From the Guidelines
Shingles typically lasts approximately 2 weeks in otherwise healthy hosts, but can last longer in immunocompromised patients, with skin lesions continuing to develop over a period of 7-14 days. The duration of shingles can be broken down into several phases, including a prodromal phase where patients experience pain, tingling, or burning for 24-72 hours before the rash appears, followed by the development of a unilateral, vesicular eruption with dermatomal pain that often precedes the skin findings 1. In healthy hosts, lesions continue to erupt for at least 4-6 days, with the entire disease duration being approximately 2 weeks 1. However, in immunocompromised hosts, skin lesions may continue to develop over a longer period and generally heal more slowly unless effective antiviral therapy is administered 1. Some key points to consider when managing shingles include:
- The importance of early treatment with antiviral medications, such as acyclovir, famciclovir, or valacyclovir, to reduce the duration and severity of the illness 1
- The need for pain management, which may require acetaminophen, NSAIDs, or prescription pain medications
- The risk of postherpetic neuralgia, a complication where pain persists for months or even years after the rash heals, particularly in older adults.
From the FDA Drug Label
In the 186 patients (44. 4% of total study population) who developed postherpetic neuralgia, the median duration of postherpetic neuralgia was shorter in patients treated with famciclovir 500 mg than in those treated with placebo (63 days and 119 days, respectively). The times to full crusting, loss of vesicles, loss of ulcers, and loss of crusts were shorter for famciclovir 500 mg-treated patients than for placebo-treated patients in the overall study population. The median time to full crusting was 5 days among famciclovir 500 mg-treated patients as compared to 7 days in placebo-treated patients
The duration of shingles can vary, but the median time to full crusting is around 5 days with famciclovir 500 mg treatment, compared to 7 days with placebo. Additionally, the median duration of postherpetic neuralgia is around 63 days with famciclovir 500 mg treatment, compared to 119 days with placebo 2.
From the Research
Duration of Shingles
- The cutaneous manifestations of shingles usually resolve in approximately 4 weeks 3
- However, the pain can persist for several months, or even years in the untreated patient 3
- Postherpetic neuralgia (PHN) can last from 30 days to more than six months after the lesions have healed 4
- In some cases, PHN can persist for years 3
Factors Affecting Duration
- Increasing age is the primary risk factor for shingles, and older patients are more likely to experience longer-lasting pain 3, 4, 5, 6
- Immunocompromised individuals are at greater risk for complications and recurrence of shingles 5
- Early treatment with antiviral agents, such as valacyclovir or famciclovir, can reduce the severity of the infection and the duration of the eruptive phase 7, 5
Treatment and Prevention
- Antiviral agents, such as acyclovir, valacyclovir, or famciclovir, can be used to treat shingles, ideally within 72 hours of the development of the rash 4, 7, 5, 6
- The varicella zoster virus vaccine can decrease the incidence of shingles and is approved for adults 50 years and older 5, 6
- The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends the vaccine for adults 60 years and older, except for certain immunosuppressed patients 6