Shingles

January 2006     View PDF     En español
Reprinted from www.aidsmeds.com, US

How is shingles treated?

Like most herpes viruses, varicella-zoster cannot be cured. However, shingles can be treated. Treatment can speed up healing time, reduce pain, and delay or prevent shingles from recurring. Most of the time, pills taken by mouth can be used to treat shingles. Sometimes, if the infection is severe or doesn’t respond effectively to the pills, it might be necessary to be admitted to the hospital to receive intravenous (IV) treatment.

There are three treatments available for the treatment of shingles:

• Acyclovir (Zovirax®): Acyclovir has been studied and used for many years as a treatment for shingles. It has been studied specifically in people with HIV and has been shown to be safe and effective. Intravenous acyclovir is used to treat serious outbreaks of shingles. The oral dose used to treat shingles is 800 mg taken five times a day for at least a week (until the rash has crusted over). Taking lower doses of the drug for a prolonged period of time can help prevent shingles from recurring. However, this is usually recommended only for patients who have a history of frequent recurrences.
• Valacyclovir (Valtrex®): Valacyclovir is a “pro-drug” of acyclovir. Unlike acyclovir, valacyclovir needs to be broken down by the body before its active ingredient—acyclovir—can begin controlling the disease. This allows for higher amounts of acyclovir to remain in the body, thus requiring a lower dose of the drug to be taken by mouth. For the treatment of shingles, valacyclovir only needs to be taken three times a day. Like acyclovir, valacyclovir rarely causes side effects. Valacyclovir is actually the preferred form of acyclovir to use for the treatment of shingles (IV acyclovir is still the preferred choice for the treatment of severe shingles).
• Famciclovir (Famvir®): Famciclovir is the pill form of a topical cream called penciclovir (Denavir®). Like valacyclovir, famciclovir needs to be taken three times a day until the rash has completely crusted over.

Oral drugs to treat shingles work best if they are started within three days of the start of symptoms. Thus, it’s always best to contact your healthcare provider immediately if you notice burning, sharp pain, tingling, or numbness in or under your skin on one side of your body or face.

In some cases, shingles does not respond to acyclovir, valacyclovir, or famciclovir, probably due to the emergence of drug-resistant forms of the virus. Fortunately, this has occurred in only a few HIV-positive people. Because acyclovir is similar to both valacyclovir and famciclovir, simply switching to these two drugs is not usually effective. At the present time, foscarnet (Foscavir®) is the most common treatment for acyclovir-resistant shingles. The drug must be administered via an intravenous (IV) line, usually three times a day, often in a hospital or under the close supervision of an in-home nurse.

Painkillers can also be used to manage the discomfort of shingles. Most of the time, mild painkillers (e.g., Tylenol® and Advil®) are helpful. Stronger painkillers, including some that can be taken by mouth or applied directly to the skin (e.g., Lidoderm® brand lidocaine patches), are also available and can be obtained with a doctor’s prescription.

During an episode of shingles, it is important to keep the sores and the area around the sores as clean and dry as possible. This will help your natural healing processes. Some doctors recommend warm showers in order to cleanse the infected area. Afterwards, towel dry gently, or dry the area with a hair dryer on a low or cool setting. To prevent chaffing, some people also find it helpful to avoid tight-fitting undergarments. Most creams and lotions do no good and may even irritate the area.

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