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 vary depending on the individual's immune status and the effectiveness of treatment. According to the 2014 practice guidelines for the diagnosis and management of skin and soft tissue infections by the Infectious Diseases Society of America 1, lesions in healthy hosts continue to erupt for at least 4-6 days, while in immunocompromised hosts, skin lesions may continue to develop over a longer period.
The illness progresses through distinct phases, starting with pain, tingling, or burning in a specific area, followed by the emergence of a characteristic blistering rash, usually on one side of the body in a band-like pattern. Early treatment with antiviral medications, such as acyclovir, valacyclovir, or famciclovir, can reduce the duration and severity of symptoms if started within 72 hours of rash onset, as stated in the guidelines 1.
Some key points to consider include:
- The duration of shingles can be influenced by the individual's immune status, with immunocompromised patients being at risk of longer and more severe illness 1.
- Early treatment with antiviral medications can reduce the duration and severity of symptoms 1.
- Pain management may be necessary to alleviate discomfort and prevent complications such as postherpetic neuralgia 1.
- The guidelines recommend high-dose IV acyclovir for VZV infections in compromised hosts, while oral acyclovir, famciclovir, and valacyclovir are beneficial for VZV infections in otherwise healthy hosts 1.
From the FDA Drug Label
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 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 duration of shingles can vary, but the median time to full crusting is around 5-7 days. Additionally, postherpetic neuralgia (pain after rash healing) can last for a median duration of 63-119 days 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 be sustained for at least 90 days after acute herpes zoster 5
Factors Affecting Duration
- Increasing age is the primary risk factor for shingles, and older patients tend to have more severe cases 3, 4, 5
- Immunocompromised patients are 20 to 100 times more likely to develop herpes zoster 5
- The duration and intensity of zoster-associated pain (ZAP) can be reduced with oral antiviral therapy, especially when initiated within 72 hours 6
Treatment and Management
- Antiviral medications such as acyclovir, valacyclovir, and famciclovir can decrease the duration of the rash and reduce the risk of PHN 3, 4, 6, 5
- Adjunct medications, including opioid analgesics, tricyclic antidepressants, or corticosteroids, may relieve the pain associated with acute herpes zoster 4
- The varicella zoster virus vaccine can decrease the incidence of herpes zoster and is approved for adults 50 years and older 3, 5