Shingles treatment options
Two main aims of treating shingles are:
- To ease any pain and discomfort during the episode of shingles.
- To prevent, as much as possible, complications from developing.
Loose-fitting cotton clothes are best to reduce irritating the affected area of skin. Pain may be eased by cooling the affected area with ice cubes (wrapped in a plastic bag), wet dressings, or a cool bath. A non-adherent dressing that covers the rash when it is blistered and raw may help to reduce pain caused by contact with clothing. Simple creams (emollients) may be helpful if the rash is itchy.
What about painkillers?
Painkillers - for example, paracetamol, or paracetamol combined with codeine (such as co-codamol), or anti-inflammatory painkillers (such as ibuprofen) - may give some relief. Strong painkillers (such as oxycodone and tramadol) may be needed in some cases.
Some painkillers are particularly useful for nerve pain. If the pain during an episode of shingles is severe, or if you develop postherpetic neuralgia (PHN), you may be advised to take:
- An antidepressant medicine in the tricyclic group. An antidepressant is not used here to treat depression. Tricyclic antidepressants, such as amitriptyline, imipramine and nortriptyline, ease nerve pain (neuralgia) separate to their action on depression; or
- An anticonvulsant medicine such as gabapentin or pregabalin. They also ease neuralgic pain separate to their action to control convulsions.
If an antidepressant or anticonvulsant is advised, you should take it regularly as prescribed. It may take up to two or more weeks for it to become fully effective to ease pain. In addition to easing pain during an episode of shingles, they may also help to prevent PHN. See separate leaflet called Postherpetic Neuralgia for more information.
What about antiviral medicines?
Antiviral medicines include aciclovir, famciclovir and valaciclovir. An antiviral medicine does not kill the virus but works by stopping the virus from multiplying. So, it may limit the severity of symptoms of the shingles episode. It had also been hoped that antiviral medicines would reduce the risk of pain persisting into PHN. However, the research so far has shown that the current antiviral medicines taken during an episode of shingles do not seem to have much impact on the prevention of PHN. Further research is needed in this area to determine if newer antiviral drugs can prevent PHN.
An antiviral medicine is most useful when started in the early stages of shingles (within 72 hours of the rash appearing). However, in some cases your doctor may still advise you have an antiviral medicine even if the rash is more than 72 hours old - particularly in elderly people with severe shingles, or if shingles affects an eye.
Antiviral medicines are not advised routinely for everybody with shingles. For example, young adults and children who develop shingles on their tummy (abdomen) very often have mild symptoms and have a low risk of developing complications. Therefore, in this situation an antiviral medicine is not necessary. Your doctor will advise if you should take an antiviral medicine.
As a general rule, the following groups of people who develop shingles will normally be advised to take an antiviral medicine:
- If you are over the age of 50. The older you are, the more risk there is of severe shingles or complications developing and the more likely you are to benefit from treatment.
- If you are of any age and have any of the following:
- Shingles that affects the eye or ear.
- A poorly functioning immune system (immunosuppression - see later for who is included).
- Shingles that affects any parts of the body apart from the trunk (that is, shingles affecting an arm, leg, neck, or genital area).
- Moderate or severe pain.
- Moderate or severe rash.
If prescribed, a course of an antiviral medicine normally lasts seven days.
What about steroid medication?
Steroids help to reduce swelling (inflammation). A short course of steroid tablets (prednisolone) may be considered in addition to antiviral medication. This may help to reduce pain and speed healing of the rash. However, the use of steroids in shingles is controversial. Your doctor will advise you. Steroids do not prevent PHN.
Further reading and references
Immunisation against infectious disease - the Green Book (latest edition); Public Health England
Gagliardi AM, Andriolo BN, Torloni MR, et al; Vaccines for preventing herpes zoster in older adults. Cochrane Database Syst Rev. 2016 Mar 33:CD008858. doi: 10.1002/14651858.CD008858.pub3.
Who is eligible for the shingles vaccine beyond 2016; Public Health England
Cohen JI; Clinical practice: Herpes zoster. N Engl J Med. 2013 Jul 18369(3):255-63. doi: 10.1056/NEJMcp1302674.
After three visits to the ER with horrible pain and three ultrasounds, three CT’s w/ contrast later with no findings! During my 3rd visit I suggested can this be shingles? I only had a small...Believe2128
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