From the Guidelines
Recurrent shingles infections can be effectively managed with a combination of antiviral medications and preventive strategies, prioritizing the Shingrix vaccine for adults 50 and older as the most effective prevention method, as recommended by recent guidelines 1. To manage recurrent shingles, the following strategies can be employed:
- Suppressive antiviral therapy with valacyclovir 500-1000 mg daily or acyclovir 400-800 mg twice daily for 6-12 months, which can be extended based on recurrence patterns.
- During acute outbreaks, higher doses are needed: valacyclovir 1000 mg three times daily, acyclovir 800 mg five times daily, or famciclovir 500 mg three times daily for 7-10 days.
- Start treatment within 72 hours of rash onset for best results. For prevention, the Shingrix vaccine is strongly recommended for adults 50 and older, administered as two doses 2-6 months apart, even for those who've had shingles previously, as it provides over 90% protection against recurrence 1. It's essential to address underlying conditions that may be contributing to weakened immunity, such as diabetes, HIV, or immunosuppressive medications, and to promote overall immune function through stress management techniques, adequate sleep, and proper nutrition. If episodes occur more than 3-4 times yearly despite these measures, consultation with an infectious disease specialist for personalized management is recommended. The varicella-zoster virus infection guidelines also emphasize the importance of preventing exposure to persons with chickenpox or shingles, especially for susceptible individuals, such as those with HIV/AIDS, and highlight the need for vaccination of household contacts to prevent transmission 1.
From the Research
Recurrent Shingles Infection
- Recurrent shingles infection is a condition where the varicella zoster virus, which causes chickenpox, reactivates and causes shingles multiple times 2.
- The risk of developing shingles is increased in individuals with conditions that decrease cell-mediated immunity, such as immunocompromised patients 3, 2.
- Treatment for shingles typically involves antiviral medications such as acyclovir, valacyclovir, or famciclovir, which can help reduce the severity and duration of the infection 3, 2, 4.
- Postherpetic neuralgia (PHN) is a common complication of shingles, characterized by pain in a dermatomal distribution that persists for at least 90 days after the acute infection 2, 5.
- The varicella zoster virus vaccine can help prevent shingles and is recommended for adults 60 years and older, except for certain immunosuppressed patients 2.
Treatment Options
- Valacyclovir and famciclovir are two antiviral medications that have been shown to be effective in treating shingles, with valacyclovir being more efficacious in some studies 4.
- Gabapentin has been studied as a potential treatment for preventing PHN, but its efficacy is still unclear 5.
- Topical lidocaine or capsaicin and oral gabapentin, pregabalin, or tricyclic antidepressants may be used to manage PHN symptoms 2.