Shingles – aftercare Information | Mount Sinai

Herpes zoster – treatment

What to Expect

An outbreak of shingles usually follows the following course:

• Blisters and pimples appear on your skin and cause pain.
• A crust forms over the blisters and pimples.
• In 2 to 4 weeks, the blisters and pimples heal. They rarely come back.
• Pain from shingles lasts for 2 to 4 weeks. You may have tingling or a pins-and-needles feeling, itching, burning, and a deep pain. Your skin may be very painful when it is touched.
• You may have a fever.
• You may have short-term weakness of certain muscles. This is rarely long term.

To treat shingles, your health care provider may prescribe:

• A medicine called an antiviral to fight the virus
• A medicine called a corticosteroid, such as prednisone
• Medicines to treat your pain

You may have postherpetic neuralgia (PHN) pain. This is pain that lasts longer than a month after symptoms of shingles start.

Skin Care and Itch Relief for Shingles

To relieve itching and discomfort, try:

• A cool, wet compresses on the affected skin
• Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or calamine lotion
• Zostrix, a cream that contains capsaicin (an extract of pepper)
• Antihistamines to reduce itching (taken by mouth or applied to the skin)

Keep your skin clean. Throw away bandages you use to cover your skin sores. Throw away or wash in hot water clothing that has contact with your skin sores. Wash your sheets and towels in hot water.

While your skin sores are still open and oozing, avoid all contact with anyone who has never had chickenpox, especially pregnant women.

Managing Pain

Rest in bed until your fever goes down.

For pain, you can take a type of medicine called NSAIDs. You do not need a prescription for NSAIDs.

• Examples of NSAIDs are ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve or Naprosyn).
• If you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or bleeding, talk with your provider before using these medicines.

You may also take acetaminophen (such as Tylenol) for pain relief. If you have liver disease, talk with your provider before using it.

You may be given a narcotic pain reliever. Take it only as directed. These medicines can:

• Make you sleepy and confused. When you are taking a narcotic, do not drink alcohol or use heavy machinery.
• Make your skin feel itchy.
• Cause constipation (not being able to have a bowel movement easily). Try to drink more fluids, eat high-fiber foods, or use stool softeners.
• Make you feel sick to your stomach. Try taking the medicine with food.

When to Call the Doctor

Call your provider if:

• You get a rash that looks or feels like shingles
• Your shingles pain is not well-managed
• Your pain symptoms do not go away after 3 to 4 weeks

Dinulos JGH. Warts, herpes simplex, and other viral infections. In: Dinulos JGH, ed. Habif’s Clinical Dermatology: A Color Guide in Diagnosis and Therapy. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 12.

Whitley RJ. Chickenpox and herpes zoster (varicella-zoster virus). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 136.

Last reviewed on: 5/12/2022

Reviewed by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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.

Top Picks

10 facts about lichen – Doctor TV channel

October 3, 2019 | 16:24

Beware! One lichen cat can cause a quarantine of 45 days

Of all the types of lichen, ringworm is the most noticeable, unpleasant and common among children. We have collected facts about him that all parents should know.

1. Ringworm is an inconspicuous beginning

Ringworm begins as a small, inconspicuous spot on the skin or head. It is easily confused with a mosquito or other insect bite. Gradually, the spot begins to grow and peel off, causing itching and a desire to scratch. If you do not pay attention to this stain, then others may soon appear, and if you wash in the bathroom with a sponge, then the whole body may become stained. Lichen on the skin has rounded and oval outlines, usually they are clearly defined, scaly scales are visible inside. On the scalp, lichen begins with a small focus 5-6 mm in size: the hair seems to be broken off.

If an animal becomes ill, you may not suspect that you are petting an infected cat, because the incubation period for this disease is very long and the animal may look quite healthy, and after a week it will begin to shed and go bald. To make a diagnosis, the doctor examines the lichen spots using a special Wood’s lamp: under its ultraviolet rays, the lichen glows emerald green. Also, a scraping of scales from the skin is taken from the patient – on the eve of this analysis, the stain cannot be treated with anything.

2. Ringworm is quarantine

Ringworm is a highly contagious fungal disease that affects the skin, nails and hair. Most often, they get sick with children who have touched a lichen cat or dog. But also ringworm can be transmitted through direct contact with the patient, when using shared hats, clothes, towels, toys and other items. Ideally, the patient should be isolated for the entire duration of treatment, and the entire apartment should be disinfected, and more than once. The incubation period is five to seven days if the infection came from an animal, and four to six weeks if the source was a human. Depending on the pathogen, there are two types of ringworm: trichophytosis and microsporia.

3. Ringworm lasts a long time

Ringworm is so contagious that the sick child is not allowed to attend school or kindergarten during the entire treatment, which can last from three weeks to several months. In difficult cases, when lichen affects the hair and is difficult to treat, the child is placed in the hospital for the entire course of treatment. They are discharged only when the person has gone through all the external signs of lichen and all three scrapings, which are taken weekly, showed a negative result. What should a parent do all this time? You can take a certificate for caring for a sick child, but this certificate of incapacity for work is issued only for 14 days. Then you will have to negotiate with your employer. You may have to take unpaid leave.

