Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Some doctors only treat symptoms of shingles, such as pain, when the disease is diagnosed later than 72 hours after the rash develops. Pain relievers, such as acetaminophen (Tylenol, for example) and ibuprofen (Advil, for example) or tricyclic antidepressants are examples of some pain medications that may be used. Topical creams (for example, calamine lotion) may help reduce itching.
Antiviral medications, such as acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir), can decrease the duration of skin rash and pain, including the pain of PHN. These medications must be started early (up to about 24-72 hours after rash development) in the disease
course to have any benefit. The doctor will decide which medications you may need. In special cases (for example, those with suppressed immune function), the antiviral medication may need to be given intravenously in the hospital. Only acyclovir is approved for use in children who get shingles.
Pain medication is often necessary as the pain level is very high in many people. The pain is often so intense that people cannot have any clothing touch the skin area with shingles. Drugs such as oxycodone (Oxycontin, Roxicodone), morphine, amitriptyline (Elavil, Endep), or
gabapentin (Neurontin), in addition to topical creams, are often required to help manage the pain.
Postherpetic neuralgia (PHN) may require additional medications such as opioids (for example, oxycodone, morphine) to control pain. PHN is the pain that remains in some people even after the rash goes away. Some patients do not respond to common pain-management therapies and may need to be referred to a pain-management specialist. Drugs usually prescribed for seizures and other nerve-related problems, gabapentin and pregabalin, have been effective in reducing pain in some patients with shingles, including those with PHN.
A new indication for a drug used to previously treat restless leg syndrome has been approved by the FDA in 2012 to treat nerve-related pain seen in PHN. The drug is gabapentin enacarbil
(Horizant), an antiepileptic, and was approved for PHN pain treatment after clinical trials showed the drug was safe and effective. PHN pain has been difficult to treat; this drug may help a significant number of shingles patients that develop PHN.
Sometimes topical corticosteroids are used to decrease inflammation and pain, but they should be used only under the supervision of a health-care professional since, in some patients, corticosteroids may make the infection worse. Topical medications may be used to soothe the area or prevent infection (see above, home treatments).