From the Guidelines
The recommended treatment for shingles (herpes zoster) includes antiviral medications started within 72 hours of rash onset, with oral famciclovir or acyclovir being the primary options, as they have been shown to accelerate the rate of cutaneous healing and reduce the severity of acute pain in adults with HZ 1. When treating shingles, it is essential to consider the following:
- Antiviral medications should be initiated within 72 hours of rash onset to maximize their effectiveness
- Oral famciclovir and acyclovir have similar efficacy in treating HZ, with famciclovir being administered during the same period as acyclovir 1
- Pain management is crucial and may include acetaminophen, NSAIDs, or in more severe cases, other medications
- Keeping the rash clean and covered helps prevent viral transmission to susceptible individuals
- Early treatment with antivirals is crucial as they work by inhibiting viral DNA replication, which reduces the duration of viral shedding, promotes faster healing, decreases the severity and duration of acute pain, and may reduce the risk of developing postherpetic neuralgia. The goal of treatment is to reduce morbidity, mortality, and improve quality of life by alleviating symptoms, promoting healing, and preventing complications.
From the Research
Treatment Options for Shingles
- Antiviral medications such as acyclovir, famciclovir, and valacyclovir are commonly used to treat shingles, and are most effective when started within 72 hours after the onset of the rash 2, 3, 4
- The addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia 2
- Ocular involvement in herpes zoster can lead to rare but serious complications and generally merits referral to an ophthalmologist 2
Management of Postherpetic Neuralgia
- Postherpetic neuralgia can be treated with tricyclic antidepressants, gabapentin, pregabalin, long-acting opioids, or tramadol 3, 4
- Moderate evidence supports the use of capsaicin cream or a lidocaine patch as a second-line agent for postherpetic neuralgia 3
- Narcotics may be required for adequate pain control in some patients 2
Prevention of Herpes Zoster and Postherpetic Neuralgia
- Immunization to prevent herpes zoster and postherpetic neuralgia is recommended for most adults 60 years and older 3, 4
- The varicella zoster virus vaccine decreases the incidence of herpes zoster and is approved for adults 50 years and older 4
- There is conflicting evidence that antiviral therapy during the acute phase prevents postherpetic neuralgia 3, 5