How Shingles Is Treated

Shingles, a painful rash caused by reactivation of the herpes zoster (HZ) virus that causes chickenpox, requires a multi-pronged treatment approach. Your treatment will be aimed at speeding up the healing of the rash, minimizing the pain associated with the outbreak, and lessening the risk of post-herpetic neuralgia (PHN), a stabbing or burning pain that can last for months or even years after the rash resolves. Home remedies such as cool compresses can help ease your symptoms, and your healthcare provider also may recommend antivirals, anti-inflammatories, and pain relievers.

If you have herpes zoster ophthalmicus, shingles that affects the eye area, it's important that you are treated as quickly as possible to reduce the risk of permanent vision damage.

Shingles symptoms
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Prescriptions

Early treatment is key to minimizing the severity of a shingles outbreak, and antivirals are the go-to choice.

Antiviral medications may speed the healing of skin lesions and reduce the severity and duration of pain. They're most effective when started within 72 hours of the first appearance of a rash, so if you have signs of shingles, see your healthcare provider right away.

If you don't begin treatment with an antiviral drug within 72 hours, it still may be helpful to take one.

Shingles Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Old Man

Antiviral drugs for treating shingles:

Acyclovir tends to be the least expensive of these antivirals, but it must be taken more frequently than other options.

  • Corticosteroids: Although they aren't commonly prescribed for shingles or PHN, anti-inflammatory corticosteroids such as prednisone are used when the eye or other facial nerves are affected.  
  • Opioids: Certain transdermal opioid remedies, such as morphine sustained-release patches or fentanyl patches, and oral opioids (narcotic medications) can be helpful in the short term for managing severe pain from shingles or PHN. 

Post Herpetic Neuralgia

The pain of PHN can be excruciating and often interferes with quality of life. Your doctor may prescribe medication that is used to treat neuropathic pain and that you can take every day for months or longer.

  • Anticonvulsants: Some medications that are typically prescribed for seizure control are also effective for controlling many types of neuropathic pain, including the pain of PHN. Examples include Neurontin (gabapentin) and Lyrica (pregabalin).
  • Tricyclic antidepressants: Some antidepressants are effective for controlling neuropathic pain. Examples include amitriptyline. Aventyl (nortriptyline), and Norpramin (desipramine).

Over-the-Counter Therapies

Over-the-counter pain treatments may be effective for controlling your pain or may be recommended along with prescription pain medication. 

  • OTC pain medications: Tylenol (acetaminophen) or non-steroidal anti-inflammatory medication (NSAID) such as Motrin or Advil (ibuprofen) can be effective in alleviating mild to moderate pain.
  • Antihistamines: An oral antihistamine such as Benadryl (diphenhydramine) may ease itching, but it can cause drowsiness, so don't take it when you need to be focused or drive. You also might try a topical antihistamine. Benadryl comes as a spray, cream, or stick for applying directly to the skin.
  • Calamine lotion: Calamine lotion can soothe itching and pain. If you don't like the classic thick pink stuff, you also can find a clear version. 
  • Lidocaine: This local anesthetic helps relieve pain by temporarily numbing the area that hurts. It's found in a variety of OTC skin-numbing creams, as well as in a patch called Lidoderm that sticks to the skin and releases small amounts of lidocaine for up to 12 hours per day. Only use lidocaine (in any form) on the skin that's intact—after the blisters and sores have healed, because it is dangerous if it absorbs into your body through an open wound.  
  • Capsaicin: The active ingredient in chili peppers that sets your mouth on fire also has a numbing effect on the skin. It works by depleting a neurochemical called substance P that transmits pain signals. A number of studies have found that capsaicin is effective for relieving neuropathic pain such as PHN. Most research has looked at prescription-only patches (Qutenza) containing a high concentration (8 percent) of capsaicin. You can find creams containing lower doses of capsaicin in drugstores, health food stores, and online. One of these, Zostrix, contains 0.1 percent capsaicin. Talk to your healthcare provider about the right amount for you.

Wear disposable gloves when applying capsaicin. Take care not to touch your eyes or any areas with broken or sensitive skin.

