Over the counter shingles

6 Natural Treatments for Shingles

Natural remedies for shingles

Shingles (herpes zoster) is a viral infection that causes a painful rash. The varicella zoster (VZV) virus causes this viral infection. It’s the same virus that causes chickenpox.

If you had chickenpox as a child, the shingles virus lies dormant in your body. The virus can reactivate later in life and cause a shingles rash. The rash can occur on any part of your body but typically only affects small sections.

Pain is usually the first symptom of shingles. The rash and fluid-filled blisters form within a couple of days after the onset of pain. Some people with shingles also have a fever, sensitivity to light, and fatigue.

According to the Centers for Disease Control and Prevention (CDC), about 1 in 3 people in the United States will develop shingles at some point in their lifetime.

The shingles virus can last between two and six weeks. Shingles isn’t life-threatening, but some people experience postherpetic neuralgia. This is when nerve fibers become damaged, causing shingles pain that lasts for weeks or months after the rash clears.

There’s no cure for shingles, but your doctor can prescribe antiviral medication to help shorten the duration of the virus and reduce symptoms.

Although an antiviral is an effective treatment for shingles, it’s not the only option. Several natural remedies may also reduce pain and discomfort.

1. Healing baths

Daily cleansing of the blisters reduces the risk of spreading the infection. Take a cool bath or shower to soothe skin. The coolness of the water can ease pain from shingles blisters and calm itchiness.

You can also take a healing bath to reduce symptoms. Pour 1 to 2 cups of colloidal oatmeal or cornstarch into lukewarm bathwater and soak for 15 to 20 minutes. Do not use hot water. Hot water can worsen shingles blisters because heat increases blood flow.

Dry your body completely and then wash your towel to avoid spreading the virus to others.

2. Wet, cool compress

In addition to taking a bath to relieve pain and itchiness associated with a shingles rash, apply a cool, moist compress. Do this several times throughout the day to relieve symptoms. Soak a cloth in cool water, wring out the water, and apply the cloth to the rash and blisters.

The coolness of the compress can reduce pain. Repeat the process as often as you need. Do not apply an ice pack to the rash. The coldness may increase skin sensitivity and worsen pain.

3. Baking soda and cornstarch paste

Create a paste using cornstarch or baking soda and water to naturally relieve itching caused by a shingles rash.

Pour two parts cornstarch or baking soda into a cup. Add one part water to get the desired consistency for the paste. Apply the mixture to your rash. Rinse it off after 10 to 15 minutes. Repeat several times a day as needed.

4. Soothing lotions and creams

Scratching a shingles rash can cause scarring and prolong blisters. If itching doesn’t improve after a healing bath, a cool compress, or a baking soda or cornstarch mixture, use soothing lotions and creams.

Lotions and creams don’t speed up the healing process, but they can increase your comfort level. Avoid scented or perfumed lotions. They can cause further irritation. Find a great selection of unscented lotions here.

Use lotions and creams sparingly. Heavy application can keep sores from drying out and lengthen the healing process. For the same reasons, don’t use antibiotic ointments on the sores.

If you decide to use creams or lotions, it would be more effective if you applied one containing the natural ingredient capsaicin, up to three or four times per day. This is the active ingredient in chili peppers.

Capsaicin has an anti-inflammatory effect to help ease pain. Pain may increase after initially applying the cream, but it’ll slowly go away. This cream works by reducing pain signals sent to your brain.

Additionally, you can apply calamine lotion after baths and showers to soothe irritated skin and help dry out blisters.

5. Dietary remedies

A weakened immune system worsens shingles. Some dietary changes can strengthen your immune system and prevent shingles from spreading to other parts of your body. Take steps to boost the function of your immune system by eating certain foods and avoiding others.

A shingles diet consists of foods with vitamins A, B-12, C, and E, and the amino acid lysine. Foods that promote healing include:

  • orange and yellow fruits
  • leafy green vegetables
  • red meat
  • eggs
  • chicken
  • wild-caught fish
  • dairy
  • whole grains
  • legumes
  • beans
  • tomatoes
  • spinach

As you heal and cope with the effects of shingles, you might crave comfort foods. However, you should avoid certain foods if you have shingles. Foods to avoid include:

  • food and juices with high amounts of sugar
  • arginine-rich foods (including chocolate, gelatin, and nuts)
  • refined carbohydrates
  • foods high in saturated fat

Eating too much of these foods can weaken the immune system and potentially prolong the virus. Foods with high levels of arginine can even cause the virus to reproduce.

6. Homeopathic or herbal remedies

You might consider homeopathic remedies along with conventional therapy to help with your shingles symptoms. Homeopathy is an alternative medicine that embraces the approach of allowing the body to heal itself.

