From the Guidelines
Topical treatments for shingles symptoms should prioritize calamine lotion to reduce itching, lidocaine patches or creams for pain relief, and capsaicin cream for post-herpetic neuralgia, as these options are supported by the most recent and relevant guidelines. When considering topical treatment options for shingles (herpes zoster) symptoms, it's essential to focus on alleviating symptoms such as itching, pain, and preventing post-herpetic neuralgia.
Key Considerations
- Calamine lotion can be used to reduce itching associated with shingles rash.
- Lidocaine patches or creams (2.5-5%) can be applied up to 3 times daily for pain relief.
- Capsaicin cream (0.025-0.075%) can help with post-herpetic neuralgia when applied 3-4 times daily.
- Cool compresses with water or aluminum acetate (Burow's solution) can soothe inflamed skin.
- Gentle cleansing with mild soap and water is crucial to prevent secondary infections. These topical treatments are most effective as adjuncts to oral antiviral medications like acyclovir, valacyclovir, or famciclovir, which remain the primary treatment for shingles, targeting the underlying viral infection 1.
Important Precautions
- Avoid applying topical treatments to broken skin unless specifically directed by a healthcare provider.
- Discontinue use if irritation occurs, as certain topical treatments can exacerbate skin conditions or cause unwanted side effects, such as those noted with greasy creams, topical acne medications, and topical steroids 1.
From the FDA Drug Label
Adults and chidren 2 years of age and older: shake well before using. Cleanse the skin with soap and water and let it dry befroe each use. Apply lotion to the affected area using a cotton or soft cloth, as often as needed for comfort. Directions Adults and children 18 years of age and older: Apply a thin film of cream to affected area and gently rub in until fully absorbed. Directions Adults and children over 12 years: ◆ Apply to affected area not more than 3 to 4 times daily ◆ AFTER APPLYING, WASH HANDS WITH SOAP AND WATER The topical treatment options for shingles (herpes zoster) symptoms are:
- Calamine lotion 2: can be applied as often as needed for comfort to the affected area
- Capsaicin cream 3: apply a thin film 3 to 4 times daily
- Lidocaine 4: apply to the affected area not more than 3 to 4 times daily
From the Research
Topical Treatment Options for Shingles Symptoms
- Topical lidocaine and capsaicin are effective in treating postherpetic neuralgia (PHN) 5
- Lidocaine patches and capsaicin can be used to control neuropathic pain in selected patients 6
- Topical treatments such as capsaicin and lidocaine patches can reduce the intensity and duration of pain 7
- Topical analgesics are commonly used for pain relief in herpes zoster and PHN 8
Additional Treatment Considerations
- Antiviral medications such as acyclovir, famciclovir, and valacyclovir are most effective when started within 72 hours after the onset of the rash 6, 5, 7
- Corticosteroids may be added to antiviral medication to alleviate short-term zoster pain, but are associated with an increased risk of serious adverse effects 6, 9, 7
- Tricyclic antidepressants, gabapentin, and pregabalin may be used to control neuropathic pain in patients with PHN 6, 5, 9, 8