One million Americans get shingles, aka herpes zoster, each year. Early treatment is key. In addition to antiviral medications to shorten the duration of your shingles outbreak, you need to know about the dreaded—and most common—complication of shingles, which will occur in 20% of cases . . . post-herpetic neuralgia.
Shingles is a viral disease caused by the reactivation of varicella zoster virus that had remained quiet in the sensory ganglia since you were first exposed to chickenpox. A vaccine against herpes zoster exists for everyone over 50; it’s called Zostavax. That’s your best way to keep from getting shingles.
I have shingles, now what?
- Repeat after me: call your doctor right away, within 72 hours. The earlier the better.
- Antiviral agents, preferably valacyclovir or famciclovir, should be started within 72 hours of onset to reduce the severity of the infection, the duration of the skin lesions, and the intensity of acute pain.
- Valacyclovir 1000 mg three times a day for 7 days works better than acyclovir in head to head studies. Valacyclovir also has better bioavailability so you only take it three times daily instead of five times a day like acyclovir.
- Famciclovir (500 mg three times daily) for 7 days is equivalent to valacyclovir for healing of shingles lesions and reducing pain from the lesions.
- Acyclovir 800 mg five times a day for 7 days will help your lesions crust over faster and help reduce pain but not as well as valacyclovir.
- Know that topical antivirals (Zovirax ointment for example) will do nothing for the rash from shingles.
I have pain from my shingles rash, what helps?
- Your next step is an opioid medication like oxycodone or hydrocodone/acetaminophen for short term treatment of your painful rash.
- What is interesting is that adding a steroid, prednisone, to an antiviral does help for acute pain but does not help lesions heal faster and does not help prevent post-herpetic neuralgia which we talk about next.
My rash is gone, but I still have pain: treatment of post-herpetic neuralgia.
- Post-herpetic neuralgia is the most common complication of shingles and occurs in 1/5th of people who get shingles. It is from damage to the nerve fibers.
- FDA approved first line therapies for treatment of post-herpetic neuralgia are: gabapentin (Neurontin), Horizant (an extended-release form of gabapentin which is brand name only and expensive), Lyrica and a lidocaine 5% patch.
- Second line FDA approved therapy is with a capsaicin 8% patch (Qutenza).
What worked for you?