Red flags and when to refer

If a person with shingles presents with the following symptoms, then emergency referral to A&E is required:

• Serious complications (such as meningitis, encephalitis or myelitis) are suspected
• They have a rash that involves the eyes and tip, side or root of the nose – this can be vision-threatening
• They have visual symptoms
• They have an unexplained red eye
• They are seriously immunocompromised, or the person is immunocompromised with shingles where the rash is severe, widespread, or they are systemically unwell
• They are an immunocompromised child with shingles³
• They have any hearing loss, dizziness or vertigo.⁴

If a person with shingles presents with the following symptoms, refer them to a GP:

• New blisters appear after seven days of antiviral therapy
• There is a delay in healing
• They have reoccurring instances of shingles
• More effective pain management is needed.³