Currently, there’s little scientific evidence that supports the use of homeopathic medicine as a treatment for any condition. Additionally, the United States Food and Drug Administration (FDA) does not regulate the safety or efficacy of any homeopathic remedies.

If you’re considering using any homeopathic remedies, be sure to talk to your doctor first.

Some supplements and herbal medicines may also help your body fight the virus, and treat insomnia and anxiety due to shingles. These include:

  • melatonin
  • St. John’s Wort
  • oregano oil
  • Echinacea
  • lemon balm
  • green tea
  • essential fatty acids

Consult your doctor before taking any supplements. Be sure you have the correct diagnosis. If your condition worsens, seek immediate medical care.

The takeaway

Understand that natural remedies don’t work for everyone. Even if you find an effective natural remedy, there’s no cure for shingles. The virus has to run its course.

However, nonconventional remedies may decrease your discomfort and irritation — and speed the healing process — when used in conjunction with conventional therapy.

What Are the Treatments for Cold Sores?

You can’t cure HSV or a cold sore, but you can alleviate the pain it causes by avoiding spicy or acidic foods, applying ice, and using over-the-counter remedies. Look for medicines that contain numbing agents such as phenol and menthol to reduce cracking and soften scabs. Abreva is an over-the-counter topical remedy used to help speed healing and minimize pain from a cold sore. It must be used many times a day to speed the healing.

If your cold sore is especially painful or irritating, your doctor may prescribe an anesthetic gel to alleviate pain or an antiviral oral medication to speed healing or prevent recurrence. The antiviral medicines available for treatment include acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). These oral medications are more effective when started within the first 48 hours of the outbreak. Valacyclovir is more expensive, but is better absorbed in the digestive tract and therefore more reliable. Acyclovir and another antiviral medication called penciclovir (Denavir) also come in a topical form.

Cold sores can become complicated by a bacterial infection, so it is also important to keep them clean by washing gently with soap and water as needed.

Oral Antivirals for Cold Sores

Topic Overview

Most cold sores heal on their own without prescription medicines. But some antiviral medicines (such as acyclovir or famciclovir) when taken orally (tablets) may be helpful in reducing the frequency and severity of attacks of cold sores .

Doctors may prescribe oral antiviral medicines that can be taken daily to prevent future outbreaks of cold sores. These medicines may also be given during periods of increased risk of getting cold sores (such as during cosmetic surgery or sun exposure).

Oral antivirals work best in treating recurring cold sores if they are taken within 24 to 48 hours of an outbreak of cold sores.

Pregnant or nursing women should seek their doctors’ advice prior to taking antiviral medicines. Those with kidney problems may be advised to take lower doses.

Some examples of oral antiviral medicines prescribed to treat cold sores include the following:

Acyclovir

Acyclovir (Zovirax) tablets may slightly shorten the duration of pain and the healing time of a first attack of cold sores. footnote 1

Common side effects of acyclovir tablets include nausea, diarrhea, and headache.

A lower dose of oral acyclovir is needed for people who have reduced kidney function.

Famciclovir

Famciclovir (Famvir) is sometimes used to treat the herpes virus that causes cold sores and genital herpes (as well as the virus that causes shingles). This medicine is available only by prescription and is taken orally in tablet form.

If you are pregnant or nursing, you should talk with your doctor before taking famciclovir.

This medicine is not recommended for people who have had an allergic reaction to it in the past.

Possible mild side effects include itching, fever, headache, fatigue, nausea, or diarrhea.

Valacyclovir

Valacyclovir (Valtrex) capsules are available by prescription only. It is absorbed by the body much better than some other antiviral medicines (such as acyclovir).

Possible side effects include skin rash, allergic reaction , headache, dizziness, insomnia , and fatigue .

Children, pregnant women, and people who have HIV or who have had bone marrow or kidney transplants should talk with their doctors before taking this medicine.

Cold Sores: Management and Treatment

How do you get rid of a cold sore?

Although it may take a while to get rid of a cold sore, some medicines can shorten the healing time and make the symptoms less painful. Cold sore treatments include:

  • Over-the-counter medications: You can buy without a prescription creams or ointments that you apply directly to the cold sore. If you start using these creams when you first notice tingling or itching — before the cold sore forms — you may be able to prevent the cold sore from appearing.
  • Oral antiviral medicine: Your doctor may prescribe an antiviral medication that you take orally (by mouth).
  • Intravenous (IV) antiviral medicine: If other medications aren’t working, your doctor may need to prescribe an antiviral medication that will be administered through an IV. In this case, your doctor will monitor you closely throughout treatment.

