Shingles Treatment, Medication, and Prevention: Pain Relief, Antiviral

Written by WebMD Editorial Contributors

• Antiviral Medications for Shingles
• Painkillers for Shingles
• Other Medications for Shingles
• Alternative Treatments for Shingles?
• Self-Care for Shingles
• Can I Prevent Shingles?
• Who Shouldn’t Get the Shingles Vaccine?
• More

The virus that causes chickenpox also causes shingles. It’s called varicella zoster. It can lie quietly in your nerves for decades after causing chickenpox but suddenly wake up and become active.

The main symptom of shingles is a painful rash that comes up on one side of your body or face. See your doctor as soon as you can if you think you might have this condition.

1 million people in the U.S. get shingles each year, according to the CDC. There is a shingles vaccine for prevention.

Your doctor may want to put you on medications to control your infection and speed up healing, cut inflammation, and ease your pain. They include:

These medicines may slow down the progress of the shingles rash, especially if you take them within the first 72 hours of having symptoms.

They can also lower your chance of having complications. Your doctor may prescribe:

• Acyclovir (Sitavig, Zovirax)
• Famciclovir (Famvir)
• Valacyclovir (Valtrex)

Talk with your doctor or pharmacist about side effects to watch for if you take one of these drugs.

Shingles causes inflammation and pain. Your doctor can suggest over-the-counter medicines to relieve milder discomfort. They include:

• Acetaminophen
• Ibuprofen
• Naproxen

These may also help you stave off postherpetic neuralgia, which is a burning pain that some people get after the rash and blisters of shingles go away.

If you have severe pain after the rash clears or an infection during your shingles outbreak, your doctor might prescribe:

Capsaicin cream: Be careful not to get it in your eyes.

A numbing medicine: You might get lidocaine (Lidoderm, Xylocaine) for pain. It can come in a variety of forms, such as creams, lotions, patches, powders, and sprays, among others.

Antibiotics: You might need these medicines if bacteria infect your skin and rash. But if bacteria aren’t involved, then antibiotics won’t help.

Tricyclic antidepressants: These medications might help ease the pain that lingers after your skin has healed, such as amitriptyline, desipramine (Norpramin), and nortriptyline (Pamelor). They may also help you with depression, if you have that in addition to shingles. Your doctor can tell you what the risks and benefits are.

Some studies show that various alternative treatments, from acupuncture to supplements, can offer relief. The research isn’t complete, but some show promise. Check with your doctor before you try any of these: 

TENS (transcutaneous electrical nerve stimulation). This therapy uses tiny electrical pulses to relieve pain. A TENS unit is about the size of a smartphone and comes with small patches called electrodes. You put them over the painful area and turn the unit on and off as your pain comes and goes. 

Traditional Chinese medicine. These treatments aim to restore balance in your body. They include acupuncture, the ancient practice of inserting very thin needles into your skin at specific points. Also, moxibustion and cupping, two types of heat therapy, are supposed to draw out toxins. These treatments may be done in combination.

Creams and other skin treatments. A mixture of liquid dimethyl sulfoxide (DMSO) and idoxuridine, an antiviral drug, may reduce swelling and the number of blisters you have when you put it on your rash. And chlorophyll, the chemical that gives plants their green color, is also used directly on the rash as a cream or saline solution. 

Supplements. You’ll find a long list of herbs, pills, and oils that claim to relieve shingles. Most have no research to back them up, but there are a couple of exceptions. Papain, a protein found in papayas, is sold in capsules. And manuka and clover honeys can be put directly on your skin. Very early studies on both show they might be helpful. 

There aren’t home remedies for shingles. But there are things you can do to help your skin heal.

Keep the affected area clean, dry, and exposed to air as much as possible.

The itching can be maddening at times, but try not to scratch or burst the blisters.

Soothe the rash. Your top priority is to find relief for the pain and itching that the rash causes. You might try:

1. Oatmeal baths. Dip into a cool tub of water. For extra relief, add colloidal oatmeal, which is made of oats that have been ground to a very fine powder. This soothing bath may help calm your itching.

