From the Guidelines
For itchy shingles, over-the-counter hydrocortisone cream (0.5-1%) or topical treatments such as lidocaine patches or creams (5%) are recommended to provide temporary relief. According to the most recent and highest quality study 1, topical corticosteroids, such as clobetasol propionate or hydrocortisone, can be used to manage pruritus. Additionally, oral antihistamines like cetirizine or hydroxyzine can be used to reduce itching and help with sleep. It's also important to keep the rash clean and dry, and avoid scratching to prevent secondary infection.
Some key points to consider when managing itchy shingles include:
- Avoiding scratching to prevent secondary infection
- Keeping the rash clean and dry
- Using topical treatments such as hydrocortisone cream or lidocaine patches to provide temporary relief
- Considering oral antihistamines or gabapentin for severe nerve-related itching
- Referring to a dermatologist for further management if itching persists or worsens despite these measures, as recommended by 1.
It's worth noting that calamine lotion is not recommended for the treatment of pruritus, as there is no literature to support its use in this context, according to 1. Similarly, topical capsaicin has not been shown to be effective in managing pruritus, except in cases of uraemic pruritus, as stated in 1.
Overall, the management of itchy shingles should prioritize reducing inflammation, blocking nerve signals, and numbing the affected skin, while also preventing secondary infection and promoting wound healing, as suggested by 1 and 1.
From the FDA Drug Label
Directions Adults and children over 12 years: ◆ Apply to affected area not more than 3 to 4 times daily Warnings For external use only Do not use ◆ on large areas of the body or on cut, irritated or swollen skin The answer is Lidocaine (TOP), a topical medication that can be applied to the affected area to relieve itchy shingles, but it should be used only as directed and for no more than one week without consulting a doctor 2 2.
- Key considerations:
- Apply to affected area not more than 3 to 4 times daily
- Do not use on large areas of the body, cut, irritated, or swollen skin
- Discontinue use and consult a doctor if condition worsens or symptoms persist for more than 7 days
From the Research
Topical Treatments for Itchy Shingles
- Topical lidocaine has been studied as a treatment for postherpetic neuralgia, a condition that can cause itchy shingles 3.
- The study found that topical lidocaine relieved pain better than placebo, with a significant difference between the topical lidocaine and control groups for the primary outcome measure of pain relief.
- However, there is insufficient evidence to recommend topical lidocaine as a first-line agent in the treatment of postherpetic neuralgia with allodynia.
- Corticosteroids, including topical and injectable forms, have also been investigated for the treatment of herpes zoster and postherpetic neuralgia 4.
- While oral corticosteroids may provide a slight benefit for initial symptoms, topical and most forms of parenteral corticosteroids have yet to be proven effective for the treatment of acute pain or prevention of complications.
- H1-antihistamines have been shown to have a synergistic effect when combined with topical corticosteroids for the treatment of pruritus in atopic dermatitis, although this is not directly related to itchy shingles 5.
Considerations for Treatment
- The effectiveness of topical treatments for itchy shingles may vary depending on the individual and the severity of their condition.
- Further research is needed to fully understand the efficacy of different topical treatments for itchy shingles and to compare different classes of drugs.