What are the complications associated with cold sores?

Although complications from cold sores are rare, they can include:

  • Eye infections: The herpes simplex virus (HSV-1) can spread to the eye when someone touches a cold sore and then touches their eye. If HSV-1 spreads to the eye, it can cause HSV keratitis — a potentially serious infection of the cornea. Severe HSV keratitis infections can lead to blindness.
  • Genital sores: HSV-1 can spread to the genitals through oral sex, producing warts or ulcers on the genitals or anus. But even though people sometimes call it oral herpes, HSV-1 is not the same as HSV-2, the sexually transmitted virus that causes most cases of genital herpes.

For certain groups of people, cold sores can lead to serious complications. The following groups of people should receive medical treatment immediately if they have a cold sore:

  • Newborns: Babies under 6 months old may develop complications such as high fever and seizures because their immune systems aren’t fully developed.
  • Immunocompromised people: For people with weakened immune systems, the herpes simplex virus can lead to encephalitis (swelling of the brain). If you have HIV or are undergoing chemotherapy, cold sores could be more severe and could take longer to go away.
  • People who have eczema: The herpes simplex virus can cause a life-threatening infection called eczema herpeticum in adults and children with eczema. It is important to see your doctor right away if you have eczema and you develop a cold sore.

What can I do to help relieve symptoms of cold sores?

While cold sores are uncomfortable, you can find relief at home. Suggestions to help manage cold sores:

  • Use over-the-counter creams and ointments: These remedies can help shorten the healing time and ease your symptoms. They are most effective when you use them as soon as you feel a cold sore coming on.
  • Take pain relievers: If you are in a lot of pain, your doctor may recommend an over-the-counter topical pain reliever such as lidocaine that you can apply directly to the cold sore. You can also take acetaminophen or ibuprofen by mouth to ease your discomfort.
  • Wear sunscreen and SPF lip balm: It is important to make sure a cold sore doesn’t get sunburned while it is healing. Also, wearing a lip balm with SPF 30 every day could prevent future cold sores.
  • Avoid acidic foods: Orange juice, tomatoes and other acidic foods can aggravate a cold sore.
  • Apply a cool compress: You can use a cool, damp washcloth to soothe a cold sore. Apply it for a few minutes off and on throughout the day. Be sure to wash the towel after you’ve used it to avoid spreading the cold sore to others.

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Dr Sarah Jarvis MBE

What are the symptoms of shingles?

Symptoms occur in the area of skin that is supplied by the affected nerve fibres. The usual symptoms are pain and a rash. Occasionally, two or three nerves next to each other are affected. Very rarely, shingles can affect both sides of the body, but this is usually in people with a weakened immune system.

The most commonly involved nerves are those supplying the skin on the chest or tummy (abdomen). The upper face (including an eye) is also a common site.

The pain is a localised band of pain. It can be anywhere on your body, depending on which nerve is affected. The pain can range from mild to severe. You may have a constant dull, burning, or gnawing pain. In addition, or instead, you may have sharp and stabbing pains that come and go. The affected area of skin is usually tender.

The rash typically appears 2-3 days after the pain begins. Red blotches appear that quickly develop into itchy fluid-filled blisters. The rash looks like chickenpox but only appears on the band of skin supplied by the affected nerve. New blisters may appear for up to a week. The soft tissues under and around the rash may become swollen for a while due to inflammation caused by the virus. The blisters then dry up, form scabs and gradually fade away. Slight scarring may occur where the blisters have been. The picture shows a scabbing rash (a few days old) of a fairly bad bout of shingles. In this person, it has affected a nerve and the skin that the nerve supplies, on the left side of the abdomen.

Signs of shingles

Images above by Mariegriffiths via Wikimedia Commons

An episode of shingles usually lasts 2-4 weeks. In some cases there is a rash but no pain. Rarely, there is no rash but just a band of pain.

You may also feel you have a high temperature (feel feverish) and feel unwell for a few days.

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Shingles is a painful, blistery rash in one specific area of your body. Most of us get chickenpox in our lives, usually when we are children. Shingles is a reactivation of that chickenpox virus but only in one nerve root. So instead of getting spots all over your body, as you do when you have chickenpox, you get them just in one area of your body.

It is almost always just on one side of your body, although it may go right around from front to back, following the skin the nerve affects. The affected skin hurts, and it may start to hurt before the rash appears, and may keep hurting for some time after the rash has gone. You may feel generally off-colour and not yourself.

Is shingles contagious?

You can catch chickenpox from someone with shingles if you have not had chickenpox before. But most adults and older children have already had chickenpox and so are immune from catching chickenpox again. You cannot get shingles from someone who has shingles.