2. Cold compresses. Run a washcloth under cool water and place it on your blisters for about 20 minutes at a time. Not only can this relieve itching, it also keeps your blisters clean. That can help you avoid a skin infection. If your blisters aren’t oozing anymore, stop using cold compresses. And if you are using any creams or patches on your rash, don’t use compresses at the same time.

3. Loose clothing. You’ll likely find that relaxed fits made from natural fibers, such as cotton or linen, give you more comfort. If you need to cover your blisters, avoid bandages that might stick to your rash.

4. Calamine lotion. Treat your skin with this smooth, cool, and soothing balm. 

Treat your body and mind. You can get worn down mentally when you’re in constant pain. Stress can make it seem even worse. Self-care starts with treating your rash, but don’t stop there. Your mind and emotional state need to be cared for as well. 

Stick with good habits: Your body is working hard to fight the varicella zoster virus that causes shingles. To give it the right support, you can:

• Eat nutritious food and have regular meals. Ask someone to make a run to the grocery store for fresh fruit and such if you’re not up for it.
• Try to get a good night’s sleep and rest anytime you need to.
• Do gentle exercises, such as walking or stretching. Light activity can help take your mind off the pain. Keep it simple though, and check with your doctor if you’re trying something new.

Distract yourself. Sometimes, the best thing you can do is to put your focus elsewhere. Here are a few things to try:

• Call a friend.
• Listen to music that relaxes you.
• Read a book.
• Watch a favorite movie.
• Work on hobbies you enjoy.

Keep calm. Relaxation can be a big help. With a calmer mind, you can better handle your discomfort. You may want to try:

• Meditation
• Tai chi
• Walking (but keep your blisters covered)
• Yoga

Experiment with these strategies as you get through your shingles outbreak. Different things can help depending on how severe your symptoms are and how you feel from day to day.

There are two shingles vaccines. Shingrix is the recommended vaccine. Zostavax is no longer avilable in the U.S.

Who should get it: The CDC recommends that you get this vaccine if you’re a healthy adult age 50 or older, whether or not you remember having had chickenpox, because most people have been exposed to the virus. If you have had the Zostavax vaccine, you can also get Shingrix.

How many shots do you need? You would need two shots for Shingrix: One at first, with a follow-up in 2 to 6 months.

What it does: Shingrix reduces your chance of getting shingles by more than 90%. Even if you still get shingles, the vaccine may help it be less painful.

I never had chickenpox. Do I still need the shingles vaccine? Yes, you do. Shingrix is recommended for everyone age 50 or older, whether or not you remember having had chickenpox.

If I’ve had shingles, can I still get the vaccine? Yes. It may help prevent another bout of shingles later on. If you have shingles right now, you should wait until the rash is gone before you get vaccinated.

What are the side effects? The most common side effects with Shingrix include pain and swelling where the needle went in you skin, muscle pain, tiredness, headache, chills, fever, and stomach troubles. With any vaccine, there is a chance of a severe allergic reaction. 

Don’t get the Shingrix vaccine if:

• You’re allergic to any of the ingredients.
• You’re pregnant or nursing.
• You have tested negative for immunity to the chickenpox virus. Ask your doctor about the chickenpox vaccine instead.
• You have shingles now.

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Shingles (Herpes zoster) – treatment in adults and children, symptoms, is it contagious, prevention, which doctor treats

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Shingles (Herpes zoster): causes, symptoms, diagnosis and treatment.

Herpes zoster is an infectious disease whose causative agent (herpesvirus type 3) also causes chicken pox.

Since the virus, penetrating into sensitive nerve endings, is integrated into the genetic apparatus of nerve cells, it is impossible to remove it from the body. In those who have had chickenpox, the virus goes into a latent (inactive) state.

When the immune system is weakened, the virus is activated, affecting the skin. The disease often develops in the elderly and in immunocompromised individuals.

