How Shingles Is Treated

Senior African American man rubbing his shoulder
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Treating shingles, also known as herpes zoster (HZ), focuses on several things: speeding up healing of the rash and minimizing the pain associated with an outbreak and lessening the risk of complications—in particular post-herpetic neuralgia (PHN), which causes stabbing or burning pain that can plague a person for months or even years. Since PHN can develop right on the heels of a shingles outbreak, note that some of the treatment options that follow may be specific to relieving PHN.

Also important to be aware of: It's vital to treat shingles that affects the eye area, herpes zoster ophthalmicus, as quickly as possible. If not dealt with right away, it can lead to permanent damage to eyesight or even blindness. Since this type of shingles affects the eye, some of the treatment strategies for other areas of the body aren't safe. The oral antiviral medications described below are most important. And sometimes a doctor will prescribe a topical steroid depending on what part of the eye is involved.

Home Remedies and Lifestyle

In many ways, shingles is like any other infection: In addition to triggering an uncomfortable and unsightly rash, it makes you feel feverish, tired, and unwell all over. Therefore, one of the most important things you can do while dealing with it is to take good care of yourself in general or, if you're caring for someone else who has shingles, lavishing them with TLC.

Beyond that, you also should take measures to relieve pain.

  • Tend to your skin. Apply cool compresses as needed to help ease pain and dry out blisters. (Don't do this if you're using a topical cream or patch, such as those described below.)
  • Take a soothing soak. An oatmeal bath can provide relief from pain. You can buy packaged colloidal oatmeal bath products at the drugstore or supermarket, or make your own: Whir regular oatmeal, the kind you eat for breakfast, in a food processor until it's a fine powder. Add a cupful per inch of water to a warm (not hot) tub.
  • Dress for comfort. Friction from clothing can exacerbate pain. If your rash is on a part of your body that needs to be covered when you're out, wear something that fits loosely and is made from a natural fiber. 
  • Get plenty of rest. In addition to clocking adequate nighttime sleep, which for most people is between 7 and 9 hours, take naps during the day if you feel you need them.
  • Eat well. This means getting a balanced variety of nutritious foods at and between meals, and keeping those that are high in saturated fat, salt, and empty calories to a minimum. 
  • Move your body when you feel able. Try simple exercises like stretching or walking. (Check with your doctor if you're new to exercise.)
  • Distract yourself. Find ways to take your mind off pain and discomfort. This could be as simple as having a friend over to chat or focusing on a hobby—picking up that knitting project again, for example. Engage a child with shingles in a card game, puzzle, or other fun activity. 
  • De-stress. Turn to activities or practices that help you to relax, such as meditation, reading, or listening to soothing music.

Over-the-Counter (OTC) Therapies

Further relief for pain and itching from shingles is just a drugstore trip away.

These products are easy to find and don't require a doctor's prescription. in fact, some you already may have in your medicine chest at home.

  • OTC pain medications. A non-steroidal anti-inflammatory medication (NSAID) such as Tylenol (acetaminophen) or Motrin or Advil (ibuprofen) can be effective in alleviating mild to moderate pain. If you're giving an NSAID to a child with shingles, make sure the dose is appropriate for her age and weight (the label will tell you, but you also can check with her pediatrician). Do not give a child aspirin or any medication that contains aspirin: This medication is associated with an increased risk of Reye's syndrome, a rare disease that causes swelling of the brain and liver.
  • Antihistamines. An oral antihistamine such as Benadryl (diphenhydramine) may ease itching (but also causes drowsiness, so don't take it when you need to be focused or drive). You also might try a topical antihistamine. For instance, Benadryl comes as a spray, cream, or stick for applying directly to the skin.
  • Calamine lotion. Like topical antihistamines, calamine lotion can soothe itching and pain. If you don't like the classic thick pink stuff, you also can find a clear version. 
  • Lidocaine. This local anesthetic helps relieve pain by temporarily numbing the area that hurts. It's found in a variety of OTC skin-numbing creams, as well as in a patch called Lidoderm that sticks to skin and releases small amounts of lidocaine for up to 12 hours per day. Only use lidocaine (in any form) on skin that's intact—that is, still sore or itchy after blisters have healed, as is the case when shingles is followed by postherpetic neuralgia (PHN).  
  • Capsaicin. The active ingredient in chili peppers that sets your mouth on fire when you encounter it in a spicy salsa also has a numbing effect on the skin. It works by depleting a neurochemical called substance P that transmits pain signals. A number of studies have found that capsaicin is effective at relieving nerve-damage pain such as PHN. Most research has looked at prescription-only patches containing a high concentration (8 percent) of capsaicin. (The brand name is Qutenza). You can find creams containing lower doses of capsaicin in drugstores, health food stores, and online. One of these, Zostrix, contains 0.1 percent capsaicin. Talk to your doctor about the right amount for you. Whatever that turns out to be, it's a good idea to wear disposable gloves when you apply capsaicin and to take care not to touch the eye area or any areas of broken or sensitive skin.

