Shingles Treatment Options

Reducing the Pain and Duration of an Oubreak

Senior African American man rubbing his shoulder
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Shingles is a painful rash caused by the same virus that causes chickenpox (varicella-zoster). If you have had chickenpox as the child, the virus will remain embedded in your nerves cells for the rest of your life.

Shingles occur later in adulthood when the virus suddenly reactivates. When this happens, the virus will travel along the nerve root that supplies a section of skin and cause a blistering rash.

Initial symptoms can include a headache, fever, and malaise, symptoms commonly mistaken for other illnesses. These are soon followed by tingling, itching, burning sensations, sensitivity to light, and sudden, glancing jolts of pain.

The initial rash outbreak will look similar to hives and will be confined a specific stripe or band of skin on one side of the body. The rash will rapidly form into tiny blisters and begin to crust over within a week to 10 days. The pain from a shingles outbreak can be extreme, even agonizing.

Goals of Shingles Treatment

Shingles are usually diagnosed based on the characteristic appearance of the rash. Treatment options are focused on two things: speeding up the healing process and minimizing the pain associated with an outbreak.

Treatment may also lessen the risk of post-herpetic neuralgia, a condition where you can feel stabbing or burning pains for months or even years following an episode.

Shingles Treatment Options

Early treatment offers the best opportunity to minimize the severity of a shingles outbreak. Ideally, a course of antiviral drugs should be given within 72 hours of the first appearance of the rash. Acyclovir has long been the drug of choice, although valacyclovir and famciclovir have proved to be just as effective.

Corticosteroids are less commonly prescribed but may be used in conjunction with an antiviral in more severe cases. People with compromised immune systems (such as organs donors or persons with advanced HIV infection) may require intravenous acyclovir.

Treating Shingles Pain

While shingles pain can be excruciating for some, there are ways to get relief. Over-the-counter pain medications, such as acetaminophen or ibuprofen, can be effective in alleviating mild to moderate pain. Calamine lotion is also often used to soothe the blistering rash.

To prevent direct painful contact with the open sores, apply a soft, non-sticky sterile dressing and change regularly to prevent the crusted lesions from sticking.

Other options include:

  • Antidepressant drugs (specifically tricyclic antidepressants such as amitriptyline, nortriptyline, or desipramine) are known to relieve nerve pain.
  • Anticonvulsants, such as gabapentin or pregabalin, have a similar effect and may help reduce post-herpetic neuralgia if used with an antiviral.
  • Certain transdermal opioid remedies, such as morphine sustained-release patches or fentanyl patches, have proven effective in more severe cases.
  • The numbing effect of lidocaine cream can also help but should only be applied to healed, intact skin.
  • Capsaicin, the active ingredient in chili peppers, can also provide pain relief to healed skin.

Treatment of Herpes Zoster Ophthalmicus

Among the many complications of shingles, herpes zoster ophthalmicus is one of the most concerning. It is a serious condition that can occur if shingles develop around the forehead or eye. If left untreated, it can seriously affect vision and even lead to blindness.

People diagnosed with herpes zoster ophthalmicus are typically treated with oral antiviral drugs.A topical corticosteroid may also be used if the cornea or uvea of the eye is involved.

Sources

  • U.S. Centers for Disease Control and Prevention (CDC). "Shingles (Herpes Zoster): Clinical Overview." Atlanta, Georgia; May 1, 2014.
  • Gnann, J. and Whitley, R. "Herpes Zoster." New England Journal of Medicine 2002; 347:340-6.

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