How Shingles Is Treated

Shingles requires a multi-pronged treatment approach. The goals: Healing the rash, minimizing the pain, and reducing the risk of post-herpetic neuralgia (PHN), a stabbing or burning pain that can last for months or even years after the rash resolves.

Home remedies such as cool compresses can help ease your symptoms. Your healthcare provider may also recommend antivirals, anti-inflammatories, and pain relievers.

Shingles often afflicts the torso and chest area. But if you have herpes zoster ophthalmicus—shingles that affects the eye area—it's crucial that you seek treatment as soon as possible to reduce the risk of permanent vision damage.

This article describes the prescriptions and over-the-counter medications that are used to treat shingles. Several home remedies and lifestyle habits can take some of the edge off the pain of shingles, too.

Chickenpox Link

If you've already had chickenpox, then you can develop shingles. The two conditions have an uneasy relationship since they are both caused by the same virus: varicella-zoster virus. A chickenpox infection never really goes away. Once it fades, the virus stays inactive—sometimes for decades, sometimes forever. But it can flare up again in some people, this time in the form of shingles.

Early treatment is key to taming the severity of a shingles outbreak, and antivirals are often the go-to choice. Antiviral medications may speed the healing of skin lesions and reduce the severity and duration of pain. They're most effective when started within 72 hours of the first appearance of a rash. So if you have signs of shingles, see your healthcare provider right away.

Symptoms

The symptoms are usually obvious and often follow a certain progression. Expect to:

• Feel tired, if not run down
• Battle a slight fever
• Feel tingling sensations under the skin in the affected area
• Experience sharp burning or stinging pain
• See reddish patches of skin topped by small bumps
• Watch the bumps turn to blisters that start to itch

Shingles Healthcare Provider Discussion Guide

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Prescriptions

Antiviral drugs for treating shingles include:

• Zovirax (acyclovir)
• Famvir (famciclovir)
• Valtrex (valacyclovir)
• Corticosteroids: Although they aren't commonly prescribed for shingles or PHN, anti-inflammatory corticosteroids such as prednisone are used when the eye or other facial nerves are affected.  
• Opioids: Certain transdermal opioid remedies, such as morphine sustained-release patches or fentanyl patches, and oral opioids (narcotic medications) can be helpful in the short term for managing severe pain from shingles or PHN.

If you don't begin treatment with an antiviral drug within 72 hours, it still may be helpful to take one.

Post Herpetic Neuralgia

The pain of PHN can be so constant that it can easily diminish quality of life. Your doctor may prescribe medication that is used to treat neuropathic pain that you can take every day for several months or longer:

• Anticonvulsants: Some medications that are typically prescribed for seizure control are also effective for controlling many types of neuropathic pain, including the pain of PHN. Examples include Neurontin (gabapentin) and Lyrica (pregabalin).
• Tricyclic antidepressants: Some antidepressants are effective at controlling neuropathic pain. Examples include amitriptyline. Aventyl (nortriptyline), and Norpramin (desipramine).
  

Over-the-Counter Therapies

Over-the-counter pain treatments may be effective at controlling pain. They may be taken alone or in tandem with prescription pain medication: 

• OTC pain medications: Tylenol (acetaminophen) or non-steroidal anti-inflammatory medication (NSAID) such as Motrin or Advil (ibuprofen) can ease mild to moderate pain.
• Antihistamines: An oral antihistamine such as Benadryl (diphenhydramine) may ease itching. It can cause drowsiness, so don't take it when you need to drive or otherwise stay highly focused. You might also try a topical antihistamine. Benadryl comes in spray, cream, and stick form.
• Calamine lotion: Calamine lotion can soothe itching and pain. If you don't like the classic, thick, pink lotion, you can also find a clear version. 
• Lidocaine: This local anesthetic helps relieve pain by temporarily numbing the area that hurts. It's found in a variety of OTC skin-numbing creams, as well as in a patch called Lidoderm that sticks to the skin and releases small amounts of lidocaine (a numbing spray) for up to 12 hours per day. Use lidocaine (in any form) only on skin that's still intact—usually after blisters and sores have healed. Otherwise, it can be toxic if it absorbs into your body through an open wound.  
• Capsaicin: The active ingredient in chili peppers that seemingly sets your mouth on fire also has a numbing effect on the skin. It works by depleting a neurochemical called substance P that transmits pain signals. A number of studies have found that capsaicin is effective at relieving neuropathic pain such as PHN. Research has focused on prescription-only patches (Qutenza) containing a high concentration (8%) of capsaicin. You can find creams containing lower doses of capsaicin in drugstores, health food stores, and online. One of these, Zostrix, contains 0.1% capsaicin. Talk to your healthcare provider about the right amount for you.

