Use clinical judgement to decide who to refer to (e.g. ophthalmology, dermatology, obstetrics, immunology, or pain specialist, depending on the presenting problem), and the urgency, depending on the risk to the person and their clinical condition.

• Urgent admission or specialist advice may be necessary if:
• Complications (e.g. meningitis, encephalitis, myelitis) are suspected.
• The person has shingles in the ophthalmic distribution of the trigeminal nerve. Referral is particularly indicated for people with:
• Hutchinson's sign — skin lesions along the side of the nose, representing the dermatome of the nasociliary nerve, which is a prognostic factor for subsequent ocular inflammation.
• Visual symptoms.
• An unexplained red eye.
• A severely immunocompromised person has shingles, or an immunocompromised person has shingles where the rash is severe, widespread, or they are systemically unwell.
• A pregnant woman has shingles.
• Refer, or seek specialist advice less urgently, if:
• New vesicles are forming after 7 days of antiviral treatment, or healing is delayed.
• Pain is inadequately controlled by oral analgesia, or a strong opioid is being considered.
• A person who is thought to be immunocompetent has had two episodes of shingles.
• There is diagnostic uncertainty.
• Consider seeking specialist advice if:
• Shingles recurs in an immunocompromised person — long-term prophylaxis to prevent recurrence of uncomplicated shingles is not routinely recommended, but may be useful for some individuals.