Evidence-based management of shingles in adults

Shingles is a common condition that is often first seen in primary care, community services, urgent treatment centres and community pharmacies. Although usually self-limiting, it can lead to significant complications, including post-herpetic neuralgia, ophthalmic disease, otic disease, neurological involvement, secondary bacterial infection and disseminated or visceral zoster in severely immunosuppressed people. This article provides a practical, UK-guidance-based overview for assessing and treating adults with suspected shingles. It considers recognition of typical and atypical presentations, risk assessment, holistic history and examination, red-flag symptoms, antiviral treatment, pain management, infection-prevention advice, safety-netting, follow-up and vaccination. An important focus is placed on identifying patients who require same-day specialist advice, checking renal risk before high-dose antiviral treatment, and supporting patients with symptom control, prevention advice and referral to reliable patient information resources.