The Centers for Disease Control and Prevention estimate that shingles strikes one million Americans each year. Most patients experience pain and a characteristic one-sided, blistering skin rash; however, sometimes shingles turns inward, affecting the internal organs. While the CDC recommends oral medications for patients with typical cases of shingles, patients with internal organ involvement require more aggressive treatments.
Antiviral Drugs
Antiviral drugs work by blocking replication of the virus that causes shingles. Although any one of three prescription antiviral drugs can be used to treat shingles, University of Alabama Professor of Infectious Diseases Richard J. Whitley in the 2008 edition of "Harrison's Principles of Internal Medicine," just one, acyclovir, is available for intravenous administration. While oral drugs are sufficient for people with typical cases of shingles, patients who exhibit signs of internal organ involvement require intravenous treatment, according to Whitley. Patients who improve on intravenous preparations can often transition to oral drugs.
Steroids
Steroids, according to Duke University Professor of Internal Medicine Jack I. Twersky, M.D. in the 2009 edition of "Hazzard's Geriatric Medicine and Gerontology," control inflammation related to shingles. Although there's not much evidence to support their use in patients with shingles, Twersky notes, many doctors prescribe them, particularly in patients who exhibit symptoms of eye, spinal cord or brain inflammation. Patients often start on intravenous or intrathecal---where the drug is injected into the cerebrospinal fluid---methylprednisolone and transition to oral prednisone when symptoms improve. Since stopping steroids abruptly can cause problems, Twersky says that most patients wean off the drugs over the course of two or three weeks.
Pain Control
All patients with shingles benefit from pain medications, however pain can be particularly severe in those with internal organ involvement. Acetaminophen is adequate for mild pain, says Twersky. Patients with severe pain require opioids such as morphine, tramodol and fentanil. Opioids can be administered orally, intravenously or intramuscularly. In the Jan.-Feb. 2008 edition of "Pain Management," Pennsylvania State University anesthesiologist Bruce Nicholson, M.D., recommends extended-release preparations to avoid sleep interruption due to shingles pain.
Symptom-Based Treatment
Patients with internal organ shingles also require care for their specific symptoms. For example, says Whitley, people with shingles-related pneumonia may require supplemental oxygen or even mechanical ventilation in the case of respiratory failure. MayoClinic.com endorses lubricant eye drops and night-time patching to protect against corneal damage in people with shingles of the eye. Patients with shingles-related inflammation of the brain or the outer protective covering of the spinal cord, known as the meninges, often require sedation to control agitation and reduce the risk of self-harm due to abnormal behavior.
References
- Centers for Disease Control and Prevention: Herpes Zoster Disease: Q and A's for Providers
- "Harrison's Principles of Internal Medicine, 23rd Edition"; A.S. Fauci et al.; 2008
- "Hazzard's Geriatric Medicine and Gerontology, 6th edition"; J.B. Halter et al.; 2009
- "Pain Practice"; Benefits of Extended-Release Opioid Analgesic Formulations in the Treatment of Chronic Pain; B. Nicholson; Jan.-Feb. 2009
- MayoClinic.com: Ramsay Hunt Syndrome
