From the Guidelines
Topical acyclovir is not recommended for shingles symptoms that persist 4 weeks after the initial outbreak, as its effectiveness is substantially less than systemic antiviral drugs 1. When considering treatment for shingles that has progressed to a point where the rash is better but still itchy and painful, it's crucial to understand that the primary goal is to manage symptoms such as post-herpetic neuralgia (PHN) and itching, rather than treating the active viral infection. Key considerations for managing these symptoms include:
- Oral medications like gabapentin, pregabalin, or tricyclic antidepressants such as amitriptyline, which are specifically used to target nerve pain.
- Topical options including lidocaine patches or capsaicin cream for localized relief.
- Over-the-counter pain relievers such as acetaminophen or ibuprofen to help manage discomfort. The use of antiviral medications like acyclovir is most beneficial when initiated within 72 hours of rash onset, primarily to shorten the duration of the active infection, not to treat lingering symptoms 1. Given that topical acyclovir's effectiveness is substantially less than its systemic counterpart, and considering the stage of your condition, it is advisable to consult your healthcare provider for appropriate treatment tailored to post-herpetic neuralgia, rather than relying on topical antivirals.
From the Research
Treatment of Shingles with Topical Acyclovir
- Topical acyclovir is not typically recommended for the treatment of shingles, as the evidence suggests that oral antiviral medications such as acyclovir, famciclovir, or valacyclovir are more effective in decreasing the duration of the rash 2, 3.
- The use of topical acyclovir may not provide significant benefits in reducing the pain and itching associated with shingles, especially 4 weeks after the onset of the rash.
Management of Postherpetic Neuralgia
- Postherpetic neuralgia (PHN) is a common complication of shingles, characterized by pain in a dermatomal distribution that persists for more than 90 days after the acute phase 4, 3.
- Treatment options for PHN include topical lidocaine or capsaicin, as well as oral medications such as gabapentin, pregabalin, or tricyclic antidepressants 2, 3.
- These treatments may help alleviate the pain and itching associated with PHN, but their effectiveness can vary from person to person.
Current Condition
- Given that the rash has improved but is still itchy and painful 4 weeks after the onset, it is possible that the patient is experiencing PHN 4.
- In this case, treatment options such as topical lidocaine or capsaicin, or oral medications like gabapentin or pregabalin, may be considered to manage the symptoms 2, 3.