PART 3 OF 5: There are many viral skin infections that range from mild to the severe. Some viral skin infections affect just the skin and others are associated with systemic diseases.  This article features massage modifications for viral skin infections including cold sores, chickenpox, shingles, and warts.

As massage therapists we are not only at risk for infection from our clients, but we can put our clients at risk when we have these pathologies ourselves. Therapists should adhere to infection control measures such as hand sanitation before and after the massage, as well the use personal protective equipment such as non-latex disposable gloves. According to the CDC, hand washing is preferred over hand sanitizers (1). Treat linens as contaminated, and click HERE for proper washing procedures.

Cold Sores: Cold sores are recurrent viral infections that affect the skin and mucous membranes. They can appear anywhere on the body but most often affect areas around the mouth. Cold sores also can occur around the nose, over the chin, or on the fingers and are contagious. Although rare, cold sores may be found inside the mouth and are often confused with canker sores. However, canker sores are ulcerations that occur only within the mouth, are not caused by viruses, and are not contagious.


Cold sores are also called fever blisters and oral herpes simplex. Herpes simplex virus type 1 is the most common cause of cold sores. Herpes simplex virus type 2 is usually responsible for genital herpes, but it also may cause oral cold sores.


Massage Therapy and Cold Sores: Avoid the affected area during the massage because cold sores are contagious, but health care–associated transmission is rare (2). Therapists can protect themselves by adhering to standard precautions and using appropriate protective barriers such as disposable gloves or massage through the drape such as a sheet. If the therapist has a cold sore, s/he can perform massage while adhering to infection control measures such as hand washing and protective barriers such as disposable gloves. Additionally, avoid touching lesions on your own body during the massage. Linens, such as face rest covers, that come into contact with lesions are treated as contaminated with appropriate measures taken.

Chickenpox: Chickenpox is an acute viral infection seen most often in children and young adults. It is highly contagious and spreads by contact with lesions or respiratory droplets. It also can be spread indirectly by touching contaminated items such as linen or clothing in recent contact with a chickenpox blister. Approximately 120,000 cases of chickenpox are reported annually in the United States, and each case produces almost complete immunity against a second occurrence. However, approximately 1 in 10 adults who had chickenpox will develop shingles (see below) later in life.




Massage Therapy and Chickenpox: Postpone massage until the client has completely recovered.


Shingles: Shingles is a viral infection of the skin. It is essentially a reactivation of the chickenpox virus. After chickenpox has resolved, the virus lies dormant within sensory spinal nerves and is kept inactive by healthy immune responses. However, if the immune response becomes weakened or is suppressed, the virus can travel down a dermatome (cutaneous area innervated by a spinal nerve), which leads to disease manifestation. The spinal nerve to which the virus had retreated previously determines the area in which shingles will appear.



Massage Therapy and Shingles: Avoid the affected area during the massage because the fluid in the lesions contain the virus and therefore contact should be avoided. Furthermore, shingles is contagious to people who have not yet had chickenpox. Linens, such as face rest covers, that come into contact with lesions are treated as contaminated with appropriate measures taken. Additionally, table warmers and thermotherapy such as hot packs should not be used on affected areas while massaging nonaffected areas.

Warts: Warts are a rough, raised, oval-shaped mass of skin. They may occur anywhere on the body, but most warts are located on the hands, feet (plantar warts), face and legs (flat warts), and genitals (genital warts). Warts may appear singularly or as multiple growths. Warts are contagious and are spread by contact with infected skin. Warts are caused by the human papillomavirus virus (HPV). Certain strains of HPV are responsible for genital warts and cervical cancer.



Massage Therapy and Warts: Avoid the affected area because warts are contagious. Although this condition is not spread easily by contact with contaminated linens, it is best to sanitize them after the massage. If you, the therapist, have warts on your hands, forearms, or elbows, be sure they are covered during the massage.


Picture Credits:

Salvo Susan “Mosby’s Pathology for Massage Therapists, 4e.

Looking for Seriously Fast and Effective Cold Sore Relief?

Articles and Journals Referenced:

  1. Show me the science – When & how to use hand sanitizer. Retreived from
  2. Goodman CC, Fuller KS: Pathology: implications for the physical therapist, ed 4, St Louis, 2014, Elsevier.


Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at