Shingles - Treatments

Introduction Causes Symptoms Treatments

There is no cure for shingles, but treatment may shorten the length of illness and prevent complications. Treatment options include:

  • Antiviral medicines to reduce the pain and duration of shingles.   
  • Pain medicines, antidepressants, and topical creams to relieve long-term pain.

Initial treatment

  • As soon as you are diagnosed with shingles, your doctor probably will start treatment with antiviral medicines. If you begin medicines within the first 2 days of seeing the shingles rash , you have a lower chance of having later problems, such as postherpetic neuralgia. Early treatment of shingles is important, because the problems that can arise can be serious and resistant to treatment. For example, 40% to 50% of people with postherpetic neuralgia do not respond to treatment

Treatment for Shingles

Most common

  • Antiviral medicines, such as acyclovir, famciclovir, or valacyclovir, to reduce the pain and the duration of shingles.
  • Over-the-counter pain medicines, such as acetaminophen, aspirin, or ibuprofen, to help reduce pain during an attack of shingles.
  • Topical antibiotics, applied directly to the skin, to stop infection of the blisters.
  • Corticosteroids also may be used to reduce pain in people younger than 50 who have had a recent outbreak of shingles.

 

Ongoing treatment

  • Antidepressant medicines, such as a tricyclic antidepressant (for example, amitriptyline).
  • Topical anesthetics, such as lidocaine patches, to numb the area.
  • Anticonvulsant medicines, such as gabapentin or pregabalin.
  • Opioids, such as codeine.
  • Topical creams containing capsaicin may provide some relief from pain. Capsaicin may irritate or burn the skin of some people, and it should be used with caution.
  • If you have pain that persists longer than a month after your shingles rash heals, your doctor may diagnose postherpetic neuralgia, the most common complication of shingles. Postherpetic neuralgia can cause pain for months or years. It affects 10% to 15% of those who experience shingles. Treatment to reduce the pain of postherpetic neuralgia includes the weekly application of liquid nitrogen spray over the region.  Enough is applied to get a 1 or 2 second frost.  Early studies have shown that the pain severity is significantly reduced after 3 to 5 sessions.  

 

Treatment if the condition gets worse

  • In some cases, shingles causes long-term complications. Treatment depends on the specific complication.
  • Postherpetic neuralgia is persistent pain that lasts months or even years after the shingles rash heals. Certain medicines, such as anticonvulsants, antidepressants, and opioids, can relieve pain. Most cases of postherpetic neuralgia resolve within a year. In very rare cases, surgical treatment may be used to treat postherpetic neuralgia by cutting nerves to help block pain signals.
  • Disseminated zoster is a blistery rash over a large portion of your body. It may affect your heart, lungs, liver, pancreas, joints, and intestinal tract. Treatment may include both antiviral medicines to prevent the virus from multiplying and antibiotics to stop infection.
  • Herpes zoster ophthalmicus  is a rash on the forehead, cheek, nose, and around one eye, which could threaten your sight. You should seek prompt treatment from an ophthalmologist for this condition. 2 Treatment may include rest, cool compresses, and antiviral medicines.
  • If the shingles virus affects the nerves originating in the brain (cranial nerves), serious complications involving the face, eyes, nose, and brain can develop. Treatment depends on the nature and location of the complication.

 

Medications

  • Medicines can help limit the pain and discomfort caused by shingles, shorten the time you have symptoms, and prevent the spread of the disease. Medicines also may reduce your chances of developing shingles complications, such as postherpetic neuralgia or disseminated zoster. Early treatment of shingles is important, because the possible complications can be serious and resistant to treatment. For example, 40% to 50% of people with postherpetic neuralgia do not respond to treatment. 5

Medication Choices

  • Medicines to treat shingles when the rash  is present (active stage) may include:
  • Over-the-counter pain medicines, such as acetaminophen, aspirin, or ibuprofen, to help reduce pain.
  • Antiviral medicines, to reduce the pain and duration of shingles.
  • Topical antibiotics, which are applied directly to the skin, to stop infection of the blisters.
  • Corticosteroids also may be used to reduce pain in people younger than 50 who have had a recent outbreak of shingles.

Medicines to treat postherpetic neuralgia pain may include:

  • Over-the-counter pain medicines, such as acetaminophen, aspirin, or ibuprofen.
  • Tricyclic antidepressants, such as amitriptyline.
  • Topical medicines, such as a lidocaine patch.
  • Anticonvulsants, such as gabapentin or pregabalin.
  • Corticosteroids, such as prednisone.
  • Weekly Liquid nitrogen sprays over the region.
  • Nerve block injections.
  • Opioids, such as codeine, oxycodone, and morphine.

 

What To Think About

  • For some people, nonprescription pain relievers (analgesics) are enough to help control pain caused by shingles or postherpetic neuralgia.
  • A prescription medicine called pregabalin ( Lyrica) has been approved for the treatment of pain caused by postherpetic neuralgia. In tests, it provided rapid and long-lasting pain relief.