Causes of disease

The virus is transmitted from a patient with chicken pox or herpes zoster by contact or airborne droplets. The person who becomes infected primarily (most often a child) gets chickenpox. Penetrating through the mucous membranes into the blood and lymph, the virus reaches the nerve cells, where it begins to multiply. After recovery, the virus remains in the body for life, often being in an inactive state. The awakening of the infection is associated with weakened immunity caused by hypothermia, long-term use of steroid hormones, immunosuppression (after transplantation), chemotherapy and radiation therapy, as well as a general decrease in immunity in patients with blood diseases, oncological and viral diseases. Shingles is very severe in HIV-infected patients.

Classification of herpes zoster

The clinical picture of herpes zoster consists of skin manifestations and neurological disorders. There are typical and atypical forms of the disease. With an atypical form, an erased course of the disease is possible, in which papules develop in the foci of hyperemia, which do not transform into vesicles.

In herpes zoster, the spread of the pathological process corresponds to a certain area of ​​the skin and does not cross the anatomical midline of the trunk. In most patients, the rash is preceded by a burning or itching sensation in a specific area of ​​the skin, as well as pain, which can be stabbing, throbbing, shooting, paroxysmal or constant. In a number of patients, the pain syndrome is accompanied by general systemic inflammatory manifestations: fever, malaise, myalgia, and headache.

Infection of the central nervous system and involvement of the meninges can produce meningeal, encephalic (symptoms suggest virus involvement of the brain and/or spinal cord and meninges), or mixed forms of herpes zoster. If the infection spreads along the optic nerve, ophthalmic herpes develops.

When a rash appears over the entire surface of the skin and on parenchymal organs (eg, liver, kidneys), a generalized form of herpes zoster develops. Another type of shingles is hemorrhagic. A characteristic feature is the bloody fluid inside the vesicles.

Symptoms of herpes zoster

The onset of the disease is accompanied by general intoxication, malaise and fever. Nausea and vomiting are possible. Lymph nodes are enlarged.

There are pronounced pains along the affected nerve, which can be permanent, but more often they are paroxysmal itchy in nature, intensifying at night.

As a rule, they are provoked by any irritants: touching the skin, cold, movement. Some patients complain of loss of sensation in certain areas of the skin, which may be combined with increased pain response. Sometimes the pain syndrome in the absence of skin rashes can resemble angina pectoris, myocardial infarction, renal colic, or pancreatitis. The period of neuralgia preceding the rash lasts up to 7 days. Then nodules appear on one side of the body, from which bubbles form with transparent contents, which gradually become cloudy. After 3-7 days, most of the bubbles dry up with the formation of yellow-brown crusts. When the bubbles are injured, bright red sores are exposed. After the sores heal, small scabs or scars remain on the skin.

Most often, rash and pain are noted in the region of the ribs, lower back and sacrum, less often along the branches of the trigeminal, facial and ear nerve and on the extremities.

In rare cases, the mucous membranes are affected.

Herpes zoster diagnostics

It is possible to make a diagnosis after examining and questioning the patient. The doctor pays attention to the nature of the rash (localized and unilateral), the type of vesicles and complaints of itchy burning pain. It is more difficult to identify the atypical form of herpes zoster. With an erased form, pain and other neurological symptoms may be absent. In case of neurogenic disorders before the appearance of rashes, the diagnosis can be made on the basis of the results of laboratory tests. In this case, a histological examination is used, and the virus is isolated in cell culture. The Zanck test helps to quickly confirm the herpetic nature of the rashes: giant multinucleated cells are found in the scraping of the material taken from the base of the vesicle. However, this test does not make it possible to determine the type of herpes. The methods of enzyme immunoassay and indirect immunofluorescent reaction are also used. Recently, the diagnosis of viral infections is carried out using the polymerase chain reaction (PCR).

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Which doctors to contact

Depending on the primary symptoms, patients with herpes zoster may see different specialists. However, first of all, you should go to
therapist for examination and referrals for tests. If limited, localized skin rashes appear and there are no pain symptoms, it is necessary to contact a dermatologist for differential diagnosis of erysipelas (caused by bacteria), eczema, etc. In case of severe pain syndrome, movement disorders, consultation is necessary
neurologist. In case of damage to the eyes, pain when moving the eyeballs, an ophthalmologist’s consultation is required. The generalized form of herpes often requires hospitalization and the combined efforts of an immunologist, a neurologist, and a dermatologist.

