Exams and Tests

Doctors can usually identify shingles when they see an area of rash around the left or right side of your body. If a diagnosis of shingles is not clear, your doctor may order lab tests, most commonly herpes tests, on cells taken from a blister.

If there is reason to think that shingles is present, your doctor may not wait to do tests before treating you with antiviral medicines. Early treatment may help shorten the length of the illness and prevent complications such as postherpetic neuralgia.

Treatment Overview

There is no cure for shingles, but treatment may shorten the length of illness and prevent complications. Treatment options include:

• Antiviral medicines to reduce the pain and duration of shingles.
• Pain medicines, antidepressants, and topical creams to relieve long-term pain.

Initial treatment

As soon as you are diagnosed with shingles, your doctor probably will start treatment with antiviral medicines. If you begin medicines within the first 3 days of seeing the shingles rash, you have a lower chance of having later problems, such as postherpetic neuralgia.

The most common treatments for shingles include:

• Antiviral medicines, such as acyclovir, famciclovir, or valacyclovir, to reduce the pain and the duration of shingles.
• Over-the-counter pain medicines, such as acetaminophen, aspirin, or ibuprofen, to help reduce pain during an attack of shingles.
• Topical antibiotics, applied directly to the skin, to stop infection of the blisters.

For severe cases of shingles, some doctors may have their patients use corticosteroids along with antiviral medicines. But corticosteroids are not used very much any more. This is because studies show that taking a corticosteroid along with an antiviral medicine doesn't help any more than just taking an antiviral medicine by itself.²

Ongoing treatment

If you have pain that persists longer than a month after your shingles rash heals, your doctor may diagnose postherpetic neuralgia (PHN), the most common complication of shingles. PHN can cause pain for months or years. It affects 10 to 15 out of 100 people who experience shingles.³ Treatment to reduce the pain of postherpetic neuralgia includes:

• Antidepressant medicines, such as a tricyclic antidepressant (for example, amitriptyline).
• Topical anesthetics that include benzocaine, which are available in over-the-counter forms that you can apply directly to the skin for pain relief. Lidocaine patches, such as Lidoderm, are available only by prescription.
• Anticonvulsant medicines, such as gabapentin or pregabalin.
• Opioids, such as codeine.

Topical creams containing capsaicin may provide some relief from pain. There is also a high-dose skin patch available by prescription (Qutenza) for postherpetic neuralgia. Capsaicin may irritate or burn the skin of some people, and it should be used with caution.

Treatment if the condition gets worse

In some cases, shingles causes long-term complications. Treatment depends on the specific complication.

• Postherpetic neuralgia (PHN) is persistent pain that lasts months or even years after the shingles rash heals. Certain medicines, such as anticonvulsants, antidepressants, and opioids, can relieve pain. Most cases of PHN resolve within a year.
• Disseminated zoster is a blistery rash over a large portion of the body. It may affect the heart, lungs, liver, pancreas, joints, and intestinal tract. Treatment may include both antiviral medicines to prevent the virus from multiplying and antibiotics to stop infection.
• Herpes zoster ophthalmicus is a rash on the forehead, cheek, nose, and around one eye, which could threaten your sight. You should seek prompt treatment from an ophthalmologist for this condition. Treatment may include rest, cool compresses, and antiviral medicines.
• If the shingles virus affects the nerves originating in the brain (cranial nerves), serious complications involving the face, eyes, nose, and brain can occur. Treatment depends on the nature and location of the complication.