The varicella-zoster virus, which causes shingles, can leave lasting marks on the skin. These marks, often referred to as shingles scars, typically appear as depressed, pitted areas or as patches of discolored skin. This guide provides information on managing and minimizing the appearance of scars left behind by a shingles infection.
How Shingles Causes Skin Damage
Shingles causes skin damage through a deep inflammatory process originating in the nerve ganglia where the virus reactivates. The resulting rash forms painful blisters along a nerve path, extending deep into the lower layers of the skin, known as the dermis. Scarring occurs when intense inflammation compromises the skin’s structure, leading to either a loss or overgrowth of collagen fibers during healing.
The most frequent type of mark is an atrophic, or sunken, scar, resulting from the destruction of collagen and fat tissue beneath the skin’s surface. This tissue loss creates the characteristic pitted appearance often seen after severe blistering. Less commonly, the body may over-produce collagen, leading to hypertrophic scars, which are raised and thickened. Keloid scars may also form, growing beyond the boundaries of the original rash.
Beyond changes in texture, shingles often causes pigmentary alterations, collectively known as dyschromia. This manifests as hyperpigmentation, where the scar tissue is darker than the surrounding skin, or hypopigmentation, resulting in lighter patches. The likelihood of permanent deep dermal damage increases with the severity of the initial infection, the degree of inflammation, and whether the blisters were picked or became secondarily infected.
Topical and At-Home Scar Treatments
For established scars, accessible, at-home treatments focus on modifying the scar tissue environment to encourage a softer, flatter appearance. Silicone gel sheets and topical silicone products are a standard non-prescription approach, particularly for raised scars. These products work by creating an occlusive barrier over the skin, which increases the hydration of the stratum corneum, the outermost layer of the skin.
This increased hydration signals to the underlying cells to slow down the excessive production of collagen, helping to flatten and soften the scar tissue over time. Silicone usage can also reduce the redness associated with the scar by decreasing local inflammation. For optimal results, silicone products should be worn against the scar for many hours each day over several months.
Over-the-counter topical ingredients can also target specific scar characteristics. Vitamin C serums are beneficial because the compound is a potent antioxidant that supports collagen synthesis, which can help fill in shallow atrophic scars. Vitamin C also inhibits the enzyme tyrosinase, helping to brighten hyperpigmented areas. Topical retinoids, such as retinol, stimulate cell turnover and promote collagen remodeling, which can improve the texture of depressed scars.
Stringent sun protection is a simple requirement for scar management. Ultraviolet (UV) radiation exposure stimulates melanocytes, which can significantly darken existing hyperpigmentation, making the scar more noticeable. Applying a broad-spectrum sunscreen with a high sun protection factor (SPF) daily is necessary to prevent the scar from becoming permanently discolored. Gentle massage of the scar tissue a few times a day can also help break down dense collagen bundles, improving flexibility and allowing topical treatments to penetrate more effectively.
Clinical Procedures for Scar Revision
For scars that do not respond sufficiently to at-home care, professional clinical procedures offer targeted solutions depending on the scar’s specific type. Atrophic scars, which are sunken due to tissue loss, are often treated with dermal fillers. Injectable materials, such as hyaluronic acid or poly-L-lactic acid, are placed beneath the depressed scar tissue to immediately restore volume, elevating the pit to the level of the surrounding skin. Certain fillers also stimulate the body’s natural collagen production over time.
Lasers provide effective tools for both texture and color correction. Fractional laser treatments deliver microscopic columns of heat into the dermis and are used to treat overall texture and depressed scars. This controlled thermal injury stimulates a wound-healing response that promotes the growth of new, healthier collagen, improving the scar’s depth and smoothness.
For scars that are red or pink, a Pulsed Dye Laser (PDL) is the standard treatment. This laser specifically targets hemoglobin, the red pigment in blood vessels, reducing the blood supply to the scar and minimizing its red appearance. This process helps to flatten and soften hypertrophic scars by reducing the vascularity that fuels their growth. Microneedling, which involves creating thousands of tiny channels in the skin, induces collagen production and is frequently combined with topical treatments like Vitamin C.
Minimizing Scarring During the Initial Outbreak
Preventing a deep scar from forming begins while the shingles rash is still active, as actions taken during this time directly impact the final outcome. The most important step in minimizing permanent scarring is to avoid scratching, picking, or peeling the developing blisters or scabs. Disrupting the skin barrier increases the risk of a secondary bacterial infection, which causes deeper inflammation and tissue damage, guaranteeing a more noticeable scar.
Keeping the rash clean and gently moist is beneficial once the blisters have crusted over and scabs have formed. Applying a fragrance-free moisturizer can prevent the scabs from drying out, cracking, and falling off prematurely, which would expose the fragile, healing skin beneath. Allowing scabs to detach naturally promotes optimal healing and reduces the chance of textural defects.
Management of the pain and inflammation associated with the outbreak is also important for prevention. Intense, prolonged inflammation drives the deep dermal damage that leads to lasting scars. Seeking medical attention within 72 hours of the rash’s onset to begin antiviral medication can limit the severity and duration of the viral attack, reducing the risk of significant tissue destruction. Pain relief and anti-itch measures, such as cool compresses, help manage discomfort and minimize the impulse to scratch the affected area.