Shingles: Treatment

Shingles almost always resolves spontaneously and may not require any treatment except for the relief of symptoms. In most people, the condition clears on its own in one or two weeks and seldom recurs.

Cool, wet compresses may help reduce pain. If there are blisters or crusting, applying compresses made with diluted vinegar will make the patient more comfortable. Mix one-quarter cup of white vinegar in two quarts of lukewarm water. Use the compress twice each day for 10 minutes. Stop using the compresses when the blisters have dried up.

Soothing baths and lotions such as colloidal oatmeal baths, starch baths or lotions, and calamine lotion may help to relieve itching and discomfort. Keep the skin clean, and do not re-use contaminated items. While the lesions continue to ooze, the person should be isolated to prevent infecting other susceptible individuals.

Later, when the crusts and scabs are separating, the skin may become dry, tight, and cracked. If that happens, rub on a small amount of plain petroleum jelly three or four times a day.

The antiviral drugs acyclovir, valacyclovir, and famciclovir can be used to treat shingles. These drugs may shorten the course of the illness. Their use results in more rapid healing of the blisters when drug therapy is started within 72 hours of the onset of the rash. In fact, the earlier the drugs are administered, the better, because early cases can sometimes be stopped. If taken later, these drugs are less effective but may still lessen the pain. Antiviral drug treatment does not seem to reduce the incidence of post-herpetic neuralgia, but recent studies suggest famciclovir may cut the duration of post-herpetic neuralgia in half. Side effects of typical oral doses of these antiviral drugs are minor with headache and nausea reported by 8–20% of patients. Severely immunocompromised individuals, such as those with AIDS,may require intravenous administration of antiviral drugs.

Corticosteroids, such as prednisone, may be used to reduce inflammation but do interfere with the functioning of the immune system. Corticosteroids, in combination with antiviral therapy, also are used to treat severe infections, such as those affecting the eyes, and to reduce severe pain.

Once the blisters are healed, some people continue to experience pain for months or even years (post-herpetic neuralgia). This pain can be excruciating. Consequently, the doctor may prescribe tranquilizers, sedatives, or antidepressants to be taken at night. As noted above, attempts to treat post-herpetic neuralgia with the antiviral drug famciclovir have shown some promising results. When all else fails, severe pain may require a permanent nerve block.

— David J. Doermann