The shingles rash is contagious (for someone else to catch chickenpox) until all the blisters (vesicles) have scabbed and are dry. If the blisters are covered with a dressing, it is unlikely that the virus will pass on to others. This is because the virus is passed on by direct contact with the blisters. If you have a job, you can return to work once the blisters have dried up, or earlier if you keep the rash covered and feel well enough. Similarly children with shingles can go to school if the rash is covered by clothes and they do not feel unwell.

Pregnant women who have not had chickenpox should avoid people with shingles. See the separate leaflet called Chickenpox Contact in Pregnancy for more details. Also, if you have a poor immune system (immunosuppression), you should avoid people with shingles. (See below for a list of people who have a poor immune system.) These general rules are to be on the safe side, as it is direct contact with the rash that usually passes on the virus.

Can other people catch it?

This one is confusing! You can catch chickenpox from other people, but you can’t catch shingles from other people. You only get shingles from a reactivation of your own chickenpox infection in the past.

So if you have shingles, and you come into contact with somebody else, they cannot ‘catch’ your shingles. But if they have never had chickenpox, it is possible that they could catch chickenpox from you. (And if you had chickenpox, and came into contact with somebody else who had never had chickenpox, they could catch chickenpox. But they couldn’t ‘catch’ shingles from your chickenpox.)

To put it another way, no, you don’t ‘catch’ shingles. It comes from a virus hiding out in your own body, not from someone else. But if you have shingles, you may be infectious, as it is possible for people to catch chickenpox from you.

Only people who have never had chickenpox are likely to be at risk of catching chickenpox from your shingles. People who have had chickenpox should be immune from catching it again. If the rash is in a covered area of skin, the risk of anyone with whom you are not in close contact catching chickenpox is very low.

How common is it?

Shingles is an infection of a nerve and the area of skin supplied by the nerve. It is caused by a virus called the varicella-zoster virus. It is the same virus that causes chickenpox. Anyone who has had chickenpox in the past may develop shingles. Shingles is sometimes called herpes zoster. (Note: this is very different to genital herpes which is caused by a different virus called herpes simplex.)

About 1 in 4 people have shingles at some time in their lives. It can occur at any age but it is most common in older adults (over the age of 50 years). After the age of 50, it becomes increasingly more common as you get older. It is uncommon to have shingles more than once but some people do have it more than once.

Causes of shingles

Most people have chickenpox at some stage (usually as a child). The virus does not completely go after you have chickenpox. Some virus particles remain inactive in the nerve roots next to your spinal cord. They do no harm there and cause no symptoms. For reasons that are not clear, the virus may begin to multiply again (reactivate). This is often years later. The reactivated virus travels along the nerve to the skin to cause shingles.

In most cases, an episode of shingles occurs for no apparent reason. Sometimes a period of stress or illness seems to trigger it. A slight ageing of the immune system may account for it being more common in older people. (The immune system keeps the virus inactive and prevents it from multiplying. A slight weakening of the immune system in older people may account for the virus reactivating and multiplying to cause shingles.)

The risk of getting shingles increases in people with a poor immune system (immunosuppression). For example, shingles commonly occurs in younger people who have HIV/AIDS or whose immune system is suppressed with treatment such as steroids or chemotherapy.

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.

General measures

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. Calamine lotion can help to cool the skin and reduce mild itchiness.

Painkillers for shingles

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 the separate leaflet called Postherpetic Neuralgia for more information.

Antiviral medicines for shingles

Antiviral medicines used to treat shingles 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.

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. 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.

Steroid medication for shingles

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.

Are there any tests for shingles?

Tests are not usually done for shingles. The rash can be recognised by its typical pattern and symptoms.

Should I see a doctor?

It is usually worth seeing a doctor to be certain about the diagnosis and to see if you need treatment or not. Ideally you should see a doctor as soon as possible after the rash appears.

The rash of shingles can be very painful. So even if the doctor doesn’t think you need an anti-shingles medicine, they may be able to give you stronger painkillers than those you can buy over the counter from the chemist.

What if I have shingles and a poor immune system?

If you have a poor immune system (immunosuppression) and develop shingles then see your doctor straightaway. You will normally be given antiviral medication whatever your age and will be monitored for complications. People with a poor immune system include:

  • People taking high-dose steroids. (This means adults taking 40 mg prednisolone (steroid tablets) per day for more than one week in the previous three months. Or, children who have taken steroids within the previous three months, equivalent to prednisolone 2 mg/kg per day for at least one week, or 1 mg/kg per day for one month.)
  • People on lower doses of steroids in combination with other immunosuppressant medicines.
  • People taking anti-arthritis medications which can affect the bone marrow.
  • People being treated with chemotherapy or generalised radiotherapy, or who have had these treatments within the previous six months.
  • People who have had an organ transplant and are on immunosuppressive treatment.
  • People who have had a bone marrow transplant and who are still immunosuppressed.
  • People with an impaired immune system.
  • People who are immunosuppressed with HIV infection.

