Shingles Treatment

Shingles is a viral infection that affects the nerves and skin. It is caused by the varicella-zoster virus, the same virus that causes chickenpox. When you have chickenpox, normally in childhood, the virus stays dormant in the body and can come back later in life as shingles. This normally occurs when your immune system is weakened due to old age, stress, illness, or certain medications. Around 1 in 4 adults will get shingles during their lifetime. It is most common in people over 70 years of age. Symptoms of shingles include:

• pain, tingling, itching, or a burning sensation in the skin. This is normally the first symptom
• headache
• fever
• chills
• after a few days, a blotchy rash appears on one side of the face or body, or less commonly, in and around the eye (ocular shingles). The rash develops into painful, fluid-filled blisters, which normally dry out and crust over within 7 to 10 days. The rash normally clears up completely in between 2 and 4 weeks
• sometimes skin pain and burning can continue for months or even years after the rash has gone. This is known as postherpetic neuralgia (PHN)

Can you catch shingles from someone who has it?

You cannot catch shingles from someone infected with the disease, but in rare cases, you may catch chickenpox if you haven’t had it before. Chickenpox is normally a mild illness, but it can be dangerous for some people. If you have shingles or chickenpox you should avoid contact with pregnant women who have never had chickenpox, people with weakened immunity (such as people with HIV, people who are on cancer treatment, or babies under 1-month-old).

There is no cure for shingles, and the infection normally goes away by itself after between 2 and 4 weeks of developing it. However, treatments are available to relieve symptoms and help you recover faster. Treatments for shingles include:

• antiviral medications
• painkillers
• lotions
• home treatments

How effective is shingles treatment?

Treatment with antiviral medications like aciclovir, valacyclovir, and famciclovir can shorten the length of an outbreak and may help prevent complications such as postherpetic neuralgia (PHN). Treatment with antivirals is most effective if started as soon as possible after the rash develops, ideally within 2 to 3 days.

How long does it take for shingles treatment to work?

Antiviral medications start to work as soon as you start taking them. A shingles infection normally lasts for between 2 and 4 weeks, but this may be shorter if you take antivirals, especially if you start taking them early (within 48 to 72 hours of the rash starting).

Can shingles come back after treatment?

Getting shingles more than once is rare, but the infection can come back a second or even a third time. This is more likely if you:

• have a weakened immune system from a condition such as HIV or leukaemia
• take medications that suppress your immune system

Does shingles treatment relieve pain?

Your doctor can recommend an over-the-counter painkiller like paracetamol to help with pain, or they may prescribe a stronger medication.

Is shingles contagious after treatment?

Shingles itself is not contagious but can cause chickenpox in people who haven’t had it. The virus is present in the fluid of blisters and is spread by direct contact with blisters and open sores. You are contagious until all your blisters have dried out and scabbed over. To prevent the spread of the virus:

• avoid sharing towels and flannels
• don’t go swimming or take part in contact sports
• stay away from work or school if you have open sores or blisters that can’t be covered
• avoid contact with people in high-risk groups including pregnant women, people with weakened immunity, and babies under 1-month-old (unless you gave birth to the baby in which case they should have antibodies to protect them)

Antiviral medications

Antivirals are prescription medications that work by stopping the virus from spreading in the body. They do not cure shingles or prevent you from passing the virus to other people. Antivirals are most effective if you start taking them as soon as possible after the rash appears. Antiviral medications used to treat shingles include:

• Aciclovir is available as a cream, tablet, capsule or liquid suspension. In people with weakened immune systems, or who are unable to take medication orally, aciclovir may be administered intravenously (into a vein). This will only be done by a nurse or doctor in hospital. The normal adult dose of aciclovir for shingles is 800mg 5 times a day for 7 to 10 days
• Valacyclovir is a tablet that is taken 3 times a day for 7 days. Treatment should be started within 48 hours of the rash developing. Valacyclovir can be taken with or without food.
• Famciclovir comes as a tablet that is taken 3 times a day for 7 days. To be effective, it needs to be started within 48 hours of the first signs of the rash. It can be taken with or without food.

