Shingles and Chickenpox (Varicella-Zoster Virus) - Treatment for an Acute Shingles Attack

Highlights	Complications	Treatment for an Acute Shingles Attack
Introduction	Vaccination	Treatment for Postherpetic Neuralgia
Symptoms	Diagnosis	Resources
Risk Factors	Treatment for Chickenpox	References

Treatment for an Acute Shingles Attack

The treatment goals for an acute attack of herpes zoster include the following:

Reduce pain.
Reduce discomfort.
Hasten healing of blisters.
Prevent the disease from spreading (disseminating).

Over the counter remedies are often effective in reducing the pain of an attack. Antiviral agents (acyclovir and others), oral corticosteroids, or both are sometimes given to patients with severe symptoms, particularly if they are older and at risk for postherpes neuralgia. In addition, psychologic therapies aimed at coping and reducing the effects of pain may be useful.

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Home Remedies for Shingles

Applied Cold. Cold compresses soaked in Burrow's solution and cool baths may help relieve the blisters. It is important not to break blisters, which can cause infection. Experts advise against warm treatments, which can intensify itching. Patients should wear loose clothing and use clean loose gauze coverings over the affected areas.

Itch Relief. In general, to prevent or reduce itching, home treatments are similar to those used for chickenpox. Patients can try antihistamines, particularly Benadryl, oatmeal baths, and calamine lotion.

Over-the-Counter Pain Relievers. For an acute shingles attack, patients may take over-the-counter pain relievers, including the following:

Children should take acetaminophen.
Adults may take aspirin or other nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil). Such remedies, however, are not very effective for postherpetic neuralgia.

Nucleoside Analogues and Other Anti-Viral Drugs

Nucleoside Analogues. The best class of drugs developed against varicella-zoster are those known as nucleoside, or guanosine, analogues, which are able to block viral reproduction. None of these agents can actually destroy the virus and cure the disease, but they can significantly reduce the severity of the attack, hasten healing, and reduce the duration. There is some evidence that early treatment (within 72 hours) with these agents can reduce the risk for postherpetic herpes.

Acyclovir (Zovirax), famciclovir (Famvir), and valaciclovir (Valtrex) are approved for shingles. Acyclovir is the oldest most studied of these drugs, but famciclovir (Famvir) or valaciclovir (Valtrex), which are both metabolized into acyclovir, are now preferred for herpes zoster for most patients. They relieve symptoms better than acyclovir and require fewer daily doses (typically three) than the five doses needed with acyclovir.