Shingles is a reactivation of the same virus that causes chicken pox, varicella-zoster, which reemerges as an outbreak of painful, sensitive blisters on the skin in an infection known as herpes zoster. Shingles may be treated with a number of medications to reduce the viral outbreak and treat the pain and sensitivity associated with the condition.
Antiviral Medications
Antiviral medications for shingles may be used in the early stages of the outbreak to reduce its severity and length. Although many patients will have no long-lasting effects after healing of the blisters is complete, some may develop a long-lasting condition known as postherpetic neuralgia, which results in long-term pain along the infected nerve tract. Antiviral use may decrease the chance for developing complications such as postherpetic neuralgia. Medications such as acyclovir, valcyclovir and famcyclovir should be given within the first 72 hours of notice of the rash and are generally given for 5 to 10 days. Antiviral medications may have side effects, such as nausea, diarrhea, headache and joint pain.
Pain Medications
During the outbreak, some patients may experience pain at the rash site. Although over-the-counter pain medications, such as acetaminophen and ibuprofen, may be effective for some, other patients will require the use of stronger pain medications, such as codeine or hydrocodone. Tricyclic antidepressants, such as amitriptyline, and anti-convulsants, such as gabapentin or pregabalin, may help reduce nerve pain both during the initial outbreak and in postherpetic neuralgia. In the case of severe postherpetic neuralgia, corticosteroid injections, such as methylprednisolone, may be injected near the spinal cord to reduce pain. However, corticosteroid use is not recommended until the rash has completely cleared.
Topical Medications
Calamine lotion, colloidal oatmeal and topical antihistamines, such as diphenhydramine (Benadryl), may help reduce itching. Topical anesthetics, such as lidocaine and dibucaine, may help treat both itching and pain by numbing the area. Compresses made with a solution of aluminum acetate, known as Burrow's solution, may help dry out the blisters and reduce oozing. Although blisters usually heal on their own, in some cases, the blisters may become infected and require treatment with a topical antibiotic, such as Bacitracin or neomycin. In cases of severe infection, oral antibiotics may be required to prevent or treat the development of cellulitis.