Painkillers

To relieve shingles pain, you can take over-the-counter painkillers such as paracetamol. If your pain is severe, your doctor may prescribe a stronger medication. Some medications used to treat severe shingles pain or PNH include:

• gabapentin —this medication is used to treat epilepsy and nerve pain. It works by blocking pain signals from the brain and spinal cord.
• amitriptyline is a type of antidepressant that can also be used to treat nerve pain. It works by lowering pain signals to the brain.
• capsaicin is a compound found in cayenne pepper. It may help with nerve pain by decreasing pain signals between the central and peripheral nervous systems. Capsaicin is available as a skin patch or topical cream.
• lidocaine is a local anaesthetic that is available as a skin patch or topical cream. It works by blocking signals at nerve endings in the skin.
• corticosteroid injections work by reducing inflammation and swelling to relieve pain.

Calamine lotion

This over-the-counter lotion can provide relief from itching and help cool and soothe shingles rash. It also contains zinc oxide which reduces inflammation and helps to reduce itching and pain.

Shingles vaccine

There are 2 shingles vaccines available in the UK.

• Zostavax is a live vaccine that is given as a single dose. This is the vaccine that most people have.
• Shingrix is a non-live vaccine given as 2 doses 2 months apart. This vaccine is given to people with weakened immune systems who cannot take live vaccines.

In the UK, the shingles vaccine is available on the NHS to everyone between 70 and 79 years of age. Having the shingles vaccine reduces your risk of getting shingles and makes the disease less severe if you do get it. If you’ve already had shingles, getting the vaccine can reduce your risk of getting it again. The shingles vaccine is also available to people over 50 years of age from Superdrug health clinics.

What’s the best treatment for Shingles?

The best treatment for shingles is antiviral medication. Your doctor will decide on the best antiviral medication for you based on your general health, any other medications you are taking, and your preference. If you have symptoms of shingles contact your GP right away so you can get the correct treatment early. Other treatments like painkillers or calamine lotion can be used at the same time as antivirals to help reduce pain and discomfort.

Like all medications, antivirals can cause side effects in some people. Common side effects of aciclovir include:

• headaches
• nausea (feeling sick)
• vomiting (being sick)
• dizziness, especially when standing up
• diarrhoea
• stomach pains
• rash
• the skin being more sensitive to light (photosensitivity)
• itching
• feeling tired
• fever (high temperature)

Uncommon side effects of aciclovir include:

• itchy rash (hives)
• hair loss

Very rare side effects of aciclovir include:

• weakness
• agitation or confusion
• tremors
• hallucinations (seeing or hearing things that aren’t there)
• seizures (fits)
• drowsiness
• unsteadiness and lack of coordination
• coma
• paralysis (being unable to move part or all of the body)
• stiff neck and sensitivity to light
• yellowing of the skin and the whites of the eyes (possible liver problems)
• passing little or no urine (possible kidney problems)
• lower back pain
• swelling of the face, lips, and tongue, difficulty breathing, rash, and collapse (a possible severe allergic reaction called anaphylaxis)

If you experience any of these side effects, stop taking your medication and see a doctor as soon as possible. For a full list of possible side effects of aciclovir read the patient information leaflet. Common side effects of valacyclovir include:

• headache
• nausea (feeling sick)
• dizziness
• vomiting (being sick)
• diarrhoea
• the skin being more sensitive to light (photosensitivity)
• rash
• itching

Uncommon side effects of valacyclovir include:

• confusion or agitation
• seeing or hearing things that aren’t there (hallucinations)
• drowsiness
• tremors
• shortness of breath
• stomach pain
• itchy rash
• lower back pain
• blood in the urine

Rare side effects of valacyclovir include:

• unsteadiness and poor coordination
• slow, slurred speech
• seizures (fits)
• coma
• confused or disturbed thoughts
• passing little or no urine (possible kidney problems)
• swelling of the face, lips, and tongue, difficulty breathing, rash, and collapse (a possible severe allergic reaction called anaphylaxis)

If you experience any of these side effects, stop taking your medication and see a doctor as soon as possible. For a full list of possible side effects of valacyclovir read the patient information leaflet. Common side effects of famciclovir include:

• headache
• nausea (feeling sick)
• vomiting (being sick)
• stomach pain
• diarrhoea
• dizziness
• itchy rash

