pain.
Shingles on holiday often starts as a mystery pain. Travellers tell us they put a burning ache across the ribs down to lifting suitcases, a stiff neck down to a long-haul flight, or a sore patch of skin down to sunburn or a bite, until a cluster of blisters appeared a few days later. We see it most in older visitors, but also in younger people who are run down or take medicines that lower immunity. The heat, sweat and swimwear straps of a beach holiday make the rash especially uncomfortable. The most useful thing you can do is get seen early.
What shingles is
Shingles, or herpes zoster, happens when varicella-zoster virus, left behind in the body after an earlier bout of chickenpox, wakes up again. For decades it sits quietly in nerve roots beside the spine. When immunity to it dips, with age, illness, some medicines or sometimes for no clear reason, it travels down a single nerve to the skin. That is why the rash keeps to one side and follows the territory of that nerve, often wrapping halfway round the chest or waist. About 1 in 3 people will have shingles at some point in their life, and the risk rises sharply after 50.
You cannot catch shingles from someone who has it. However, anyone not immune to chickenpox, through past infection or vaccination, can pick up chickenpox from the fluid in the blisters.
Early symptoms and how the rash develops
The pain usually comes first. Most people notice tingling, burning, itching or aching in one patch of skin for a few days, typically up to five, before anything is visible, sometimes with a headache, tiredness or mild fever. At this stage the pain can be mistaken for heart pain, a pulled muscle, gallbladder or kidney trouble, sciatica or toothache. Next, red patches come up and within a day or so turn into groups of small, clear blisters along the strip. Scabs form over the next 7-10 days, and most skin has healed by 2-4 weeks.
| Condition | Rash pattern | Key clue |
|---|---|---|
| Shingles | Clustered blisters in a band on one side | Burning pain days before the rash |
| Herpes simplex (cold sores, genital herpes) | Small blister cluster, lips or genitals | Returns in the same spot |
| Chickenpox | Itchy spots scattered over the whole body | Both sides, starts on the trunk and face |
| Contact dermatitis | Red, itchy patch matching what touched the skin | Itch rather than nerve pain |
| Jellyfish sting | Red lines or welts | Instant pain in the sea |
Shingles near the eye or ear
Shingles on the forehead, scalp, upper eyelid or tip of the nose, known as herpes zoster ophthalmicus, can involve the eye and threaten vision. A rash on the tip or side of the nose is a particular warning sign. This needs an eye assessment the same day. Shingles around the ear can cause Ramsay Hunt syndrome, with facial weakness or drooping, hearing loss, ringing in the ear or dizziness, which also needs urgent treatment.
How we diagnose and treat shingles
Diagnosis is usually clear from the pattern of pain and rash. When it is not, a swab of blister fluid can be tested for the virus by PCR, a genetic test. In adults under about 50, or after a second episode, we may suggest a blood sugar check and an HIV test, because shingles can be the first sign of a weaker immune system.
Antiviral tablets stop the virus multiplying and shorten the illness. The usual choices are aciclovir 800 mg five times a day, valaciclovir 1 g three times a day or famciclovir 500 mg three times a day, each for 7 days, adjusted for kidney function, and ideally started within 72 hours of the rash appearing. Later than that, we still prescribe them if new blisters are forming, the eye or ear is involved, you are over 50, your immunity is weakened or pain is severe. Pain relief starts with paracetamol or an anti-inflammatory; medicines aimed at nerve pain, for example amitriptyline, pregabalin or gabapentin, reach burning, stabbing pain that ordinary painkillers miss. Eye involvement goes to a hospital eye specialist.
Looking after yourself, and travel while you recover
Keep the rash clean, dry and covered with a loose, non-stick dressing or clothing, and leave blisters alone. Cool compresses and calamine lotion ease discomfort, and loose cotton is kinder than swimwear straps. Stay out of pools and the sea until all the blisters have crusted, usually about a week, and until then avoid close contact with pregnant women who have not had chickenpox, newborn babies and people with weak immunity. Flying is generally fine if you feel well and the rash is covered, but check your airline’s policy.
When to see a doctor
Get checked as soon as shingles seems likely, ideally within 72 hours of the rash starting, because that is when antivirals help most. Go the same day if the rash is on your face, especially near the eye or nose, if you are pregnant or have a weakened immune system, or if the pain is severe.
