Shingles - Treatment Overview

Treatment Overview

There is no cure for shingles, but treatment may shorten the length of illness and prevent complications. Treatment options include:

• Antiviral medicines, sometimes in combination with corticosteroids, to reduce the pain and duration of shingles.
• Pain medicines, antidepressants, and topical creams to relieve long-term pain.

Initial treatment

As soon as you are diagnosed with shingles, your doctor probably will start treatment with antiviral medicines. If you begin medicines within the first 2 days of seeing the shingles rash, you have a lower chance of having later problems, such as postherpetic neuralgia. Early treatment of shingles is important, because the problems that can arise can be serious and resistant to treatment. For example, 40% to 50% of people with postherpetic neuralgia do not respond to treatment.⁶

The most common treatments for shingles include:

• Antiviral medicines, such as acyclovir, famciclovir, or valacyclovir, to reduce the pain and the duration of shingles.
• Over-the-counter pain medicines, such as acetaminophen, aspirin, or ibuprofen, to help reduce pain during an attack of shingles.
• Corticosteroids, in combination with antiviral medicine, to reduce pain and the duration of shingles.
• Topical antibiotics, applied directly to the skin, to stop infection of the blisters.

Ongoing treatment

If you have pain that persists longer than a month after your shingles rash heals, your health professional may diagnose postherpetic neuralgia, the most common complication of shingles. Postherpetic neuralgia can cause pain for months or years. It affects 10% to 15% of those who experience shingles.⁶ Treatment to reduce the pain of postherpetic neuralgia includes:⁶

• Antidepressant medicines, such as a tricyclic antidepressant (for example, amitriptyline).
• Topical anesthetics, such as lidocaine patches, to numb the area.
• Anticonvulsant medicines, such as gabapentin or pregabalin.
• Opioids, such as codeine.

Topical creams containing capsaicin may provide some relief from pain. Capsaicin may irritate or burn the skin of some people, and it should be used with caution.

Treatment if the condition gets worse

In some cases, shingles causes long-term complications. Treatment depends upon the specific complication.

• Postherpetic neuralgia is persistent pain that lasts months or even years after the shingles rash heals. Certain medicines, such as anticonvulsants, antidepressants, and opioids, can relieve pain. Most cases of postherpetic neuralgia resolve within a year. In very rare cases, surgical treatment may be used to treat postherpetic neuralgia by cutting nerves to help block pain signals.
• Disseminated zoster is a blistery rash over a large portion of your body. It may affect your heart, lungs, liver, pancreas, joints, and intestinal tract. Treatment may include both antiviral medicines to prevent the virus from multiplying and antibiotics to stop infection.
• Herpes zoster ophthalmicus is a rash on the forehead, cheek, nose, and around one eye, which could threaten your sight. You should seek prompt treatment from an ophthalmologist for this condition.³ Treatment may include rest, cool compresses, and antiviral medicines.
• If the shingles virus affects the nerves originating in the brain (cranial nerves), serious complications involving the face, eyes, nose, and brain can develop. Treatment depends on the nature and location of the complication.