Uncommon side effects of famciclovir include:

• confusion
• drowsiness
• itchy rash with irregular raised bumps (hives)

Rare side effects of famciclovir include:

• hallucinations (seeing or hearing things that are not really there)
• awareness of your own heartbeat, fast or irregular heartbeat (palpitations)
• severe blisters on the skin, lips, eyes, mouth, inside the nose, or genitals (possible severe allergic skin reaction)
• swelling below the surface of the skin (angioedema)
• unexplained bruising, or bleeding (including nosebleeds)
• yellowing of the skin and the whites of the eyes (possible liver problems)
• red or purple discolouration of the skin which doesn’t fade
• seizures (fits)
• swelling of the face, lips, and tongue, difficulty breathing, rash, and collapse (a possible severe allergic reaction called anaphylaxis)

If you experience any of these side effects, stop taking your medication and see a doctor as soon as possible. For a full list of possible side effects of famciclovir, read the patient information leaflet.

How long do these side effects last?

Most side effects of antivirals are mild and go away on their own. If your side effects are bothering you, are getting worse, or not going away, speak to your pharmacist or GP. If you experience serious side effects while taking antivirals, seek immediate medical attention.

What to do if you get side effects

If you experience mild side effects while taking antivirals, there are a few things you can do to prevent or reduce them, such as:

• taking your medication exactly as directed by a doctor
• taking your medication with or after food. This may reduce gastric symptoms such as nausea and vomiting
• spreading your doses evenly apart
• keeping a journal noting what your side effects are, when they occur, and how long they last. This may be helpful for your pharmacist or GP to see what is causing your side effects
• asking your GP or pharmacist for advice

Shingles treatment is normally safe and effective, but it may not be right for everyone. Always tell your GP about any medical conditions or allergies you have before taking antiviral medications. You should not take antiviral drugs if you: are allergic to aciclovir, valacyclovir, famciclovir, or any of the other ingredients (you can see what these are in the patient information leaflet). Tell your doctor if you:

• have or have ever had kidney problems
• have or have ever had liver problems
• are over 65 years of age
• are pregnant or breastfeeding
• have a weakened immune system

Drug interactions

Sometimes taking different medications together can be unsafe or make your medication less effective. Always tell your doctor about any other medications you are taking, including vitamins, supplements, and over-the-counter medications. Medications that may interact with aciclovir include:

• probenecid
• cimetidine
• mycophenolate mofetil
• asthma medication such as theophylline
• colistimethate
• the shingles or chickenpox vaccines
• any medications that are passed through your kidneys

Medications that may interact with valacyclovir include:

• aminoglycosides
• mycophenolate motefi
• asthma medication such as theophylline
• colistimethate
• the shingles or chickenpox vaccines
• organoplatinum compounds
• iodinated contrast media
• methotrexate
• pentamidine
• foscarnet
• ciclosporin
• tacrolimus
• cimetidine
• probenecid
• any other medication that can affect your kidneys

Medications that may interact with famciclovir include:

• raloxifene
• probenecid
• the chickenpox or shingles vaccines
• any other medication that can affect your kidneys

Only a doctor can diagnose shingles. If you have symptoms of shingles, make an appointment to see a doctor as soon as possible so that you can get treated straight away.

Alternatively, you can get an online diagnosis quickly and easily by using Superdrug Online Doctor’s Skin Diagnosis service.

In addition to medical treatments like antivirals, lotions, and painkillers, there are some things you can do at home to help relieve the symptoms of shingles. These include:  

• keeping the rash clean and dry to avoid infection
• not touching or scratching your blisters
• applying cool compresses (such as a bag of frozen food wrapped in a damp cloth) to your rash several times a day
• wearing loose-fitting clothing
• getting plenty of rest

There is currently no cure for shingles. Treatment for shingles, such as antivirals, can reduce symptoms like pain and itching, help you get better more quickly, and prevent complications.

Other treatments such as painkillers, nerve medications, and lotions help to relieve or reduce symptoms.

Antiviral treatment for shingles needs to be started as early as possible to be most effective. If you are worried about shingles or think you may have symptoms of shingles, contact your GP, or call 111 immediately if you are pregnant or have a suppressed immune system.