Treatment of shingles is usually through antiviral drugs that should be commenced in the first three days of the pain arising, hopefully before the blisters appear. These drugs, such as acyclovir, famciclovir, and valacyclovir can shorten the course of shingles, reduce the risk of complications and help relieve pain. Most patients receive the antivirals orally but some are given the drugs intravenously in high doses.

Steroids for Shingles?

Although the immune system will be trying to fight off the infection it may be thought necessary for some patients to have strong anti-inflammatories in the form of corticosteroids, such as prednisone and some patients are given amitriptyline (an antidepressant) to relieve nerve pain. Antihistamines, analgesics and capsaicin (hot pepper) creams can help reduce itching, relieve pain and reduce the risk of postherpetic neuralgia, although capsaicin creams are poorly tolerated by many patients.

Approved Treatments for Shingles

Gabapentin and transdermal lidocaine have become standard treatment for postherpetic neuralgia and little research has been carried out since the mid twentieth century on alternatives to pharmaceuticals. Spontaneous resolution of pain after shingles appears common in those who have had symptoms for less than six months.

Those with persistent pain may be treated with tricyclic antidepressants, topical capsaicin 0.075%, gabapentin, and controlled-release oxycodone, although decisions over treatment should weigh the possible benefits against adverse effects and cost.

Longer-lasting, refractory postherpetic neuralgia may lead physicians to prescribe intrathecal steroid therapy. Some patients find relief from chronic symptoms through use of a Transcutaneous Electrical Nerve Stimulation (TENS) machine.

Treatment Directions for Shingles

Around half of all adults reaching the age of 90 will have had an attack of Herpes zoster, with 6% going on to have a second attack, according to Johnson and Whitton (2004). The current concentration of research is not so much on finding new treatments for shingles but, instead, on finding effective ways to reduce the incidence and severity of shingles through vaccination and prompt treatment remains the most significant factor it seems in helping those with shingles back to good health.

References

Johnson RW, Whitton TL., Management of herpes zoster (shingles) and postherpetic neuralgia. Expert Opin Pharmacother. 2004 Mar;5(3):551-9.

Alper BS, Lewis PR. Treatment of postherpetic neuralgia: a systematic review of the literature. J Fam Pract . 2002;51:121-128.

Billigmann P. Enzyme therapy—an alternative in treatment of herpes zoster. A controlled study of 192 patients [translated from German]. Fortschr Med . 1995;113:43–48.

Kleine MW, Stauder GM, Beese EW. The intestinal absorption of orally administered hydrolytic enzymes and their effects in the treatment of acute herpes zoster as compared with those of oral acyclovir therapy. Phytomedicine. 1995;2:7–15.