From the Guidelines
Corticosteroids, such as oral prednisone, should be prescribed alongside antiviral medications for acute shingles flare-ups to reduce inflammation and pain, with a typical regimen starting at 60mg daily for the first week, then tapering down to 30mg daily for the second week, and 15mg daily for the third week, initiated within 72 hours of rash onset. When treating acute shingles, it is essential to consider the use of antiviral medications, such as acyclovir or famciclovir, as they have been shown to accelerate the rate of cutaneous healing and reduce the severity of acute pain in adults with herpes zoster (HZ) 1. Some key points to consider when prescribing corticosteroids for acute shingles include:
- Starting the treatment within 72 hours of rash onset for maximum effectiveness
- Using corticosteroids in conjunction with antiviral therapy, such as acyclovir (800mg five times daily), valacyclovir (1000mg three times daily), or famciclovir (500mg three times daily) for 7-10 days
- Monitoring patients for potential side effects, including increased blood glucose, mood changes, insomnia, and fluid retention
- Avoiding the use of corticosteroids in patients with immunosuppression, uncontrolled diabetes, or active peptic ulcer disease
- Ensuring patients follow the tapering schedule carefully to avoid adrenal suppression.
From the Research
Current Steroid Treatment for Acute Shingles Flare Up
- The use of corticosteroids in the treatment of acute shingles is mentioned in the study 2 as providing modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia.
- However, the study 2 does not specify the exact steroid treatment regimen, and its focus is more on the antiviral medications such as acyclovir, valacyclovir, and famciclovir.
- The other studies 3, 4, 5, 6 do not provide information on the current steroid treatment for acute shingles flare up, focusing instead on antiviral medications, pain management, and prevention through vaccination.
- It is worth noting that while steroids may be used to reduce inflammation and pain, the primary treatment for acute shingles involves antiviral medications, and the management of postherpetic neuralgia may include a variety of medications and therapies 2, 4, 5, 6.