Medicines for Shingles

What it is

Shingles, or herpes zoster, occurs when the varicella-zoster virus that causes chickenpox, which stays dormant in the body after the first infection, reactivates years later in a single nerve. It typically causes a painful, tingling or burning sensation in a band of skin on one side of the body, followed a few days later by a rash of small blisters in that same area. The rash usually crusts over and heals within a few weeks. Reactivation is more likely with increasing age and when the immune system is weakened, for example by illness or certain treatments. Most cases are uncomplicated, but shingles affecting the eye, the ear or a widespread area, or occurring in someone with a weakened immune system, needs prompt medical attention. The most common longer-term problem is post-herpetic neuralgia, where nerve pain persists in the affected area after the rash has healed. Diagnosis is usually made from the typical one-sided rash and its distribution, with tests rarely needed.

How it is treated

The main aims are to ease pain, help the rash heal and reduce the risk of lasting nerve pain. Antiviral treatment works best when it is started early, ideally within the first few days of the rash appearing, and is particularly recommended for older people, those with eye or other complicated involvement, and anyone with a weakened immune system. Pain relief is an important part of care from the outset, starting with simple analgesia and stepping up as needed; stronger options, including opioid analgesics, may be used for more severe pain. Where nerve pain persists as post-herpetic neuralgia, treatment shifts to medicines aimed specifically at nerve pain, such as gabapentinoids or a tricyclic antidepressant. Keeping the rash clean and covered helps healing and reduces the small risk of passing the virus to people who have not had chickenpox.