From the Guidelines
Shingles will typically go away on its own within 2 weeks, but medical treatment is strongly recommended to reduce pain, speed healing, and prevent complications, especially in immunocompromised hosts. According to the 2014 practice guidelines for the diagnosis and management of skin and soft tissue infections by the Infectious Diseases Society of America 1, herpes zoster usually causes a unilateral, vesicular eruption with dermatomal pain that often precedes the skin findings by 24–72 hours.
Key Considerations
- Lesions in otherwise healthy hosts continue to erupt for at least 4–6 days, with the entire disease duration being approximately 2 weeks 1.
- However, among immunocompromised hosts, skin lesions may continue to develop over a longer period (7–14 days) and generally heal more slowly unless effective antiviral therapy is administered 1.
- High-dose IV acyclovir remains the treatment of choice for VZV infections in compromised hosts, while oral acyclovir, famciclovir, and valacyclovir are beneficial for VZV infections in otherwise healthy hosts 1.
Treatment Recommendations
- Antiviral medications like acyclovir, valacyclovir, or famciclovir are most effective when started within 72 hours of rash appearance and are usually taken for 7 days.
- Pain management may include over-the-counter options like acetaminophen or ibuprofen, or prescription medications for severe pain.
- People with weakened immune systems, those over 50, or anyone experiencing eye involvement should seek immediate medical attention as complications can be more serious in these cases.
From the Research
Shingles Resolution
- Shingles, also known as herpes zoster, can resolve on its own, but the pain associated with it, known as post-herpetic neuralgia (PHN), can persist for several months or even years without treatment 2.
- The cutaneous manifestations of shingles usually resolve in approximately 4 weeks, but antiviral therapy can help shorten the duration of PHN 2, 3.
Antiviral Therapy
- Antiviral drugs such as aciclovir, famciclovir, and valaciclovir are effective in treating acute herpes zoster and can shorten the duration of PHN 2, 3, 4, 5.
- These drugs can also reduce the severity of zoster-associated pain and hasten the healing of skin lesions 3, 4, 5.
- Valaciclovir has been shown to be more effective than aciclovir and equally effective as famciclovir in treating herpes zoster 4, 5.
Treatment Outcomes
- Studies have shown that antiviral therapy can reduce the duration and intensity of zoster-associated pain and PHN, and can also improve the quality of life of patients with herpes zoster 2, 3, 4, 5.
- The choice of antiviral drug and treatment regimen can depend on various factors, including the patient's age, immune status, and severity of symptoms 3, 4, 5.