Treatment Options for Shingles
The virus that causes shingles—varicella-zoster virus (VSV)—is a herpes virus. It’s the same virus that causes chickenpox. After the initial infection (chickenpox), the virus moves into the nervous system, where it can hide inactive for decades before something—such as stress, another illness, or certain medications—reactivates it causing shingles (herpes zoster). When VSV starts growing again, it causes pain or tingling, followed by tell-tale lesions (similar to chickenpox spots).
Shingles treatment typically includes antiviral medication, which is most effective when begun early in the disease. Other treatments aim to relieve pain and other symptoms and prevent future reactivation of the virus.
Almost all adults 40 and older in the United States have had chickenpox and are at risk for shingles, but it can occur in anyone who has recovered from chickenpox. Shingles is more than a rash. It is a painful condition that can take two to four weeks to clear up, and complications are possible.
VSV is a type of herpes virus, and both shingles and chickenpox can be treated with antiviral medications. Most commonly, these medications include acyclovir (Zovirax), famciclovir (Famvir) or valacyclovir (Valtrex). These drugs are most effective when given within 24 to 72 hours after your shingles rash first appears. Antivirals can help the shingles blisters dry up faster, which cuts the length of time you experience shingles symptoms. They also reduce the pain you may experience and significantly reduce your chance of getting serious complications.
Some people experience little pain with shingles, but for most people shingles is a painful condition. If you have severe pain, your doctor may prescribe medication. You also may receive additional medication if you develop a painful complication called postherpetic neuralgia, which involves pain lasting weeks to months after the rash disappears. Some of these medication options include:
- Anticonvulsants such as gabapentin (Neurontin)
- Tricyclic antidepressants, including amitriptyline
- Numbing agents, such as lidocaine you can put on your skin via cream, gel, spray or patch
- Capsaicin patch (Qutenza)
- Narcotic medications such as codeine
- Injections that combine corticosteroids and long-acting local anesthetics
- Anti-inflammatory corticosteroids, such as prednisone, especially if your shingles lesions are in or near your eyes or if your facial nerves are affected
In addition to shingles medications, you can help relieve your shingles symptoms—such as pain and itching—with these techniques:
- Put a cool, damp washcloth on blisters during times when they aren't covered with topical creams; this helps them dry faster and relieves pain.
- Apply ice packs or take cool baths.
- Gently dab calamine lotion on the rash and blisters.
- Cover the rash with loose, nonstick, sterile bandages; wear loose cotton clothing over shingles lesions.
- Keep the area clean to avoid bacterial infection of blisters, while also avoiding picking at, scratching or popping the blisters.
- Relax as much as possible, keeping stress to a minimum.
- Eat well and exercise gently, such as walking or stretching, if your doctor says this is OK.
You can prevent or diminish future episodes of shingles and shingles symptoms by getting a shingles vaccine. The shingles vaccine Shingrix (recombinant zoster vaccine) was approved by the FDA in 2017 for people 50 and older. In 2021, Shingrix was approved for people 18 years and older whose immune system is weakened or compromised by a medical condition (such as HIV/AIDS or severe combined immunodeficiency) or immune-suppressing medications (such as anti-rejection drugs or many chemotherapy medications).
Shingrix is given in two shots, two to six months apart, and is more than 90% effective in blocking the virus.
You can get the vaccine even if you’ve had shingles or previously received the Zostavax shingles vaccine. (Zostavax is no longer available in the U.S. If you previously received Zostavax, talk with your healthcare provider about when you should get the Shingrix vaccine.) If you've had shingles, the risk of a shingles recurrence is low, but it is possible. Vaccination can help you protect your health and well-being.