If an adult becomes ill with deprivation, a temporary disability certificate for an infectious form is issued for a period of 7–15 days. The issue of extending the sick leave is decided by the doctor.

4. Ringworm is a lot of cleaning

When it becomes known that a family member has ringworm, a general cleaning with special agents that kill pathogenic fungi and spores is necessary. The patient’s things are soaked in a disinfectant solution or boiled, it is recommended to quartz the room to kill all lichen spores. They are very tenacious and can live on surfaces for years without treatment, which can lead to reinfection or spread the disease to others. Upholstered furniture is recommended to be cleaned with a steam cleaner; chloramine or chlorhexidine is suitable for disinfection. The patient should sleep daily on a new pillowcase, put on new stretched and ironed clothes, and put the old clothes in a bag separately from other family members. He should have a personal bed, dishes, a towel, a comb and other personal items – they should not be used by other family members. After use, the patient’s personal belongings are soaked in a disinfectant solution for three hours. In the patient’s room, it is recommended to disinfect daily, then boil the rags or simply throw them away.

5. Lichen is not once

It is believed that lichen is very common: 90% of parents experience it at least once. But if children suffer from chickenpox once, then it’s more difficult with lichen: you can treat the baby and after some time find spots again if there is a re-infection. Immunity to the disease is not developed. But doctors say that not everyone gets lichen. For example, a mother sleeping in the same bed with a sick child may not catch the disease if she has strong immunity.

6. Lichen is a limitation

Man is a social being. Locking the patient in the house for three weeks is impossible, and not required. Doctors forbid visiting children’s institutions, public baths, swimming pools, hairdressers, but you can and even need to go outside, because recovery is associated with immunity. Doctors have noticed that people with immunodeficiency, poor health, who are in chronic stress most often get sick with lichen. But the child will not be able to walk with his friends, play on his favorite playground, attend holidays and interesting events. Siblings will have to be separated so that the sick person does not infect the healthy one. Of course, if there is a free room and parents can provide such quarantine.

7. Lichen is noticeable

When treating ringworm, doctors usually prescribe iodine or fucorcin in combination with anti-flu ointments – thanks to them, inconspicuous spots get a bright color and it is almost impossible to hide them from others. This can create additional discomfort for the patient, who did not want to signal his problem so clearly. If there is a spot in the hair, and even more than one, then not everyone decides to go out into the street with such a head. It is not recommended to close the spots, especially if they are located on the neck and face – in this case, the lichen can go to the head and recovery will be delayed indefinitely. If a characteristic spot appeared on the neck of the owner of a long head of hair, doctors urge not to hide it under loose hair, but, on the contrary, to collect it in a tight bun. Washing and combing in the first days of treatment is not recommended.

8. Lichen is a disruption of all plans

You were planning a family vacation or paid for a camp for a child – and then you saw a characteristic spot. What to do? You will have to hand over tickets, cancel the trip, postpone all business and events. And if the child has just started going to school and classes? Again, everything will have to be postponed and treated. As soon as the child is diagnosed with lichen in the Dermatovenerological Dispensary (CVD), the educational institution will be informed about your problem and quarantine will be established. So it’s not possible to move on quietly. This will have to be dealt with.

9. Lichen is a brain explosion

Let’s say you are a responsible parent and honestly told the teacher that your child has lichen and you will be gone for three weeks. Well get ready, this is just the beginning. Expect a heated discussion of the problem in the chat among the parents of classmates. People will be in shock and panic, they will send a hundred messages and maybe even call the principal demanding to invite a dermatologist to the school, keep the patient out of the classroom, take urgent measures, switch to home schooling (depending on the degree of hysteria). If the director is strict, the classroom will be quarantined for 45 days. At this time, children will be let in from a separate entrance, not let out into the corridor during breaks, all lessons, including physical education, will be held in the classroom, and disinfection will take place daily. You may feel guilty or, depending on the strength of your nerves, simply surprised at how many problems arose because of one lichen cat that a child stroked in the country. What awaits the child after returning from quarantine is unknown. Whether classmates will tease him, whether he will fall behind the school curriculum, whether he will fall into the rank of outcasts – all this is very optional, but there will be experiences. You may even regret that you did not go to a private clinic, but registered with the KVD.

10. Lichen is in the past

In the old days, children infected with lichen were excluded from educational institutions, placed under house arrest or in isolated “lichen” orphanage schools, where they could stay for years. In France, such children studied in special institutions on the territory of hospitals. Fortunately, these days, lichen is well treated. And the practice of placing young patients in hospital wards without parents is already becoming a thing of the past. Western doctors are no longer so strict in establishing quarantine for infected children. For example, a guideline for British doctors says that no isolation is required for ringworm: “Once the skin and scalp infection is treated, children can return to school.” Doctors in Australia are ordered to exclude the child from school only “until the next day after the start of treatment.” The validity of such a decision is also confirmed by analyzes: as soon as treatment is started, a scraping shows a negative result, the stain usually stops glowing.