Herpes zoster treatment

With any localization of rashes, antiviral agents are first prescribed (the drug, the frequency of administration and dosage are determined by the attending physician!).

Their action is especially effective in the first 72 hours from the onset of clinical manifestations.

In the presence of a strong pain syndrome, the doctor may recommend anti-inflammatory therapy. However, contraindications must be taken into account (for example, chronic diseases such as arterial hypertension, diabetes mellitus, erosive lesions of the intestine, peptic ulcer of the stomach and duodenum). If analgesics don’t work, your doctor may prescribe central analgesics (often prescription drugs) and nerve blocks. External (topical) treatment is necessary to eliminate inflammation and prevent infection of the skin by other agents (eg, bacteria). With erosive forms of herpes zoster, creams and ointments with antibacterial action are applied to the affected areas.

Your doctor may also recommend treatments to improve immunity, such as taking vitamins (particularly B vitamins).

Complications

When the vesicles open, a secondary infection (bacterial infection of the skin) is possible, which is accompanied by fever and general intoxication.

Typical complications of herpes zoster include neuritis, paresis and paralysis of sensory and motor nerves.

Postherpetic neuralgia is difficult to treat.

The ocular form of herpes can lead to keratitis (inflammation of the cornea), less often to iritis (inflammation of the iris) or glaucoma (increased intraocular pressure). In addition, the development of optic neuritis is possible, sometimes with its subsequent atrophy and blindness. With the defeat of the branch of the oculomotor nerve, ptosis develops (drooping of the upper eyelid). Sometimes patients complain of hearing loss, damage to the vestibular apparatus, in severe cases – paralysis and paresis of the oral cavity. In addition, patients may report tinnitus or increased sensitivity to sounds. Damage to the lumbosacral nerve nodes sometimes leads to urinary retention, constipation or diarrhea. In patients with significantly weakened immunity (with HIV infection, oncological diseases), herpes zoster often occurs in a generalized form and is complicated by meningitis, encephalitis, or meningoencephalitis.

Shingles prevention

Since shingles is caused by the same pathogen as varicella, prevention of the disease will be based on the same measures as with chickenpox.

To prevent the spread of infection, isolation of the patient is necessary, which lasts up to 5 days from the moment the last element of the rash appears.

Persons who have been in contact with a patient with chickenpox are observed for 21 days. Active (vaccination) and passive (immunoglobulin administration) immunization are used as emergency prophylaxis. Vaccination is carried out for children older than 12 months and adults with no contraindications in the first 72-96 hours after probable contact with a person with chickenpox or shingles. Passive immunization with anti-varicella immunoglobulin is indicated for people with low immunity who have contraindications to vaccinations, pregnant women, children under 12 months of age and newborns whose mothers fell ill with chicken pox within 5 days before the birth of the child. The introduction of immunoglobulin is also carried out within 72-96 hours after contact with a patient with chicken pox or herpes zoster.

References

1. Herpes zoster: Clinical guidelines. Ministry of Health of the Russian Federation. 2016.
2. Decree of the Chief State Sanitary Doctor of the Russian Federation dated February 5, 2018 No. 12 on the approval of SP 3.1.3525-18 “Chickenpox and Shingles Prevention”. 2018.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

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Shingles: photo, symptoms, treatment

What is shingles and ways of infection

Shingles, or herpes zoster, is a viral disease that manifests itself in the form of painful skin rashes on the trunk, face, head, arms and legs. Eruptions on the trunk (chest, abdomen and pelvis) appear in 90% of cases.

The disease is caused by the Herpes Zoster virus. This is the same virus that causes chickenpox. In 80% of people, infection with the virus occurs at a young age. A person falls ill with “chickenpox”, and after the cure, the virus lingers in the body and penetrates the nerve cells, where it remains in a “dormant” state.

