From the Guidelines
Topical steroids are generally contraindicated in shingles (herpes zoster) infections. Using topical corticosteroids on shingles rash can potentially worsen the infection by suppressing the local immune response, allowing the virus to replicate more extensively and potentially prolonging healing time.
Key Considerations
- The provided evidence does not directly address the use of topical steroids in shingles, but it discusses their use in other conditions such as bullous pemphigoid 1 and lichen sclerosus 1.
- In the context of shingles, the primary concern is the potential for topical steroids to suppress the local immune response, which could exacerbate the infection.
- Instead, the recommended treatment for shingles includes oral antiviral medications such as acyclovir, valacyclovir, or famciclovir for 7-10 days, ideally started within 72 hours of rash onset.
Treatment Recommendations
- For pain management, acetaminophen, NSAIDs, or in severe cases, prescription pain medications may be used.
- Calamine lotion can help soothe the rash, and cool compresses may provide relief.
- If you suspect shingles, seek medical attention promptly as early antiviral treatment is crucial for reducing the severity and duration of the outbreak and lowering the risk of post-herpetic neuralgia, a painful complication that can persist after the rash resolves.
From the Research
Topical Steroids in Shingles
- There is no direct evidence in the provided studies that topical steroids are contra-indicated in shingles 2, 3, 4, 5, 6.
- The studies focus on the treatment of herpes zoster with oral antiviral agents, such as acyclovir, valacyclovir, and famciclovir, and the management of postherpetic neuralgia with medications like tricyclic antidepressants, gabapentin, and pregabalin 2, 3, 4, 5.
- One study mentions the use of adjunct medications, including corticosteroids, to relieve pain associated with acute herpes zoster, but it does not specify topical steroids 3.
- Another study discusses the use of topical lidocaine or capsaicin for symptom control in postherpetic neuralgia, but it does not mention topical steroids 4.
- The study on prevention of shingles in dermatology patients on systemic medications mentions systemic steroids as a risk factor for herpes zoster, but it does not discuss topical steroids 6.