Home Remedies and Lifestyle

In addition to triggering the uncomfortable rash, shingles can cause symptoms that are similar to those of other viral infections.

Shingles can make you feel feverish, tired, and generally unwell.

While prescription and over-the-counter drugs can help, one of the most important things you can do while dealing with it is to take good care of yourself. If you're caring for someone else who has shingles, lavish them with TLC. 

Home remedies for shingles.

Laura Porter / Verywell

Some specific strategies can help ease the pain:

  • Tend to your skin: If you are not using a topical cream or patch, apply cool compresses as needed to help ease the pain. Try to keep the area dry so the sores and blisters can dry out.
  • Take a soothing soak: An oatmeal bath can provide relief from itching. You can buy packaged colloidal oatmeal bath products at the drugstore or supermarket, or make your own: Run regular oatmeal, the kind you eat for breakfast, in a food processor until it's a fine powder. Add a cupful per inch of water to a warm (not hot) tub.
  • Dress for comfort: Friction from clothing can exacerbate pain. If your rash is on a part of your body that needs to be covered when you're out, wear something that fits loosely and is made from a natural fiber. 
  • Get plenty of rest: In addition to clocking adequate nighttime sleep, which for most people is between seven and nine hours, take naps during the day if you need extra rest.
  • Eat well: This means getting a balanced variety of nutritious foods at and between meals, and minimizing foods that are high in saturated fat, salt, and empty calories. 
  • Move your body: Try simple exercises like stretching or walking.
  • Distract yourself: Find ways to take your mind off pain and discomfort, such as having a friend over to chat or focusing on a hobby—picking up that knitting project again, for example.
  • De-stress: Turn to activities or practices that help you to relax, such as meditation, reading, or listening to soothing music. Stress can make the pain worse and can lead to depression.

Complementary Medicine (CAM)

If you're open to trying a non-traditional approach to treating shingles pain, consider talking to your healthcare provider about transcutaneous electrical nerve stimulation (TEN). This therapy involves applying harmless levels of electricity to stimulate the skin, which can provide relief by interfering with the transmission of pain signals. 

Research has found TENS to be effective for relieving shingles pain and preventing PHN. 

Although other alternative treatments for shingles have been considered, none have been researched enough to be considered viable. Among these are proteolytic enzymes, which are produced naturally by the pancreas to help digest protein from the diet. They also are found in certain foods, such as papaya and pineapple.

Supplements derived from papaya (called papain), pineapple (called bromelain), and from the animal pancreas can be found online, in health food stores, and in some grocery and drugstores. They are often marketed as digestive enzyme supplements.

In a 1995 German study of 192 people with shingles, half took proteolytic enzymes for 14 days and the other half took acyclovir. Both groups experienced similar pain relief and skin improvement, with the exception of skin redness, which showed greater improvement with the acyclovir treatment. The group taking proteolytic enzymes had significantly fewer side effects.

Proteolytic enzymes can have some side effects, including digestive upset and allergic reactions. If you're allergic to pineapple or papaya, avoid supplements derived from those fruits.

Proteolytic enzymes, particularly bromelain and papain, should not be taken with blood-thinners such as aspirin or Coumadin (warfarin) as they may increase the effect of these drugs. The proteolytic enzyme pancreatin also may interfere with the absorption of the vitamin folate.

Given that there's so little evidence that proteolytic enzymes are truly helpful in relieving shingles symptoms and that they can have side effects, you should check with your healthcare provider before taking them to treat shingles.

Frequently Asked Questions

  • How long does shingles last?

    It depends on the individual case. Shingles symptoms typically last about three to five weeks. If antiviral treatment is started as soon as possible after symptoms begin, it can reduce the pain and shorten healing time. Antiviral medications can also reduce the risk of PHN, which can cause chronic pain for months or years.

  • How long is shingles contagious?

    You can't catch shingles from another person who has shingles or chickenpox, but the virus that causes shingles can cause chickenpox in people who haven't had chickenpox before or been vaccinated against it. The fluid from the blisters can spread the virus to others. Once the blisters from the rash crust or scab over, you're no longer considered contagious.

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