How does the visit work?
The doctor reads your answers and sends a plan. If it is safe for you, the plan can include a prescription lidocaine patch (5%). If it is not, the plan tells you about choices you can buy at the store. The patch numbs the skin that hurts. Use it only on whole, healed skin. Put it over the most painful spot. Use only the number of patches your doctor prescribes. Do not use more. Wear them for up to 12 hours. Then leave the skin bare for at least 12 hours. Do not use a heating pad over the patch. Keep it dry. Wash your hands after you touch it. Keep it out of your eyes. Keep patches away from children and pets. Fold used patches sticky side in, and throw them away where children and pets cannot reach.
What can a patch or cream do?
A patch or cream on the skin can help the pain. It does not cure it. Pain after shingles can take months to ease. You can also buy a lidocaine 4% patch or capsaicin cream at the store. Their labels do not name shingles pain. Follow the box. Use only one patch or cream on the same skin at a time. That includes the prescription patch. Do not use a lidocaine patch if you ever had a bad reaction to lidocaine. Do not use a store-bought lidocaine patch if your plan says lidocaine is not safe for you.
Do you give pills for nerve pain?
No. This visit does not give pills for nerve pain. Those pills can need a check of your heart, your eyes, and your balance. We cannot do that checkup here. If a patch or cream is not enough, see your own doctor.
What should I tell you for safety?
Tell us if you ever had a bad reaction to lidocaine or a numbing shot. Tell us if you are allergic to anything in a patch or cream, such as the glue. Tell us if you have an allergy to chili peppers. Tell us if you have G6PD deficiency, a blood problem called methemoglobinemia, severe liver disease, heart or lung disease that limits what you can do, or a heart rhythm medicine such as mexiletine, flecainide, propafenone, or quinidine. Tell us if you take a medicine such as nitroglycerin, a sulfa antibiotic, dapsone, nitrofurantoin, or acetaminophen. Tell us if you use another numbing medicine anywhere on your body, such as benzocaine gel or spray, a lidocaine cream, or a numbing throat spray. Tell us every medicine you take.
What if my skin reacts to a patch or cream?
If the skin under your prescription patch burns, turns red, or gets small blisters, take the patch off. Do not put it back on until the skin settles. This is usually mild and passes within a few hours. If it comes back each time you wear a patch, message us. If it lasts longer, spreads, or comes with a jump in your pain, follow the steps for a new rash in the care answer below. A store-bought lidocaine patch is different. If it gives you a rash or blisters, take it off, do not use another one, and follow the steps for a new rash. If your skin under it only itches, turns red, swells, or hurts, take it off, do not use another one, and message us. If capsaicin cream blisters your skin, stop it and follow the steps for a new rash. If capsaicin cream burns badly and the burning does not ease, stop it and message us. If a pet chews a patch, call your vet right away.
When do I need care right away?
Read from the top. If more than one fits, follow the first one. If you are pregnant, the order is the same. If a warning sign starts while you wear a patch, take the patch off. Call 911 or go to the ER now if you have any of these. You have sudden loss of vision, or a sudden dark spot in what you see. You have new weakness, or weakness that is getting worse, in an arm, a leg, or your face. You have a drooping face, or trouble speaking. You have numbness that is spreading past the sore area, or numbness in both legs, or around your private parts or buttocks. You have new trouble passing urine, or you lose control of urine or stool. You have a stiff neck, a very bad headache, or confusion. You have chest pain or pressure, or trouble breathing. You have a sudden, severe change in your pain, or pain in your belly, side, or back with vomiting or a swollen belly. You have eye pain, a red eye, or light that hurts your eyes. You have blurry, double, or cloudy vision, or any other change in your vision. You have a new rash or blisters on your forehead, scalp, eyelid, or nose. After you start a patch, you get hives, or swelling of your lips, tongue, or face. After you start a patch, you get a headache, a fast heartbeat, light-headedness, unusual tiredness, or trouble breathing. After you start a patch, your skin or lips turn blue, gray, or pale. A child chews or swallows a patch. If you have thoughts of ending your life, or of hurting yourself, call or text 988 now. Call 911 if you are in danger. Go to the ER or urgent care today if you have a fever of 100.4°F (38°C) or higher, or shaking chills. Go there today too if you have a new rash or blisters anywhere, even where you had the shingles rash, and you have a weak immune system or you are pregnant. See a doctor in person today if you have a new rash or blisters anywhere, even where you had the shingles rash. A new rash could be shingles again. Treatment works best in the first 3 days. See a doctor in person today too if you have new ear pain, new hearing loss or ringing in an ear, or spinning dizziness.
When do I need an exam in person?
See a doctor in person within 7 days if your shingles rash was on your face, head, scalp, ear, eyelid, or nose, or on your buttock, groin, or private parts, even if it was in other places too. See a doctor in person within 7 days too if your pain is spreading, is on both sides of your body, or is in a place where you never had the rash. Do the same if the skin where you had the rash still has scabs or open sores, or your pain keeps getting worse over weeks. We cannot examine you online.
When should I see my own doctor instead?
Please see your own doctor if no doctor, nurse practitioner, or physician assistant told you that you had shingles, you never had a rash, or you are not sure. See your own doctor if your shingles rash first showed up less than 90 days ago. See your own doctor if you have a weak immune system, from HIV, an organ transplant, chemotherapy, steroid pills, other medicines that lower your defenses, or a blood cancer. See your own doctor if you are pregnant, might be pregnant, or are breastfeeding, or if you are under 18. See your own doctor too if you have used a patch or cream for about 4 weeks and your pain is not better.
What if the pain does not go away?
Pain after shingles usually gets better over time. It can take months. If you start the prescription patch, we check in with you at about 4 weeks. If you have used a patch or cream for about 4 weeks and your pain is not better, see your own doctor. Do not wait for our reply if a warning sign starts. Our reply can take up to 6 hours. You can get shingles more than once. A shingles vaccine can help. Ask your pharmacist.
What does it cost?
The visit price is shown before you pay. You pay the pharmacy for the medicine. If you start the prescription patch, the first check-in is free. Later check-ins have a price that is shown before you pay.