From the Guidelines
After shingles, it is crucial to focus on pain management and preventing complications, and taking prescribed antiviral medications like acyclovir, valacyclovir, or famciclovir for the full course (typically 7-10 days) is essential, even if symptoms improve, as recommended by the Infectious Diseases Society of America 1. To manage pain and prevent complications, the following steps can be taken:
- Take prescribed antiviral medications for the full course
- Use over-the-counter options like acetaminophen or ibuprofen for pain relief
- Keep the rash clean and covered until all blisters have crusted over
- Apply cool, wet compresses to reduce pain and itching
- Use calamine lotion to help with itching, and capsaicin cream for lingering nerve pain It is also important to watch for signs of bacterial infection, such as increased redness, warmth, swelling, or pus, and contact a doctor if these occur 1. For post-herpetic neuralgia, treatments may include gabapentin, pregabalin, tricyclic antidepressants, or lidocaine patches, and it is essential to note that the risk of herpes zoster can be increased by certain medications, such as JAK inhibitors, and vaccination before initiating such treatments is recommended, particularly for older patients 1. Adequate rest and stress management can support the immune system during recovery, and most people recover completely within 3-5 weeks, but nerve pain can persist longer in some cases, particularly in older adults.
From the FDA Drug Label
Herpes Zoster (Shingles) There are no data on treatment initiated more than 72 hours after onset of zoster rash Patients should be advised to initiate treatment as soon as possible after a diagnosis of herpes zoster.
The answer to post shingles care is not directly addressed in the provided drug label. However, it is mentioned that patients should initiate treatment as soon as possible after a diagnosis of herpes zoster.
- Post-shingles care is not explicitly discussed in the label.
- The label only provides information on the treatment of shingles, not on the care after the treatment.
- It is essential to consult a healthcare provider for proper post-shingles care instructions 2.
From the Research
Post-Shingles Care
- The primary goal of post-shingles care is to manage pain and prevent complications, such as postherpetic neuralgia (PHN) 3, 4, 5.
- Treatment for PHN includes:
- Interventional therapies, such as:
- Transcutaneous electrical nerve stimulation
- Local botulinum toxin A, cobalamin, and triamcinolone injection
- Intrathecal methylprednisolone and midazolam injection
- Stellate ganglion block
- Dorsal root ganglion destruction
- Pulsed radiofrequency therapy may be considered for patients who do not respond to conservative treatments 4
- Antiviral medications, such as valacyclovir, famciclovir, and acyclovir, can help reduce the duration of the rash and pain associated with shingles 3, 6, 7
- The varicella zoster virus vaccine can help prevent shingles and PHN, and is recommended for adults 60 years and older 3, 5
Management of Postherpetic Neuralgia
- PHN can last from 30 days to more than six months after the lesions have healed 3
- Treatment of PHN is focused on symptom control and includes topical and oral medications 5
- Spinal cord stimulation and peripheral nerve stimulation may be useful for the treatment of PHN, although the evidence is limited 4
Comparison of Antiviral Medications
- Valacyclovir and famciclovir have been compared in terms of efficacy in treating herpes zoster, with valacyclovir showing significant benefits in reducing pain and accelerating the resolution of zoster-associated pain 7
- Valacyclovir is also more effective than acyclovir and equally effective as famciclovir in hastening the healing of zoster-associated pain and PHN 6