What complications are there from shingles?

Most people do not have any complications. Those that sometimes occur include the following.

Postherpetic neuralgia (PHN)

This is the most common complication. It is where the nerve pain (neuralgia) of shingles persists after the rash has gone. See the separate leaflet called Postherpetic Neuralgia for more details.

Skin infection

Sometimes the rash becomes infected with germs (bacteria). The surrounding skin then becomes red and tender. If this occurs you may need a course of medicines called antibiotics.

Eye problems

Shingles of the eye can cause inflammation of the front of the eye. In severe cases it can lead to inflammation of the whole of the eye which may cause loss of vision.

Weakness

Sometimes the nerve affected is a motor nerve (ones which control muscles) and not a usual sensory nerve (ones for touch). This may result in a weakness (palsy) of the muscles that are supplied by the nerve.

Various other rare complications

Examples are infection of the brain by the varicella-zoster virus, or spread of the virus throughout the body. These are very serious but rare. People with a poor immune system (immunosuppression) who develop shingles have a higher than normal risk of developing rare or serious complications. (For example, people with HIV/AIDS, people on chemotherapy, etc.)

Is there a shingles vaccine?

In the UK there is a shingles vaccine immunisation programme for people aged 70 years to protect against herpes zoster. There is also a catch-up programme which offers the vaccine to certain people aged between 70 and 79 years who may have previously missed out on immunisation. The vaccine is licensed for people over 50 years, and if you are not eligible for the vaccine on the NHS, your pharmacist may be able to provide the vaccine as a private (paid for service.

The chickenpox vaccine is not routinely given to children in the UK but is offered to people who are in close contact with someone who is particularly vulnerable to chickenpox or its complications – eg, people with a weakened immune system.

Did you know your local pharmacist can vaccinate against shingles? Book a consultation today.

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Can I Prevent Shingles?

There are two shingles vaccines. Shingrix (RZV) is recommended over the older vaccine, Zostavax, because it is more than 90% effective in preventing a shingles outbreak

Who should get it: The CDC recommends that you get this vaccine if you’re 50 or older whether or not you remember having had chickenpox, because most people have been exposed to the virus. If you have had the Zostavax vaccine, you can also have Shingrix.

How many shots do you need? You would need two shots for Shingrix. One initially, with a follow up in 6 months.

What it does: Shingrix reduces your chance of getting shingles by more than 90%. Even if you still get shingles, the vaccine may help it be less painful.

I never had chickenpox. Do I still need the shingles vaccine? Yes, you do. Shingrix is recommended for everyone age 50 and older, whether or not you remember having had chickenpox.

If I’ve had shingles, can I still get the vaccine? Yes. It may help prevent you having another bout of shingles later on. If you have shingles right now, you should wait until the rash is gone before you get vaccinated.

What are the side effects? The most common side effects with Shingrix include pain and swelling where you got the shot, muscle pain, tiredness, headache, chills, fever, and stomach troubles. With any vaccine there is a chance of a severe allergic reaction. Also since Zostavax is a live virus vaccine, it is also possible to get a small chicken-pox like rash around the spot where you got the shot.

Shingles

Shingles, or herpes zoster, is a common infection of the nerves. It is caused by a virus. Shingles triggers a painful rash or small blisters on an area of skin. It can appear anywhere on the body, but it typically appears on only one side of the face or body. Burning or shooting pain and tingling or itching are early signs of the infection. Even after the rash is gone, the pain can continue for months, even years.

What causes shingles?

Shingles is caused when the chickenpox virus is reactivated. After a person has had chickenpox, the virus lies dormant in certain nerves for many years. Shingles is more common in people with weakened immune systems, and in people over the age of 50.

However, each person may experience symptoms differently. Symptoms may include:

  • Skin sensitivity, tingling, itching, and/or pain in the area of the skin before the rash appears
  • Rash, which typically appears after 1 to 5 days once symptoms begin and initially looks like small, red spots that turn into blisters
  • Blisters typically scab over in 7 to 10 days and clear up within 2 to 4 weeks

Other early symptoms of shingles may include:

  • Stomach upset
  • Feeling ill
  • Fever and/or chills
  • Headache

The symptoms of shingles may look like other medical conditions or problems. Always talk with your healthcare provider for a diagnosis.

