From the Guidelines
Shingles should be treated with antiviral medications like acyclovir or famciclovir as soon as possible, ideally within 72 hours of rash onset, to reduce the severity and duration of the outbreak. The symptoms of shingles include a painful, blistering rash that typically appears on one side of the body, often in a band-like pattern, accompanied by early symptoms such as tingling, itching, or burning pain in the affected area, followed by the development of fluid-filled blisters that eventually crust over 1. Other symptoms may include fever, headache, fatigue, and sensitivity to light.
Treatment Options
- Antiviral medications:
- Acyclovir (dosing not specified in the provided evidence)
- Famciclovir (dosing not specified in the provided evidence)
- Pain management:
- Over-the-counter medications like acetaminophen or ibuprofen for mild pain
- Prescription medications such as gabapentin, pregabalin, or tricyclic antidepressants for more severe pain
- Topical treatments:
- Calamine lotion
- Capsaicin cream It is essential to keep the rash clean and covered to prevent spreading the virus to others who haven't had chickenpox. Shingles occurs when the varicella-zoster virus, which causes chickenpox and remains dormant in nerve tissue, reactivates later in life, typically due to factors like aging, stress, or weakened immunity 1.
From the FDA Drug Label
Immunocompetent Adult Patients( 1. 1) • Herpes labialis (cold sores) o Treatment of recurrent episodes • Genital herpes o Treatment of recurrent episodes o Suppressive therapy of recurrent episodes • Herpes zoster (shingles) Herpes Zoster (shingles) 500 mg every 8 hours for 7 days The most common adverse events reported in at least 1 indication by greater than 10% of adult patients are headache and nausea.
The symptoms of shingles are not explicitly listed in the provided drug labels. However, the treatment options for shingles are mentioned as 500 mg of famciclovir every 8 hours for 7 days 2 and 2.
- Treatment options: 500 mg every 8 hours for 7 days
- Common adverse events:
- Headache
- Nausea
From the Research
Symptoms of Shingles
- Pain or discomfort in the involved dermatome, usually without constitutional symptoms 3
- Local edema and erythema appear before the development of a rash 3
- Maculopapular and vesicular rash that evolves into crusts 3
- The most commonly involved ganglia are lumbar, thoracic, sacral posterior root ganglia, then geniculate ganglion of the VIIth cranial nerve and the trigeminal ganglion 3
- Burning pain that typically precedes the rash by several days and can persist for several months after the rash resolves 4
Complications of Shingles
- Postherpetic neuralgia, which may last for as long as two or three weeks, sometimes even one year or more 3
- Ocular complications such as keratitis, iridocyclitis, secondary glaucoma, and loss of sight 3, 4
- Neurological complications such as various motor neuropathies, encephalitis, and Guillain-Barre syndrome 3
- Secondary bacterial infection of vesicles 3
Treatment Options for Shingles
- Symptomatic therapy, predominantly directed toward reduction of fever and avoiding secondary bacterial skin infection in immunocompetent hosts 3
- Acyclovir therapy, which is limited to ophthalmic cases 3
- Antiviral medications such as famciclovir and valacyclovir, which are most effective when started within 72 hours after the onset of the rash 4, 5
- Addition of an orally administered corticosteroid, which can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia 4, 6
- Pain management with analgesics, tricyclic antidepressants, or anticonvulsants for patients with postherpetic neuralgia 4