Is a triamcinolone (corticosteroid) and lidocaine (local anesthetic) combination ointment effective for treating shingles?

Triamcinolone and Lidocaine Combination Ointment for Shingles

Subcutaneous injection of triamcinolone and lidocaine is effective for treating shingles and can significantly reduce the risk of postherpetic neuralgia, but topical combination ointments are not recommended as first-line therapy for shingles. 1

First-Line Treatment for Shingles

• Oral antiviral medications (acyclovir, valacyclovir, or famciclovir) are the recommended first-line treatment for herpes zoster and should be started within 72 hours of rash onset 2, 3
• Antiviral medications reduce healing time, decrease acute pain, and may reduce the risk of postherpetic neuralgia 2, 3
• Intravenous acyclovir is recommended for disseminated or invasive herpes zoster, particularly in immunocompromised patients 2

Role of Corticosteroids and Local Anesthetics

• Systemic corticosteroids may provide modest benefits in reducing acute pain of herpes zoster when used as an adjunct to antiviral therapy, but they do not significantly reduce the incidence of postherpetic neuralgia 4, 5
• Topical antiviral therapy is substantially less effective than systemic therapy and is not recommended for shingles 2
• For pain management, topical analgesics may provide symptomatic relief but are not curative 6

Evidence for Triamcinolone and Lidocaine Combination

• Subcutaneous injection (not topical application) of triamcinolone and lidocaine has shown effectiveness in reducing pain and preventing postherpetic neuralgia in patients with acute herpes zoster 1
• In a randomized clinical trial, only 4% of patients receiving subcutaneous triamcinolone and lidocaine injections developed postherpetic neuralgia at 3 months, compared to 20% in the standard therapy group 1
• Intralesional triamcinolone (10 mg/mL) injections have demonstrated significant reductions in erythema, edema, suppuration, and size of inflamed lesions 7

Treatment Algorithm for Shingles

1. Initial therapy (within 72 hours of rash onset):

   • Oral antiviral medication (acyclovir 800 mg 5 times daily for 7-10 days, or valacyclovir or famciclovir at appropriate doses) 2, 3

2. For moderate to severe pain:

   • Consider subcutaneous injection of triamcinolone and lidocaine in the affected dermatome 1
   • This approach has been shown to reduce acute pain and prevent postherpetic neuralgia more effectively than oral antivirals alone 1

3. For persistent pain or high risk of postherpetic neuralgia (elderly patients):

   • Consider adjunctive oral corticosteroids (prednisone starting at 40 mg daily with tapering over 3 weeks) 4
   • Note that corticosteroids should be avoided in immunocompromised patients 2

Important Considerations

• While subcutaneous injections of triamcinolone and lidocaine have shown benefit, there is insufficient evidence supporting the efficacy of topical combination ointments specifically for shingles 2, 1
• Topical lidocaine patches (5%) may be helpful for pain relief but are not curative 3
• Monitor for complete healing of lesions and development of complications 2
• For immunocompromised patients, more aggressive antiviral therapy is required, and corticosteroids should generally be avoided 2

Prevention

• The recombinant zoster vaccine (Shingrix) is recommended for adults aged 50 years and older to prevent future episodes of herpes zoster 2
• Vaccination can be considered after recovery from an episode of shingles 2