Your healthcare provider will do a complete physical exam and ask about your medical history, specifically about whether you have ever had chickenpox.

Your healthcare provider will likely know right away that it is shingles based on the unique rash. The rash usually appears one area on one side of the body or face. It appears as red spots, small fluid- or pus-filled vesicles, or scabs.

The healthcare provider may also take skin scrapings for testing.

Specific treatment for shingles will be determined by your healthcare provider based on:

  • Your age, overall health, and medical history
  • How long the shingles have been present (some medicines are not as effective if given more than 2 to 3 days after the rash has appeared)
  • Extent of the condition
  • Your tolerance for specific medicines, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

There is no cure for shingles. It simply has to run its course. Treatment focuses on pain relief. Painkillers may help relieve some of the pain. Antiviral drugs may help lessen some of the symptoms and reduce nerve damage. Other treatments may include:

  • Creams or lotions to help relieve itching
  • Cool compresses applied to affected skin areas
  • Antiviral medicines (such as acyclovir, valacyclovir, and famciclovir)
  • Steroids
  • Antidepressants
  • Anticonvulsants

What are the complications of shingles?

Symptoms of shingles usually don’t last longer than 3 to 5 weeks. However, complications can happen. The main complications that can result from shingles include:

  • Postherpetic neuralgia (PHN). The most common complication of shingles is called postherpetic neuralgia (PHN). This continuous, chronic pain lasts even after the skin lesions have healed. The pain may be severe in the area where the blisters were present. The affected skin may be very sensitive to heat and cold.
    If you had severe pain during the active rash or have impaired senses, you are at increased risk for PHN. The elderly are also at greater risk. Early treatment of shingles may prevent PHN. Pain relievers and steroid treatment may be used to treat the pain and inflammation. Other treatments include antiviral drugs, antidepressants, anticonvulsants, and topical agents.
  • Bacterial infection. A bacterial infection of the skin where the rash happens is another complication. Rarely, infections can lead to more problems, such as tissue death and scarring. When an infection happens near or on the eyes, a corneal infection can happen. This can lead to temporary or permanent blindness.

Two different vaccines are available to prevent shingles. Experts recommend vaccination for all adults 50 and older, even if you’ve had shingles before. Talk with your healthcare provider about the most appropriate time for you to get vaccinated, and which vaccine is best for you.

When should I call my healthcare provider?

To reduce the severity and shorten the length of the illness, treatment must be started as soon as possible. If you think you have shingles, call your healthcare provider as soon as possible.

Key points about shingles

  • Shingles is a common viral infection of the nerves. It causes a painful rash or small blisters on an area of skin.
  • Shingles is caused when the chickenpox virus is reactivated.
  • It is more common in people with weakened immune systems, and in people over the age of 50.
  • Shingles starts with skin sensitivity, tingling, itching, and/or pain followed by rash that looks like small, red spots that turn into blisters.
  • The rash is typically affects just one area on one side of the body or face.
  • Treatment that is started as soon as possible helps reduce the severity of the disease.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Treating Shingles

May/June 2013

By Shengping Zou, MD, and Steven Ropers, MD
Today’s Geriatric Medicine
Vol. 6 No. 3 P. 28

The incidence of shingles (herpes zoster) in the United States among people aged 60 and older is about 10 per 1,000 people, according to the Centers for Disease Control and Prevention (CDC). With an estimated 1 million cases each year, nearly one in three Americans will develop shingles, and between 1% and 4% of people suffering from shingles are hospitalized for complications, the CDC notes.

Shingles is a painful skin condition caused by the reactivation of a dormant varicella zoster virus (VZV). VZV often is contracted early in life and causes chicken pox, but it is not fully cleared by the immune system. Instead, the virus stays in the nerve cell bodies and less frequently in the non-neuronal satellite cells of the dorsal root ganglia, cranial nerve, or autonomic ganglia, where it remains in a dormant state until it becomes reactivated later in life.

Reactivation of VZV often happens in individuals over the age of 60 or when the immune system is weakened by medications or disease. It typically presents with pain, a rash, and blistering in a dermatomal distribution. Shingles usually lasts from two to three weeks, and early treatment with antiviral agents can reduce complications. The most common complication is the development of postherpetic neuralgia (PHN), which is nerve pain lasting for more than three months after the acute rash has healed.1 PHN can be debilitating and last for years. Other rare complications may occur, including aseptic meningitis, facial paralysis, and encephalitis.

