The Importance of Early Treatment for Shingles

April 21, 2020

Early treatment of shingles reduces symptoms and risk of serious complications.

Herpes zoster (shingles) is not only painful and can significantly alter daily life for sufferers, but it can also leave them with devastating, long-lasting pain and nerve damage. Anti-viral drugs administered within 72 hours of the first signs of the telltale rash can treat shingles in its earliest stages to help reduce symptoms and avoid serious complications.

The typical shingles outbreak often starts with a general feeling of unwellness or fatigue. Other early signs and symptoms include mild skin irritation; a burning, tingling, itching, or numbness concentrated in 1 small area on 1 side of the body; aching muscles, fever, headache, chills, and gastrointestinal distress like nausea, vomiting, and diarrhea. Pain can be intense and stabbing, and it usually worsens over the course of the illness.

Within 5 days of the first symptoms, an itchy and burning rash comprised of blisters filled with clear fluid typically forms. This is the infectious period, lasts 7 to 10 days until the blisters scab over, dry up, and grow smaller.

Individuals who experience these symptoms and have a history of chickenpox should consider the likelihood of shingles and seek a medical diagnosis. This is particularly true if blisters develop on the face.

“Blisters near or in the eye can cause lasting eye damage or blindness,” noted the National Institute on Aging.1 “Hearing loss, a brief paralysis of the face, or, very rarely, swelling of the brain can also occur.”

The risk of developing shingles increases for people over the age of 60; cancer, HIV and organ transplant patients; diabetics and anyone who is under a lot of stress.

Antiviral medicines-including acyclovir, famciclovir, and valacyclovir-can shorten the length and severity of the illness. According to the CDC, “These medicines are most effective if you start taking them as soon as possible after the rash appears.”2

OTC and prescription pain medications can be used as needed. Itchiness can be alleviated by using wet compresses, calamine lotion, and colloidal oatmeal baths.  

Postherpetic neuralgia (PHN) is the most common complication of shingles, afflicting up to 20% of patients. This long-term, debilitating nerve pain occurs in the same areas that were covered by the rash. Steroids, analgesics, antidepressants, anticonvulsants, and the application of capsaicin or lidocaine in transdermal patch form can help deliver pain relief.

The risk of developing PHN, its duration, and severity increases with age. Additionally, its incidence is greater among immunocompromised individuals, those who have pain during the early stages of shingles, and those who experienced a severe rash that covered a large portion of skin. Patients over the age of 60 who do not seek treatment for the illness are more likely to develop PHN than those who are treated.

Other complications of shingles may be rare, but serious, including postherpetic itch, brain inflammation, hearing or vision problems, pneumonia, bacterial skin infections, facial paralysis, loss of taste, and vertigo.

Although there is no cure for shingles, an effective vaccination against it is available as the first line of defense. Shingrix was licensed by the FDA for adults 50 and older in 2017. It has proven to be over 90% effective at preventing shingles in clinical trials, and is recommended by the FDA’s Advisory Committee on Immunization Practices as the preferred shingles vaccine.

 

References:

1. Shingles. National Institute on Aging. Last reviewed October 29, 2018. Accessed April 21, 2020. https://www.nia.nih.gov/health/shingles.

2. Treating Shingles. CDC. Last reviewed July 1, 2019. Accessed April 21, 2020. https://www.cdc.gov/shingles/about/treatment.html