Shingles or Herpes zoster is basically a viral infection caused by Varicella zoster virus that also causes chicken pox. The condition needs to be treated with drugs that act against viral infections called antiviral drugs.
The condition almost always resolves by itself within 2 to 4 weeks. However, the use of these drugs reduces the complications (short and long term) as well as pain and severity of the disease.
The antiviral agents in use for shingles are Acyclovir, famciclovir, valacyclovir etc.
These drugs have to be started within a day (24 hours) of onset of the burning or pain over the area and almost always before the rash appears.
Starting the course of the drugs beyond this period does not guarantee reduced symptoms of the condition.
These drugs are given as tablets. Severe infections need to be treated with intravenous or injected antiviral drugs. (1, 2, 3)
Sometimes, if there is severe inflammation, anti-inflammatory medicines like corticosteroids (e.g. Prednisolone) may be prescribed. These reduce swelling and pain.
They may not be effective in all patients.
Antihistamines like Levocetirizine are prescribed to ease the itching. They may be given as tablets to be taken orally or as creams to be applied locally over the skin.
Pain medicines may be prescribed to alleviate the pain.
Antiviral creams and soothing lotions are also prescribed to be applied locally. (1, 2, 3)
Cleanliness and hygiene
Bed rest is advised. Patients are advised to maintain cleanliness and hygiene.
Bathing with soap and water is permitted.
They need to use items that are washed in boiling water or otherwise disinfected before using them again.
Isolation from vulnerable individuals like children, pregnant women and elderly is also important. (1, 2, 3)
Vaccination for adult Herpes zoster
U.S. Food and Drug Administration (FDA) in May 2006 approved the first vaccine for adult herpes zoster.
Now the U.S. Centers for Disease Control and Prevention recommends use of the vaccine for 60 years and older population who have already had chicken pox.
It is a single injection with no need for booster shots.
The vaccine is actually a booster dose of the chickenpox vaccine given to children.
People with weakened immune systems however, cannot be given this vaccine. Pregnant women also cannot take this vaccine. (1, 2, 3)
For secondary bacterial infections over the lesions, antibiotics orally, as well as in form of creams need to be taken.
Eye infections or conjunctivitis or ear infections need therapy with antibiotic eye and ear drops.
In long term complications, like Postherpetic neuralgia, drugs used for certain types of epilepsy are found useful. These include gabapentin, carbamazepine, pregabalin etc.
Locally applied creams containing Capsaicin found in chili peppers may also be effective in pain relief. Anaesthetic creams and patches are prescribed for severe pain. (3)
Shingles and pregnancy
Pregnant women are susceptible to shingles. However this is a rare condition.
The antiviral medications may be given safely to pregnant women.
They cannot be administered chicken pox or shingles vaccine. If a woman as received the shingles vaccine, she needs to wait three months before trying to conceive.
If the woman contracts chicken pox during pregnancy there is a risk of birth defects that can affect the unborn child. (3)
Alternative therapies like Acupuncture has been used as a Chinese therapy for centuries. It may be tried in post herpetic neuralgia.
Another alternative is Biofeedback method of pain control. Transcutaneous electrical nerve stimulation or TENS therapy uses mild electric current to treat pain.
Counselling, behavioural therapy and breathing and relaxation exercises are also suggested for long term pain control in postherpetic neuralgia. (4)
Edited by April Cashin-Garbutt, BA Hons (Cantab)
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