Despite the fact that the body develops immunity to the virus, when the immune system is weakened, it can become more active and manifest itself as shingles. Therefore, chickenpox and shingles are two stages of the same disease. Chickenpox manifests itself when the virus is first infected, and shingles occurs due to reactivation of the infection. Here are the reasons for the recurrence of the virus:

• chronic stress
• malnutrition and vitamin deficiency
• overwork and lack of sleep
• malignant tumors
• HIV infection
• condition after organ transplant
• taking drugs that reduce immunity: glucocorticoids, chemotherapy drugs;
• frequent SARS;
• previous radiation therapy

A feature of the Herpes Zoster virus is extreme virulence, or contagiousness. Infection occurs in 100% of cases when the virus enters the body if there is no immunity to it. To become infected, household contact with a sick person is enough – the infection is transmitted by airborne droplets.

What does shingles look like, symptoms and diagnosis of shingles

Below are photographs of typical herpes sores: and, chills, fever up to 38 degrees, indigestion. Since the virus nests in nerve cells, the rashes occur along the line of the nerve trunks and are manifested by unilateral lesions.

Activated viruses rush from the nerve nodes to the outer integument of the body – the skin. After a day or two, spots similar to skin edema appear on the skin in places where viruses accumulate. On the 3-4th day, rashes form on the spots in the form of severely painful transparent blisters. In more than half of the cases, rashes are accompanied by an increase in the lymph nodes on the body, sometimes with lymphadenitis. After a week, the bubbles dry up and form a crust. The period of “malaise – disappearance of crusts – disappearance of pain and complete normalization of the condition” lasts 20-30 days, but in rare cases, clinical manifestations disappear in 10-12 days.

The described clinical picture is typical for 90% of cases of herpes zoster. In other patients, the disease proceeds atypically and manifests itself in the form of:

• muscle weakness
• appearance of blood in vesicles
• one large blister on the body instead of a rash of numerous vesicles
• absence of rashes
• skin lesions near the eyes, inflammation of the cornea up to loss of vision in this eye (ocular form). Eye involvement is often accompanied by inflammation of the facial or trigeminal nerve and even paralysis on one side of the face
• severe pain in the ear canal up to hearing loss in one ear (ear form)
• lesions of the meninges (meningoencephalic form) and brain tissue, which manifests itself in the form of hallucinations, ataxia, paralysis and in more than 50% of cases leads to death
• tissue necrosis (necrosis) at the site of the rash with the formation of numerous scars on the skin. Common in immunocompromised patients.

Complications of herpes zoster should be feared, which occur no more than in 5% of cases. Complications include:

• post-herpetic neuralgia – persistence of pain for several months after complete disappearance of lesions
• transverse myelitis – partial or complete motor paralysis
• viral pneumonia
• hepatitis
• glomerulonephritis, etc.

In the presence of typical rashes, the diagnosis of herpes zoster is not a problem for a dermatovenereologist, infectious disease specialist or immunologist, however, early diagnosis is difficult due to the fact that the first manifestations of the disease are disguised as influenza or a cold.

Atypical cases of the disease are dangerous due to late diagnosis and late treatment. In such cases, laboratory studies are needed: microscopy, serology, immunofluorescent analysis and hybridization. The most accurate result is given by the analysis of fluid from bubble eruptions.

Shingles treatment

Typical shingles resolves on its own unless complications occur. But in 70% of cases, treatment is required, which is prescribed by a doctor. Treatment is aimed at reducing itching and pain at the site of the rash, as well as speeding up recovery and preventing complications.

• Pain relief. For this purpose, Aspirin, Ibuprofen, Paracetamol and Lidocaine ointment are used. With intense pain, Ketoprofen and even narcotic analgesics – Galapentin and Oxycodone will be prescribed.
• Acceleration of recovery and prevention of complications are achieved with the help of antiviral drugs – Acyclovir, Famciclovir and Valaciclovir, ointments with antiviral drugs. In case of severe illness or in case of complications, hospitalization and intensive treatment will be required.

