Topical medications for postherpetic neuralgia

Several medications that can be applied to the skin will help manage the ongoing pain (postherpetic neuralgia) that sometimes lingers long after a shingles skin rash heals.

• Anesthetics (such as benzocaine) are available in over-the-counter forms that you can apply directly to the skin for pain relief. Anesthetics cause partial or complete loss of feeling when applied to a particular area of skin around the area of pain.
• The Lidoderm patch, which contains the anesthetic lidocaine, is used for treatment of pain due to postherpetic neuralgia. This patch, available only by prescription, is effective, causes no serious side effects, and is simple to use.
• Capsaicin is a naturally occurring substance found in hot chili peppers. Medications containing capsaicin, such as Zostrix, may be effective in relieving the pain of postherpetic neuralgia. When applied to the skin, capsaicin blocks the skin's nerve impulses, stopping pain without interfering with the transmission of other sensations. Capsaicin often causes burning, stinging, or redness of the skin. Do not apply it to the skin during the active rash stage or if the skin is broken; this could cause extreme aggravation of the rash.¹