What are the treatments for shingles?
Two main aims of treating shingles are:
1. To ease any pain and discomfort during the episode of shingles.
2. To prevent, as much as possible, postherpetic neuralgia from developing (described above).
General measures
Loose fitting cotton clothes are best to reduce irritating the affected area of skin. Pain may be eased by cooling the affected area with ice cubes (wrapped in a plastic bag), wet dressings, or a cool bath. A non-adherent dressing that covers the rash when it is blistered and raw may help to reduce pain caused by contact with clothing. Oily calamine lotion may be helpful if the rash is itchy.
Painkillers
For example, paracetamol, or paracetamol combined with codeine, or anti-inflammatory drugs such as ibuprofen may give some relief. Strong painkillers such as oxycodone and tramadol may be needed in some cases.
Antiviral drugs
Antiviral drugs include aciclovir, famciclovir, and valaciclovir. An antiviral drug does not kill the virus but works by stopping the virus from multiplying. It may limit the severity of symptoms of the shingles episode. However, a main purpose of antiviral medication is to reduce the risk of pain persisting into postherpetic neuralgia.
Antiviral medication is most useful when started in the early stages of shingles (within 72 hours of the rash appearing). However, in some cases your doctor may still advise antiviral medication even if the rash is more than 72 hours old - particularly in elderly people with severe shingles, or if shingles affects an eye.
Antiviral drugs are not advised 'routinely' to everybody with shingles. For example, young adults and children who develop shingles on their abdomen very often have mild symptoms and have a low risk of developing postherpetic neuralgia. Therefore, in this situation an antiviral drug is not necessary. Your doctor will advise if you should take an antiviral drug.
As a general rule, the following groups of people who develop shingles will normally be advised to take an antiviral drug:
* If you are over the age of 50. The older you are, the more risk there is of severe shingles or complications developing, and the more likely you are to benefit from treatment.
* If you are of any age and have any of the following:
o Shingles that affects the eye or ear.
o A poorly functioning immune system (see later who this includes).
o Shingles that affects any parts of the body apart from the trunk (that is, shingles affecting an arm, leg, neck, or genital area).
o Moderate or severe pain.
o Moderate or severe rash.
If prescribed, a course of an antiviral drug normally lasts seven days.
Antidepressant and anticonvulsant medicines if the pain during an episode of shingles is severe, or if you develop postherpetic neuralgia, you may be advised to take:
- an antidepressant medicine in the 'trycyclic' group. An antidepressant is not used here to treat depression. Tricyclic antidepressants such as amitriptyline, imipramine, and nortriptyline ease neuralgia (nerve pain) separate to their action on depression. OR:
- an anticonvulsant medicines such as gabapentin and carbamazepine. They also ease neuralgic pain separate to their action to control convulsions.
If an antidepressant or anticonvulsant is advised, you should take it regularly as prescribed. It may take up to two or more weeks for it to become fully effective to ease pain. In addition to easing pain during an episode of shingles, they may also help to prevent postherpetic neuralgia.
Steroid medication
Steroids help to reduce inflammation. A short course of steroid tablets (prednisolone) may be considered in addition to antiviral medication. This may help to reduce pain and speed healing of the rash. However, the use of steroids in shingles is controversial. Your doctor will advise. Steroids do not prevent postherpetic neuralgia.
- Read more: what if you have a poor immune system?
More help and advice
- Expert advice on shingles
- How to relieve the pain of shingles
- Read Joanne's story: 'A jabbing pain turned out to be shingles'
- Check out the full facts about chickenpox
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H S S, over 2 years
I know that shingles comes from the same virus as chickenpox, but what I wanted to know is how many times could you develop shingles? I had it about 10 years ago. Would I still be able to have this some time in the future, or is it a 'once only' thing?
Report this commentBERYL BROWN, over 2 years
MY SISTER RANG SAYING SHE HAD A RASH I THOUGHT IT MIGHT BE SHINGLES AND I TOLD HER TO SEE A DOCTOR STRAGHT AWAY .SO WHEN I READ WHAT YOU WROTE I WAS PLEASED THAT I TOLD MY SISTER RIGHT THANK YOU VERY MUCH BERYL BROWN
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paul brundle, 4 months
my daughter has a rash on top of both her thigh's, i've taken her to the doctors to make sure it was not shingles, if she had only shown the doctor one leg he would have said it was shingles, but because it,s on both legs shingles only attack one nervous system she also has been tired and had back and leg pain
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