How Is Shingles Treated?

Shingles, also named herpes zoster, is a viral condition that causes a painful, itchy, blistering rash, along with other symptoms like fever, headache, and upset stomach.

Typically, the rash appears on one side of the body or face. Less commonly, the rash can be more widespread on the body. This usually happens in people who are immunocompromised, meaning they have a weakened immune system. The rash generally goes away within two to four weeks, although the pain can last for one or two months.

Shingles is caused by the varicella-zoster virus (VZV)—the same virus that causes chickenpox. You can get shingles if you have had chickenpox or gotten the chickenpox vaccine After recovering from chickenpox, the virus travels to nerves in your body where it stays inactive. When VZV reactivates, it causes shingles.

Most people who get shingles may only have it once, but it is possible to have it multiple times.

There is no cure for shingles. However, there are medications that help prevent shingles, reduce your symptoms, shorten the length of your disease, and decrease the risk of complications. 

Your primary care provider or a dermatologist (a doctor who specializes in hair, skin, and nails) can provide a specific treatment plan based on your condition.

Why Early Treatment Is Important

As shingles can spread to different areas of the body, it can sometimes cause serious health complications if left untreated. 

The most common complication of shingles is postherpetic neuralgia (PHN), a type of long-term nerve pain that lasts more than three months. About 1 in 5 people with shingles may develop PHN, though it usually affects people aged 50 years and older.

While less common, other potential complications of shingles may be vision or hearing loss, pneumonia, or inflammation in the brain (encephalitis).

Getting diagnosed and treated for shingles by a healthcare provider may help prevent these long-term health complications.

Medications for Treating Shingles

Treatments for shingles generally help relieve symptoms and stop the rash from spreading further in your body. The types of treatment include antivirals, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids.

Antivirals

Antiviral medications suppress the virus by preventing it from multiplying in your body. This allows the rash to heal quicker and reduces the severity and length of  pain. If you suspect you may have shingles, it’s important to get diagnosed as soon as possible as antiviral medications are most effective if started within 72 hours after the rash appears. 

In addition to shortening the duration of shingles, antiviral treatment can cut your risk of developing PHN in half.

Your doctor may prescribe one of three antiviral drugs that are FDA-approved to treat shingles:

• Zovirax (acyclovir): A common side effect is general discomfort.
• Famvir (famciclovir): Common side effects are nausea and headache.
• Valtrex (valacyclovir): Some side effects include nausea, headache, dizziness, and abdominal pain.

Usually, you’ll take an antiviral drug for about one week.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

For mild shingles pain, your healthcare provider may recommend over-the-counter NSAIDs like Advil (ibuprofen), Aleve (naproxen), and Tylenol (acetaminophen). Common side effects may include stomach ulcers and increased blood pressure. If you have a kidney condition, consult your doctor before taking an NSAID.

If your pain is severe and affecting your ability to fall asleep, your doctor may prescribe stronger types of pain-relief medication.

Opioids 

For severe shingles pain and PHN, your healthcare provider may prescribe opioids. In a 2022 study of U.S. health insurance data (commercial insurance or Medicare), for about 130,000 people with shingles, over 25% received opioid prescriptions. People with immunocompromised status, PHN, or multiple health comorbidities were more likely to be prescribed opioids. 

Side effects of opioids can include constipation, nausea, drowsiness, and decreased rate of breathing. Opioids can be dangerous and addictive and lead to overdose and death. It is important only to take opioids as prescribed and alert your doctor with any concerns right away.

At-Home Remedies 

Along with shingles medication, there are common at-home methods to help alleviate symptoms, such as wet compresses and calamine lotion. 

Wet Compresses

Applying a cool, damp washcloth as a compress may help ease discomfort from your shingles rash. You can use a cool compress multiple times a day for five to 10 minutes each interval. Be sure to use a clean washcloth each time.

Calamine Lotion

Calamine lotion is known to calm itchy skin caused by insect bites, poison ivy, and eczema. This lotion may also help ease itching from shingles. Wait until the blisters on your rash have scabbed over to begin using this product. Wash your hands before and after applying calamine lotion to prevent infection.