In an uncomplicated course, you can use traditional medicine:

• wipe the rashes in the morning and evening with a decoction of immortelle grass. You will need to pour a tablespoon of grass with a glass of boiling water. Leave for 1 hour.
• to strengthen the immune system with tincture of willow bark: brew a spoonful of willow bark with a glass of boiling water. Insist and drink 50 ml 3 times a day.
• to reduce the activity of the virus tincture of wormwood. Pour 2 tablespoons of raw materials with a glass of vodka or diluted alcohol, insist and make lotions on the rash for 15 minutes. For the same purpose, you can use an infusion of burdock: insist a tablespoon of leaves with a glass of boiling water for 2 hours. Drink an infusion of 50 ml 2 times a day.
• lubricate the affected areas with a mixture of soda and salt in equal proportions, diluted in water.

Prevention of shingles

The only way to prevent the disease is the varicella vaccine. If infection cannot be avoided, the virus cannot be eradicated from the body. The task is to prevent the virus from reactivating and causing repeated symptoms of shingles. To do this, you need to support immunity with:

• vitamins A, C, E and P
• healthy lifestyle
• avoiding stress, exhaustion, overload and lack of sleep
• treatment of somatic diseases

Which doctor to contact for the treatment of herpes zoster

If the rash is accompanied by intense pain, does not go away within 2 weeks, or is complicated by postherpetic neuralgia, myalgia, etc., consult a dermatovenereologist or infectious disease specialist. Contact the doctors of the Botkin.pro medical video consultation service. See how our doctors answer patients’ questions. Ask a question to the service doctors for free, without leaving this page, or here. Consult with your favorite doctor.

Questions from patients – answers from Botkin.pro doctors online:

• What does shingles look like?

  I have had a rash on the side of my stomach for 2 weeks. They don’t hurt, but they itch. I think it’s nerves, but my wife said it was shingles. Now I have become afraid. I want to know from a specialist what shingles looks like, because my wife claims that this is herpes – a serious matter and is treated poorly

  Hello. It is desirable for you to address to the dermatologist and the neuropathologist.

  Herpes zoster, or herpes zoster, looks like itchy crayon bubbles with transparent contents, the bubbles can merge with each other. Without treatment, these blisters go away on their own after a few weeks, leaving small erosions or sores that also go away with time. A complication may develop – postherpes neuralgia, which is treated for a long time and is not easy. I recommend contacting a neurologist.

  Dobry vechir, in order to know exactly what is herpetic gangionitis – turn to a neurologist or a dermatologist, so that you can live in peace.

• How contagious is shingles?

  Good afternoon. The situation is as follows – a relative was diagnosed with shingles, and I have 2 children at home – 2 years old and 15 days younger. She contacted them, took them in her arms. The question is – is it dangerous, with whom is it better to consult? Now the lichen has appeared visually

  Good afternoon. Shingles is contagious only when fresh blisters appear. In children who have been in contact with the patient, chickenpox develops, provided that this disease did not exist before. The incubation period for chickenpox is 1-3 weeks. Supervise the children during this time. If the youngest child is breastfed, the chance of infection is small.

• Shingles

  Hello, my father, he is 62 years old, has shingles for the third week, what drugs can be taken and how to lubricate externally, he did not take anything, he only lubricated with brilliant green and herpevir ointment. Outside a little passes, but inside the pain is felt.

  Hello. In addition to acyclovir (Gerpevir, Valaciclovir) at a dose of 400 or 700 mg, it is necessary to take the drug Lyrica or Neogabin to relieve pain, as well as Caiver 1 t in the evening – 10 days

• Shingles

  Hello. Eruptions on the forehead and slightly to the right. Severe swelling on the face. Forehead, eyes, under the eyes, on both sides. It is very scary that the swelling. Treatment – only pills for 7 days. Is it normal for a rash to be accompanied by swelling? Thank you.

  Yes, facial swelling can be very severe, continue treatment.

• Fever on the head and on the cheek

  My husband’s head began to hurt, then plaques and pimples formed. Then something like a fever popped up on her cheek. For a long time it was once on the cheek and this happens all the time in the wind on the Sea of ​​\u200b\u200bAzov. But for the first time! Can you tell me if it’s contagious? What is the fastest way to heal? And how to protect yourself? Are we going to the sea? Thank you!

  If the changes are on one side, then it may well be shingles.