Epidemiology
The incidence of shingles in healthy individuals is about 0.2% in patients under the age of 50 and increases to 1% in those over the age of 80.2 The increase in herpes zoster in the elderly is thought to be a consequence of decreasing cellular immune function. Other risk factors include being female and reduced immune function for various reasons, such as HIV infection, cancer, prolonged steroid therapy, chemotherapy, and psychological stress.3

Although difficult to estimate, PHN occurs in 10% to 20% of shingles patients.4 Individuals over the age of 60 are at increased risk of developing PHN and suffering a prolonged course.5 Risk factors are thought to include more severe acute pain, the presence of a prodrome (preeruptive pain), and a more severe rash.6

Signs and Symptoms
The earliest symptoms of shingles are nonspecific and include headache, fever, and malaise. A painful vesicular rash in a unilateral dermatomal distribution, often involving the T3-L3 dermatomes or the ophthalmic division of the trigeminal nerve, usually follows the initial symptoms. The pain often is described as having two components: an ongoing burning or raw, severe aching and superimposed paroxysmal pains of stabbing or electric quality.7 Preeruptive pain (prodrome) before the development of the typical rash may be present for 48 to 72 hours. Herpes zoster usually lasts between seven and 10 days; however, the skin lesions may take up to one month to heal.

Diagnosis
A shingles diagnosis often is made clinically but can be confirmed by immunofluorescent staining of cells from the lesion base, isolation of VZV in tissue culture, or by detection of VZV DNA by polymerase chain reaction.8 A PHN diagnosis is made when pain lasts for three months or longer after an acute attack of shingles or appears after the skin lesions have healed. No tests are necessary to diagnose PHN.

Shingles Treatment
Shingles treatment aims to limit symptom severity and pain duration, decrease viral shedding, and prevent PHN.

The first-line agents for treating shingles, acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir), are nucleoside analogues that have been shown to quicken the healing of skin lesions and reduce the pain associated with herpes zoster.9 The recommendation is to start the antiviral agents within 48 to 72 hours of rash onset to achieve the best clinical benefit.10 It is not clear whether antiviral therapy decreases the incidence of PHN.11

Acyclovir (800 mg orally five times per day for seven to 10 days) has a poor bioavailability and needs to be taken frequently. Valacyclovir (1,000 mg orally three times per day for seven days) is a prodrug of acyclovir and has a better bioavailability than acyclovir. Famciclovir (500 mg three times per day for seven days) is a prodrug of penciclovir, which is active against VZV but has a longer duration of action.

NSAIDs and acetaminophen are useful for treating mild pain associated with herpes zoster. If the pain is moderate or more severe, opioid analgesics such as oxycodone and morphine can be prescribed.

Steroids (30 mg of prednisone orally twice a day for seven days, then tapered off) often are given with acyclovir to improve quality of life, hasten skin lesion healing, and reduce the incidence of PHN. While some trials have found a moderate improvement in quality of life,12 other trials could not identify any benefit of corticosteroids on PHN incidence or duration.13 Given the potential adverse effects of steroids, such as immunosuppression and secondary bacterial superinfection of the skin lesions, current expert opinion is to limit corticosteroid administration to those patients with severe herpes zoster pain or severe neurological involvement (facial paralysis).14 Steroids should not be administered without concurrent antiviral therapy.

Neuraxial and sympathetic blocks have been used in both herpes zoster and PHN for pain control. There is strong evidence for the beneficial effects of epidural local anesthetics and steroid administration in herpes zoster as well as intrathecal local anesthetics and steroids in PHN. Epidural injections during herpes zoster also may reduce the incidence of PHN.15

Other treatment modalities for herpes zoster pain include topical lidocaine and capsaicin.

PHN Treatment
There are several treatment options available for PHN. In clinical practice the most common challenge is to identify the combination of drugs that is best suited for each patient, as no single medication is considered the gold standard for relieving PHN.

Tricyclic antidepressants are among the main pillars of treatment for patients with PHN. These medications are very effective in providing pain relief, but they are limited by their anticholinergic side effects, such as sedation and dry mouth. One thing to remember is that it may take up to three weeks before tricyclic antidepressants develop their full effect.

Anticonvulsants are another class of drugs used for patients with PHN. Both gabapentin (Neurontin) and pregabalin (Lyrica) have been shown to be effective in reducing the neuropathic pain associated with PHN.

Opioids such as morphine are highly effective in reducing PHN pain. One randomized controlled trial showed a trend toward greater pain relief with opioids than tricyclic antidepressants.16 Opioids, however, have a higher incidence of drowsiness and gastrointestinal side effects, such as constipation.