Medications for Postherpetic Neuralgia (PHN)

The main focus of treatment for PHN is pain relief. Because the symptoms of PHN are caused by nerve pain, the medications used to treat it may be different from other pain medications you are familiar with. 

Anti-seizure Medications

Pain management for PHN often begins with a prescription for an anti-seizure medication, commonly known as anticonvulsants. Examples of different anticonvulsants for PHN-related nerve pain include gabapentin, known by the brands Neurontin and Gralise, as well as Horizant (gabapentin enacarbil). Lyrica (pregabalin) is also an anticonvulsant that’s commonly prescribed for PHN. These anticonvulsants may block pain signals traveling to the brain.

Common side effects of gabapentin and pregabalin include drowsiness, dizziness, double vision, coordination difficulties, and swollen hands, legs, and feet. These symptoms could put you at a higher risk for a fall. If you experience these symptoms, consult a healthcare provider. You should take extra care when standing up and moving around. 

Tricyclic Antidepressants

Tricyclic antidepressants (TCAs) are a class of medications used to treat depression and can be used to reduce pain from PHN. TCAs are usually prescribed at lower doses for PHN, compared to the typical dosage for treating depression. 

If you are taking a TCA, it may take three weeks or longer to notice a difference in your pain. These medications are often started at a very low dose and gradually increased. Despite being a common treatment for PHN, researchers don’t fully understand how TCAs work to reduce pain in the body. 

Feeling tired is a common side effect when first starting TCAs. Talk to your healthcare provider if you have a heart condition—in which case, taking TCAs are not recommended and may affect your heart.

Topicals

There are topical medications that you can apply to the skin to help relieve pain from PHN. For example, capsaicin, a chemical compound found in chili peppers, can be used to treat pain; however, about a third of people may not be able to tolerate the burning and stinging side effects of capsaicin application to the skin.

Lidocaine is a local anesthetic drug that can numb your skin over the painful or itchy area.

Either of these ingredients may be found in gels, patches, creams, or ointments. 

Complementary and Alternative Therapies for Nerve Pain

Another treatment option is using a combination of complementary and alternative therapies to help reduce pain, alongside other pain relief medication. The following therapies may help treat shingles-related pain:

• Acupuncture: Acupuncture needles are inserted into certain areas of the body, near muscles and pressure points.
• Moxibustion: This method involves placing burned dried mugwort, a type of herb, on similar areas of your body where acupuncture needles would go.
• Cupping: This involves placing heated suction cups on your body.

Some research suggests these therapies could help prevent the development of PHN, although more research is needed.  

Shingles and Nerve Pain Prevention

You can reduce your chance of getting shingles by getting vaccinated. 

Even if you still develop shingles after getting vaccinated, the vaccine is at least 90% effective at preventing severe shingles and PHN. The CDC recommends getting Shingrix even if you’ve had shingles before, as it reduces the likelihood you’ll get shingles again.

Living With and Managing Shingles

Shingles can cause discomfort and pain and may lead to long-term symptoms in some people. About 20% of people will develop shingles at some point in their lives. Although hospitalization and death from shingles are rare, older adults or people who are immunocompromised may be at higher risk.

Most people with shingles may see their rash fade within two or four weeks and have no residual symptoms. Taking antiviral medications for shingles may help you recover faster. You can manage pain with over-the-counter or prescription medicines.

People with shingles who go on to develop PHN may experience pain and itching for months to years. Managing PHN can be difficult, but there are various treatment options available to help with pain relief. Speak with your healthcare provider to find a treatment strategy that works for you.

A Quick Review

Shingles is a viral infection that can cause symptoms ranging from an itchy, painful rash to life-altering symptoms. However, there are several effective treatments available for preventing shingles, as well as pain relief from shingles, reducing the recovery time for an active rash, and lowering the chance of developing postherpetic neuralgia (PHN) and other long-term complications.