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Shingles Treatment

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Updated March 31, 2014

Shingles is a painful rash caused by a reactivation of the varicella zoster virus, the same virus that causes chickenpox.

What Treatment Can Do

Treatments for shingles can do the following:
  • Speed the healing of the rash
  • Decrease the duration and pain of the rash
  • Make post-herpetic neuralgia less likely to occur, or less severe if it does occur.

Shingles Treatment: Antivirals, Corticosteroids

Please note that if you have a normal and healthy immune system, shingles treatment is most effective if you get medication within 72 hours (3 days) of developing a rash.

Your doctor may prescribe drugs known as corticosteroids and antivirals for shingles, such as Acyclovir.

If you have a compromised (weakened) immune system, you will probably receive similar treatment, but you need to be followed closely by your healthcare provider. You also probably will not receive corticosteroids, since they are riskier to take if your immune system is impaired. Always see your doctor for specific treatment options.

Treating Shingles Symptoms and Pain

Placing a soft, sterile non-sticky dressing or bandage over your lesions will protect your skin from clothing, and it will protect others from direct contact with open wounds. For pain related to an acute case of shingles, usually opoids are necessary. To prevent or treat post-herpetic neuralgia, the American Academy of Neurology states that any of the following may be necessary (but see your doctor for specific treatment):

  • Antidepressant drugs, specifically tricyclic antidepressants such as amitriptyline, nortriptyline, and desipramine
  • Anticonvulsants, such as gabapentin (Neurontin) or pregabalin (Lyrica)
  • Pain medications, either anti-inflammatory drugs like ibuprofen, or opioids, such as morphine sustained-release or fentanyl patches
  • Topical anesthetics, such as lidocaine gels or patches, which should be applied to healed, intact skin only.
  • Capsaicin is also growing in popularity as a pain treatment

Shingles Treatment for Herpes Zoster Ophthalmicus

Herpes zoster ophthalmicus is a serious complication that can occur if the shingles virus affects a certain nerve around the eye. People who are suspected to have this complication are treated with oral antiviral medications as above AND should have close follow-up with an ophthalmologist.

Sources:

Dubinsky, R.M., et al. "Practice Parameter: Treatment of Posterpetic Neuralgia." Neurology 63(2004): 959-65.

Finch, Roger, Dennis Maki, Allan Ronald. "Varicella-Zoster Virus Infections." Infectious Diseases, 2nd edition. Ed. Jonathan Cohen, et al. New York: Mosby, 2004. 125-9.

Gnann, John, and Richard Whitley. "Herpes Zoster." The New England Journal of Medicine 347(2002): 340-6.

Stalkup, Jennifer, et al. "Human Herpesviruses." Dermatology. Ed. Jean L Bolognia, MD, et al. London: Mosby, 2003. 1241-4.

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