Prescriptions

Early treatment is key to minimizing the severity of a shingles outbreak, starting with antiviral medications. Other drugs may be prescribed to alleviate pain and discomfort.

  • Antiviral medications. These prevent the varicella virus from multiplying, speed healing of skin lesions, and reduce the severity and duration of pain. They're most effective when given within 72 hours of the first appearance of a rash, so if you suspect an outbreak of blisters might be shingles, see your doctor right away. Keep in mind that if you don't manage to begin treatment with an antiviral drug within 72 hours, it still may be helpful to take one. There are three antiviral drugs for treating shingles: Zovirax (acyclovir), Famvir (famciclovir), and Valtrex (valacyclovir). People with compromised immune systems (such as organs donors and those with advanced infection with human immunodeficiency virus, or HIV) may require intravenous acyclovir. Acyclovir tends to be the least expensive of these but it must be taken more frequently than the other drugs.
  • Anticonvulsants. For pain relief, certain drugs used to control seizures sometimes help. Examples are Neurontin (gabapentin) and Lyrica (pregabalin), which may relieve PHN pain if used with an antiviral.
  • Tricyclic antidepressants. This class of antidepressants, which is different from the more well-known selective-serotonin reuptake inhibitors, or SSRIs, such as Prozac (fluoxetine), has been found to relieve nerve pain. Specific examples include amitriptyline (which is available only in generic form), Aventyl (nortriptyline), and Norpramin (desipramine).
  • Corticosteroids. Although they aren't commonly prescribed for shingles or PHN, corticosteroids are sometimes used in conjunction with antiviral medications in severe cases.  
  • Opioids. Certain transdermal opioid remedies, such as morphine sustained-release patches or fentanyl patches, have proven effective when shingles or PHN causes extreme pain. 

Complementary Alternative Medicine (CAM)

Although some alternative treatments for shingles have been considered, none have been researched enough to be considered viable. Among these are proteolytic enzymes, which are produced naturally by the pancreas to help digest protein from the diet. They also are found in certain foods, such as papaya and pineapple. Supplements derived from papaya (called papain), pineapple (called bromelain), and from animal pancreas can be found online, in health food stores, and in some grocery and drug stores. They are often marketed as digestive enzyme supplements.

In a 1995 German study of 192 people with shingles, half took proteolytic enzymes for 14 days and half took acyclovir. Both groups experienced similar pain relief and skin improvement, with the exception of skin redness, which showed greater improvement with the acyclovir treatment. The group taking proteolytic enzymes had significantly fewer side effects.

Even so, proteolytic enzymes can have some side effects, including digestive upset and allergic reactions. In particular, people with allergies to pineapple or papaya should avoid supplements derived from those fruit.

Proteolytic enzymes, particularly bromelain and papain, should not be taken with blood-thinners such as aspirin or Coumadin (warfarin) as it may increase the effect of these drugs. The proteolytic enzyme pancreatin also may interfere with the absorption of the vitamin folate. Given that there's so little evidence that proteolytic enzymes are truly helpful in relieving shingles symptoms and that they can have side effects, you should check with your doctor before taking them to treat shingles.

Sources:

Derry, S, Rice, AS, Cole, P, Tan, T, and Moore, RA. "Topical Capsaicin (High Concentration) for Chronic Neuropathic Pain in Adults." Cochrane Database Syst Rev. Jan 13, 2017; 1:CD007393. DOI: 10.1002/14651858.CD007393.pub4.

MedlinePlus. "Shingles—Aftercare." May 21, 2016.

National Institue on Aging.  Shingles. " Dec 31, 2016.

U.S. Centers for Disease Control and Prevention (CDC). "Shingles (Herpes Zoster): Clinical Overview." Atlanta, Georgia; May 1, 2014.

UpToDate. Albrecht, M., "Patient Education: Shingles (Beyond the Basics)." Mar 6, 2018.