From the Guidelines
For first-time herpes zoster (shingles), treatment should begin as soon as possible after symptom onset, ideally within 72 hours of rash appearance, with oral antiviral medications such as acyclovir, valacyclovir, or famciclovir, as they have been shown to accelerate cutaneous healing and reduce the severity of acute pain in adults with HZ 1. The standard treatment includes oral antiviral medications such as:
- Acyclovir (800 mg five times daily for 7-10 days)
- Valacyclovir (1,000 mg three times daily for 7 days)
- Famciclovir (500 mg three times daily for 7 days) Valacyclovir and famciclovir are generally preferred due to better bioavailability and simpler dosing schedules. Pain management is also essential and may include:
- Acetaminophen
- NSAIDs
- In more severe cases, short-term opioids or gabapentin (starting at 300 mg daily and titrating up as needed) Topical treatments like calamine lotion or cool compresses can help soothe the rash. Patients should keep the rash clean and covered to prevent transmission to high-risk individuals who haven't had chickenpox. Antiviral therapy works by inhibiting viral DNA synthesis, reducing viral shedding, accelerating healing, and decreasing the severity and duration of acute pain. Early treatment is crucial as it can reduce the risk of postherpetic neuralgia, a potentially debilitating complication of shingles characterized by persistent pain after the rash resolves, as supported by the study on prevention of varicella 1.
From the Research
Treatment Guidelines for First-Time Herpes Zoster (Shingles)
- The treatment guidelines for first-time herpes zoster (shingles) involve the use of antiviral medications, such as acyclovir, valacyclovir, and famciclovir, to reduce the severity and duration of the disease 2, 3, 4, 5, 6.
- These medications are most effective when started within 72 hours of the onset of the rash 4, 5, 6.
- Valacyclovir and famciclovir have been shown to be more effective than acyclovir in reducing the risk of pain and postherpetic neuralgia (PHN) 2, 3.
- The recommended dosages for these medications are:
- In addition to antiviral therapy, other treatments such as topical lidocaine or capsaicin and oral gabapentin, pregabalin, or tricyclic antidepressants may be used to manage pain and other complications of herpes zoster 4, 5.
- The varicella zoster virus vaccine is also recommended for adults 50 years and older to prevent herpes zoster and PHN 5.