Home Remedies and Lifestyle

In addition to triggering an uncomfortable rash, shingles can cause symptoms that are similar to those of other viral infections.

While prescription and over-the-counter drugs can help, one of the most important things you can do while dealing with the illness is to take good care of yourself. If you're caring for someone else who has shingles, "creature comforts" can be enormously soothing.

Integrate these basic tactics into even the busiest daily routine:

• Baby your skin: If you're not using a topical cream or patch, apply cool compresses as needed to help ease the pain. Try to keep the area dry so the sores and blisters can dry out.
• Enjoy a good soak: An oatmeal bath can provide great relief from itching. Buy packaged oatmeal bath products at the store or make your own by running regular oatmeal through a food processor until it's a fine powder. Add a cupful per inch of water to a warm (not hot) tub.
• Dress for comfort: Friction from clothing can agitate skin pain. If your rash is on a part of your body that needs to be covered when you're out, wear something that fits loosely and is made from a natural fiber. 
• Get plenty of rest: In addition to clocking adequate nighttime sleep, which for most adults is between seven and nine hours, take a nap during the day if you're tired.
• Eat well: Choose nutritious foods whenever you can and minimize foods that are high in saturated fat, salt, and empty calories. 
• Move your body: Try simple but worthwhile exercises like stretching or walking.
• Distract yourself: Find ways to take your mind off pain and discomfort, such as losing yourself in an enjoyable hobby.
• Avoid contact with vulnerable people: Shingles can spread varicella to people with a weakened immune system or who have never had chickenpox or been vaccinated for it. This includes infants and pregnant people.
• Wash your hands: Be sure to wash your hands after making any contact with your lesions to avoid transmitting the virus.
• De-stress: Turn to activities or practices that help you relax, such as meditation, reading, or listening to music.

Complementary Medicine (CAM)

If you're open to trying a non-traditional approach to treating shingles pain, consider talking to your healthcare provider about transcutaneous electrical nerve stimulation (TEN). This self-administered therapy involves applying harmless levels of electricity to stimulate the skin, which can provide relief by interfering with the transmission of pain signals.

Although other alternative treatments for shingles have been considered, none have been researched enough to be considered viable. Among these are proteolytic enzymes, which are produced naturally by the pancreas to help digest protein from the diet. They are also found in certain foods, such as papaya and pineapple.

Supplements derived from papaya (called papain), pineapple (called bromelain), and from the animal pancreas can be found online, in health food stores, and in some grocery and drugstores. They are often marketed as digestive enzyme supplements.

In a 1995 German study of 192 people with shingles, half took proteolytic enzymes for 14 days and the other half took acyclovir. Both groups experienced similar pain relief and skin improvement, with the exception of skin redness, which showed greater improvement with the acyclovir treatment. The group taking proteolytic enzymes had significantly fewer side effects.

Considering that there's so little evidence that proteolytic enzymes can relieve shingles symptoms, and that they can have side effects, it makes sense to be cautious. Check with your healthcare provider before taking them as a treatment for shingles.

Summary

There are multiple ways to extinguish the painful, burning sensation of shingles. Physicians often prescribe Zovirax (acyclovir), Famvir (famciclovir), Valtrex (valacyclovir), corticosteroids, and opioids. Over-the-counter options include Tylenol (acetaminophen), antihistamines, calamine
lotion, Lidocaine, and capsaicin.

As effective as these tactics may be, you may find the greatest relief in home remedies, including dressing comfortably, following a nutritious diet, stretching or walking, getting plenty of rest, taking an oatmeal bath, and applying cool compresses. You may also try transcutaneous electrical nerve stimulation (TENS), a non-invasive and inexpensive way to relieve pain.

You don't know if you'll get shingles, but you can do your part to prevent an outbreak by getting the shingles vaccine. It's called Shingrix, and it's 90% effective. Even if you do develop shingles, the vaccination should go a long way toward blunting pain in the affected area.