You can greatly reduce your risk of contracting lichen by vaccinating your pets against it—usually two shots. Do not let your child stroke animals on the street, wear other people’s hats, follow general hygiene – and lichen will forever be a thing of the past.

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Why pink lichen is dangerous – Yarreg

Pink lichen is an infectious-allergic disease. It often develops after a sore throat, flu, bronchitis and other colds. Pink lichen can be accompanied by allergic reactions, since the skin of patients is highly sensitive to various kinds of mechanical, thermal, toxic irritants.

The disease begins with the appearance of a so-called plaque, after 7-10 days, round or oval pink rashes appear. After a few days, the skin in the center of the “mother’s plaque” acquires a yellowish tint, and the stratum corneum shrinks and cracks into small scales.

During the period of fresh rashes, there may be malaise, fever, enlargement of the cervical and submandibular lymph nodes.

More often the disease occurs in women aged 20-40 years, rarely in children. Seasonality of the disease – spring, autumn.

Uncomplicated disease does not require treatment. In such cases, it is recommended to follow a diet (refrain from taking alcoholic beverages, spicy, salty, pickled and other irritating foods), limit the intake of water procedures (you can not wash in baths, use washcloths, wear skin-irritating underwear, etc.).

In case of exacerbation and complication of pink lichen and the spread of the process, it is recommended to consult a doctor for timely treatment. The duration of the disease is 6-8 weeks (no more than 3 months). As a rule, the disease does not recur.

HEALING BOWL

For lichen, which can be obtained from a cat or dog, air-dry (but not in the sun) the herb of bluebell, sprinkle the herb powder on the areas of the skin affected by the lichen, bandaging them loosely.

PHARMACY IN THE BED

Rhubarb. It has no less healing power than lettuce, spinach, celery. It contains nicotinic acid, carotene, thiamine, mineral salts of phosphorus and magnesium, iron, potassium, calcium.

Recipe 1. Stewed rhubarb. Peeled rhubarb cut into pieces, pour a small amount of water and simmer with semolina. Serve with milk or cream. For 300 g of rhubarb 50 g of semolina, sugar, salt – to taste.

Recipe 2. Rhubarb and beetroot salad. Dice boiled or baked beets. Add finely chopped rhubarb. Fill with sour cream. Sugar and salt – to taste. If you add chopped onions, and grated horseradish to sour cream, give the salad a completely original taste.

Recipe 3. Spring cabbage rolls. Chopped eggs, parsley, butter put in any crumbly porridge and minced meat is ready. Scald young rhubarb leaves with boiling water, put minced meat in them and wrap. Bay with sour cream sauce, simmer in a saucepan under the lid for 10-15 minutes.

NATURAL

COSMETOLOGIST

Since ancient times, cucumbers have been used in cosmetics as a cleanser, refresher and skin whitener. Try wiping your face with a slice of cucumber or a piece of skin removed from it – you will immediately feel a pleasant freshness.

Want to make a cucumber mask that moisturizes and whitens your skin? Grate a fresh cucumber or chop it very finely, put this mass on cheesecloth and apply to your face and neck. After 15 minutes, wash your face and lubricate the skin with cream.

If you have the first wrinkles on your forehead, a daily massage with a piece of fresh or pickled cucumber is useful. The juice, being absorbed, moisturizes the skin, and after drying it creates a mask. Wash off after 30 minutes.

THE READER ADVISES
Rimma Mikhailovna Simonova from Yaroslavl advises applying fresh cabbage leaves to the temple, back of the head and forehead for headaches.

Fresh cucumber with peel, eaten without salt, has a positive effect on the body’s metabolism and has a healing effect on skin prone to acne and blackheads.

AMBULANCE

Itching, redness, swelling from a mosquito, bee, hornet or wasp sting is reduced by lubricating the skin with the juice of calendula or onion, plantain, fresh parsley leaves, fresh potatoes crushed into gruel. Itching from mosquito bites also goes away if you use lemon juice, table vinegar, ammonia, a solution of baking soda (half a teaspoon of one or the other in a glass of water).

An effective, tried and tested folk remedy is the milky juice of dandelion, a common garden weed. Squeeze a few drops of juice from the flower stem or the base of the succulent leaves and lubricate the bite wound and the skin around it. Lubricate the bite site 5-6 times during the first hour after the bite – then the swelling that begins to form will quickly pass and the pain will subside.

VITAMINS FOR SAFETY

The only vitamin that a person can determine the lack of in himself is vitamin A. If you move from a bright room into a dark room, check how long it will take for your eyes to get used to the dark. If more than 6 seconds, then your body lacks vitamin A. Then we recommend that you drink at least a glass of tomato juice daily. You can add some finely chopped parsley to it.

* Do not store tomato juice in metal containers.