While there's no cure for
shingles, a viral infection that causes a painful, blistering rash and nerve damage, you can avoid getting it in the first place by receiving the
recombinant zoster vaccine (Shingrix). And if you do develop shingles, getting immediate treatment can help speed the healing process and reduce your risk of complications, including a condition called
postherpetic neuralgia, which causes lingering nerve pain.
“People with shingles almost always have a rash around [either] the left or right side of the body,” though both sides may be affected in immunocompromised people, says Dushyantha T. Jayaweera, MD, an infectious disease specialist and professor at the University of Miami’s Miller Medical School in Miami, Florida. “[It] is usually painful, itchy, or tingly.”
Antiviral drugs can shorten the duration and severity of shingles, but they’re most effective if you start them as quickly as possible after the rash emerges. Delays can lead to lifelong neuropathic (nerve) pain in the form of postherpetic neuralgia Dr. Jayaweera says.
Prescription or over-the-counter pain medication may also help relieve pain during the acute phase of shingles, along with home remedies, like colloidal oatmeal baths, wet compresses, and calamine lotion, that also soothe any itchiness.
But shingles and its potential complications are almost always avoidable. “Do not wait for [an infection] to happen,” says Jayaweera. “This is almost always preventable [if you] vaccinate early.”
Getting the
shingles vaccine is the only way to reduce the risk of developing shingles and to lessen the risk of complications like postherpetic neuralgia.
Shingles, which affects one in three adults, is caused by the varicella zoster virus, the same virus that causes
chickenpox. If you’ve had a past chickenpox infection, as more than 99 percent of people born before 1980 have, the virus can become reactivated later in life and cause shingles. You can also get shingles more than once, but getting vaccinated can prevent subsequent infections.
The
recombinant zoster vaccine, also known as Shingrix, is approved for adults age 50 and older, as well as for adults age 19 and older who are or will be at increased risk of
herpes zoster due to a weakened immune system caused by illness or medication.
An older, live vaccine, Zostavax, was discontinued in 2020. If you have had shingles already, received Zostavax, or aren't sure whether you ever had chickenpox, you should get vaccinated with the recombinant zoster vaccine (Shingrix), which is given as two shots, two to six months apart.
In an 18-country study of more than 15,000 people, researchers found that the recombinant zoster vaccine was 97.2 percent effective in
preventing shingles among those age 50 and older.
In a second study, which included nearly 14,000 participants, the same researchers found that the vaccine was 91.2 percent effective at preventing postherpetic neuralgia, the aforementioned complication that causes nerve pain that can last for months or years, in adults over the age of 50. And it was 88.8 percent effective at preventing it in adults age 70 and older.
A follow-up study of the people from these two clinical trials looked at how long protection from the vaccine lasts. At 11 years, it proved to be 82 percent effective at preventing shingles, 87.5 percent effective against postherpetic neuralgia, and 91.7 percent effective against other shingles complications in participants over 50.
Out-of-pocket costs for the recombinant zoster vaccine can vary. Most private health insurance and Medicaid plans cover the vaccine, but you may be responsible for some of the cost, depending on which plan you have. Medicare Part D (the
Medicare prescription drug plan) should cover the cost.
There is no cure for shingles, but medication can help lessen symptoms.
To help diminish the length and severity of a
shingles infection and limit nerve damage, your physician may prescribe an antiviral drug such as the following:
- acyclovir
- famciclovir
- valacyclovir (Valtrex)
Ideally, you should take antiviral medication as soon as the rash appears. Taking these drugs within 72 hours of the eruption of the rash will help prevent postherpetic neuralgia. With postherpetic neuralgia, nerve fibers, inflamed or damaged by shingles, continue to send pain signals to your brain months or even years after the blisters have gone away.
Up to 20 percent of
shingles cases may affect the nerve connected to the eye and the skin around it, which can lead to permanently impaired vision. This condition is called herpes zoster ophthalmicus, and it’s treated using topical or oral antivirals, corticosteroids (steroids), eye drops, cold compresses, and antibiotics, if needed.
“This is an emergency, because if it progresses, it can involve the eye itself and threaten sight,” says Andrew Tout, MD, an internal medicine specialist at Northwestern Medicine in Chicago.
“Treatment is initially with high-dose [oral] antiviral medication that is reduced slowly over the course of weeks to months under the close supervision of an ophthalmologist. Anti-inflammatory eye drops may also be used.”
Treating herpes zoster ophthalmicus promptly — within 72 hours — can reduce the chances of eye-related complications by about 50 percent compared with no treatment, Dr. Tout says, but there’s still a small chance of significant vision loss.
Antibiotics may also be prescribed if a secondary bacterial infection occurs with the shingles rash.
Before taking any medication for shingles, be sure to talk to your doctor about possible side effects.
“Shingles can be very, very painful,” says Tout. “The pain is related to inflammation of the nerves and is often described as burning, throbbing, stabbing, or an electric-shock sensation.”
In addition to antivirals, your doctor may prescribe the following treatments for pain.
- Acetaminophen (Tylenol)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve)
- Capsaicin topical patch (Qutenza)
- Anticonvulsant drugs such as gabapentin (Neurontin, Gralise) and pregabalin (Lyrica)
- Tricyclic antidepressants such as amitriptyline and nortriptyline (Pamelor)
- Numbing medications such as lidocaine
- Opioids such as tramadol, oxycodone, or morphine
- An injection of corticosteroids and local anesthetic
- Oral corticosteroids
“[W]hile [pain medications] can be somewhat helpful, they often have drawbacks, especially in older adults or individuals with certain health conditions like diabetes,” Tout says. “Starting antiviral medication promptly has been shown to reduce the severity and duration of time with shingles-related pain, but it doesn't make the pain medications themselves work better.”
If postherpetic neuralgia develops, similar medications are used to treat the related pain.
While it may seem strange for your doctor to prescribe drugs that are commonly used to
treat depression and prevent seizures, shingles is a nerve disorder at its root, and these drugs work in different ways to calm damaged nerves.
Anticonvulsant medications used to prevent seizures are thought to work by disrupting the pain signals sent out by
damaged nerves.
And it’s believed that tricyclic antidepressants — an older
class of antidepressants — work by increasing the levels of the neurotransmitters (brain chemicals) that modify pain response.
“Like the pain-relieving treatments for shingles itself, the medications we use for treating postherpetic neuralgia are less effective than we would like and can often come with side effects,” Tout says.
“It is expected [you’ll] need less and less pain medications over time, and most people experience resolution by three months. However some [people], most commonly older individuals, can experience pain for up to two years or even longer.”
- Shingles (herpes zoster), a viral infection that causes a painful rash, can be prevented by getting vaccinated, or treated within 72 hours with antivirals and other medications, to prevent complications.
- In addition to antivirals, shingles symptoms like pain are treated using over-the-counter or prescription pain medications, antidepressant and anticonvulsant drugs that alter pain signaling or responses, corticosteroids (steroids), and antibiotics, if needed.
- Most of the same medications are used to treat complications of shingles, such as eye involvement and lingering nerve pain.
Additional reporting by Carlene Bauer and Laura Casey.
