Treatment for Shingles Rash and Pain

Despite the availability of a highly effective vaccine, an estimated 1 million Americans develop shingles (herpes zoster) each year.1 Early diagnosis and treatment are key to limiting the severity of the outbreak as well as its associated complications, including nerve damage. There are also simple at-home remedies that can help patients stay as comfortable as possible.

Antiviral medications should be started within 72 hours of the first shingles symptoms. The three antivirals most often prescribed are acyclovir, valacyclovir, and famciclovir. They help the shingles rash crust over, dry up, and heal, shortening the course of the infection.

Pain is a major factor with shingles. Patients can consult with their health care provider on over-the-counter and prescription options to manage it. Nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen, naproxen, and acetaminophen can be effective, while prescription glucocorticoids such as prednisone can help with more aggressive pain. Short-term usage of opioid pain medicationlike oxycodone or hydrocodone/acetaminophen is reserved for the highest levels of pain.

Shingles typically lasts between 2 and 6 weeks; patients are usually confined to their home for the duration both for their own comfort and to prevent spreading the virus to others. There are a number of simple steps they can take to promote healing and increase their comfort level.

Lukewarm baths infused with colloidal oatmeal or cornstarch can soothe the skin and reduce itchiness. Make sure to towel off completely to keep the affected area dry. Cool, moist compresses used several times throughout the day, and a paste of baking soda and cornstarch applied to the rash, are also effective. Unscented lotions can also be comforting. Those containing capsaicin, a natural ingredient, have an anti-inflammatory effect and reduce pain signals sent to the brain. Finally, calamine lotion applied after baths or showers is soothing and helps to dry out the lesions.

A weakened immune system worsens all illnesses, including shingles. A well-balanced diet helps shore it up and supports recovery. Foods high in vitamins A, B12, C, and E, as well as the amino acid lysine promote healing. Foods and beverages to avoid include those that are high in sugar and/or saturated fats, refined carbohydrates, and foods rich in arginine such as chocolate, gelatin, and nuts. These foods can weaken the immune system, potentially prolonging the virus and the damage it does.

Up to 20% of patients develop postherpetic neuralgia (PHN),² the most common complication of shingles. PHN develops due to nerve fibers that have been damaged by the virus. This severe pain continues after the rash has healed and can last for months or years. Although there is no cure, there are ways to deal with the pain.

The risk for developing shingles and PHN increases with age, as do other complications. Fortunately, immunocompetent individuals age 50 and older are eligible to receive the recombinant zoster vaccine (Shingrix), recommended by the CDC for this age group.³ Approval for immunocompromised adults age 19 and older is currently under consideration by the agency.⁴

Currently, Shingrix is the only vaccine available to immunize against the varicella zoster virus in the United States. It is the only way to prevent both initial and recurrent shingles. Eligible adults should ask their health care provider or pharmacist for information about Shingrix.

References

1. Shingles (herpes zoster). CDC. Updated October 5, 2020. Accessed December 21, 2020. Shingles https://www.cdc.gov/shingles/index.html 
2. Shingles burden and trends. CDC. Updated August 14, 2019. Accessed December 21, 2021. https://www.cdc.gov/shingles/surveillance.html
3. What everyone should know about the shingles vaccine (Shingrix). CDC. Updated January 25, 2018. Accessed December 21, 2021. https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html
4. US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices votes unanimously to recommend Shingrix for immunocompromised adults aged 19 and up. News release. GSK. October 20, 2021. Accessed December 21, 2021. https://www.gsk.com/en-gb/media/press-releases/votes-unanimously-to-recommend-shingrix-for-immunocompromised-adults-aged-19-and-up/