Prevention and early detection
The recombinant zoster vaccine, known as Shingrix, is given as two doses 2-6 months apart. The US recommends it from age 50, and earlier for adults whose immune system is weakened, while the UK offers it by age band, so check your home schedule. It is more than 90% effective at preventing shingles in people over 50. On a long stay you can start the course here and finish it at home; ask us on WhatsApp whether it is in stock today. After an episode, it is given once the rash has fully healed.
Seeing us about shingles
Our Bangtao (Cherngtalay) clinic, Patong clinic and Kata-Karon clinic are open 24 hours, so a rash that appears at midnight can be treated before morning. A walk-in doctor in Phuket visit needs no booking, and antivirals and pain relief come from our on-site pharmacy. If you are in too much pain to travel, arrange a doctor hotel visit in Phuket through WhatsApp or by calling +66 81 718 9080. We will confirm the cost on WhatsApp before you come, bill most travel insurers directly and provide receipts, a medical report and an itemised invoice.
Related services and treatments
Blisters that keep returning to the lip or genitals are more likely herpes simplex, covered by our herpes treatment page, and the shingles vaccine is one of the vaccinations in Phuket we can discuss. If shingles blisters become red, hot and pus-filled, they may need skin infection treatment. Other painful or itchy rashes may turn out to need sunburn treatment, insect bite treatment, jellyfish sting treatment or scabies treatment. See all conditions we treat.
Summary
Shingles is the chickenpox virus returning along one nerve, bringing burning pain and then a one-sided band of blisters. Antivirals are most useful when begun inside 72 hours of the rash, and pain control matters from day one. A rash near the eye or ear needs same-day care. Adults over 50 can greatly lower their risk with two doses of the recombinant shingles vaccine.
“If you notice a painful, blistering rash on one side of your body, see a doctor within 72 hours. Early antivirals shorten shingles and reduce complications.”
Dr. Ponlawat Pitsuwan, Physician, Takecare Clinic Phuket
Frequently asked questions
Will travel insurance cover my shingles treatment?
Shingles is usually treated as a new, unexpected illness under travel insurance, although policies differ on excesses and pre-existing conditions that affect immunity. We bill most travel insurers directly, and we provide receipts, a medical report and an itemised invoice if you need to claim yourself. We confirm the price on WhatsApp beforehand.
How fast can I start antivirals if I walk in today?
Usually within the same visit. No appointment is needed at any of our three clinics, walk-in patients are generally seen within minutes and most visits take under 30 minutes. If the doctor confirms shingles, you collect antivirals and pain relief from our on-site pharmacy and can take the first dose before you leave.
Can a doctor come to my hotel if the pain is too bad to travel?
Yes. We send doctors to hotels and villas all over the island around the clock, so we can confirm the diagnosis, check your eyes if the rash is on your face and bring antivirals and pain medicines. If you notice confusion, weakness in a limb or sudden vision loss, call 1669 rather than waiting.
Could I give shingles to my grandchildren?
They cannot catch shingles from you, but a child with no immunity to chickenpox, from earlier infection or vaccination, could catch chickenpox from fluid in your blisters. Keep the rash covered, wash your hands and avoid close contact with unvaccinated children, newborns and pregnant women until all the blisters have crusted over.
My rash started four days ago. Is it too late for antivirals?
Not necessarily. Antivirals help most within 72 hours, but doctors still prescribe them after that if new blisters are still forming, the eye or ear is involved, you are over 50, your immunity is weakened or the pain is severe. Pain treatment is worthwhile at any stage, so it is still worth being seen.
Should I get the shingles vaccine after having shingles?
Yes, for most adults aged 50 and over, because shingles can come back. The recombinant vaccine is given once the rash has fully healed, and some countries advise waiting longer, so check your home guidance. We can discuss timing and whether it is in stock today when you message us on WhatsApp.
Sources
The NHS describes the symptoms and treatment of shingles and who is eligible for the shingles vaccine. MedlinePlus offers a clear shingles overview, including complications.
Shingles, herpes zoster, varicella-zoster virus, chickenpox, postherpetic neuralgia, Ramsay Hunt syndrome, PCR swab, herpes zoster ophthalmicus, aciclovir, valaciclovir, famciclovir, amitriptyline, gabapentin, pregabalin, Hutchinson’s sign, recombinant zoster vaccine, Shingrix, NHS, MedlinePlus, Takecare Clinic Phuket, Bangtao, Patong, Kata, Karon, Dr. Ponlawat Pitsuwan
This page is general health information and not a substitute for a medical consultation.