Data for topical lidocaine patches are not as strong as for the above medications, but the relative lack of side effects compared with the systemic agents allows topical lidocaine to be a useful addition in the treatment of PHN.17 Capsaicin is another topical agent that provides moderate pain relief in PHN, but its use is limited by its burning and stinging sensation in up to one-third of patients in a clinical trial.18

Intrathecal glucocorticoids are another treatment option, particularly if none of the above measures works. Preservative-free intrathecal methylprednisolone has been shown to provide superior pain relief compared with intrathecal lidocaine19 and epidural methylprednisolone.20

Transcutaneous electrical nerve stimulation is used to treat patients with various pain disorders, such as PHN, but there still is considerable debate regarding the effectiveness of this treatment because controlled studies are lacking.

Prevention
Zostavax is an FDA-approved shingles vaccine. The Advisory Committee on Immunization Practices recommends that all patients aged 60 and older be vaccinated against shingles, including patients with a history of herpes zoster. One large randomized double-blind, placebo-controlled trial found that the herpes zoster vaccine reduced the incidence of shingles by roughly 50%. Patients who were vaccinated but still affected by herpes zoster had a roughly 66% reduction in their risk of developing PHN.21 The vaccine is not recommended to treat active shingles or PHN once it develops.

— Shengping Zou, MD, is medical director of the Center for the Study and Treatment of Pain at New York University (NYU) Langone Medical Center. He also is program director at the NYU School of Medicine Pain Medicine Fellowship and an assistant professor of anesthesiology at the NYU School of Medicine in New York City.

— Steven Ropers, MD, is a third-year resident in the department of anesthesiology at New York University Langone Medical Center School of Medicine.

1. Watson CP, Evans RJ, Watt VR, Birkett N. Post-herpetic neuralgia: 208 cases. Pain. 1988;35(3):289–297.

2. Kost RG, Straus SE. Postherpetic neuralgia—pathogenesis, treatment, and prevention. N Engl J Med. 1996;335(1):32–42.

3. Thomas SL, Hall AJ. What does epidemiology tell us about risk factors for herpes zoster? Lancet Infect Dis. 2004;4(1):26-33.

5. Helgason S, Petursson G, Gudmundsson S, Sigurdsson JA. Prevalence of postherpetic neuralgia after a first episode of herpes zoster: prospective study with long term follow up. BMJ. 2000;321:794–6.

6. Dworkin RH, Schmader KE. The epidemiology and natural history of herpes zoster and postherpetic neuralgia. In: Watson CPN, ed. Herpes Zoster and Postherpetic Neuralgia. 2nd ed. New York, NY: Elsevier Press; 2001:39–64.

10. Li Q, Chen N, Yang J, et al. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2009;2:CD006866.

11. Jackson JL, Gibbons R, Meyer G, Inouye L. The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia. A meta-analysis. Arch Intern Med. 1997;157(8):909–912.

12. Whitley RJ, Weiss H, Gnann JW Jr, et al. Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Ann Intern Med. 1996;125(5):376–383.

15. Kumar V, Krone K, Mathieu A. Neuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: an appraisal of current evidence. Reg Anesth Pain Med. 2004;29(5):454–461.

18. Watson CP, Evans RJ, Watt VR. Post-herpetic neuralgia and topical capsaicin. Pain. 1988;33(3):333–340.

19. Kotani N, Kushikata T, Hashimoto H, et al. Intrathecal methylprednisolone for intractable postherpetic neuralgia. N Engl J Med. 2000;343(21):1514–1519.

20. Kikuchi A, Kotani N, Sato T, Takamura K, Sakai I, Matsuki A. Comparative therapeutic evaluation intrathecal versus epidural methylprednisolone for long Term analgesia in patients with intractable post herpetic neuralgia. Reg Anesth Pain Med. 1999;24:287–293.

The pain of shingles can be severe and sometimes even occurs when no rash is present. Postherpetic neuralgia, a complication of shingles, occurs when your nerve pain persists after your rash has disappeared. Fortunately, there are effective treatment options to help reduce your pain.

Antiviral medications for Shingles

Antiviral medications are prescription drugs that can reduce the length and severity of your outbreak if they are given early enough. Examples of these drugs include acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir). It has been shown that antiviral medications can help prevent the development of postherpetic neuralgia and reduce its duration if it does occur.

Other treatments for shingles

Medications for pain relief may be required. These may be either over the counter or prescription drugs, depending on the severity of the pain. Nonsteroidal anti-inflammatory medications may help some people, while others may require narcotic pain medications. Nonmedical treatments for shingles and home remedies include the use of cool compresses to relieve pain and anti-itching lotions like calamine lotion. Aluminum acetate solutions can help dry up the blisters. Additionally, different medications have been used to control the pain of postherpetic neuralgia, including tricyclic antidepressants and antiseizure medications. Topical agents that can help relieve the pain of postherpetic neuralgia include capsaicin cream and lidocaine patches.

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