Herpes Zoster Health Article

Treatments

Shingles almost always resolves spontaneously and may not require any treatment except for the relief of symptoms. In most people, the condition clears on its own in one or two weeks and seldom recurs. The antiviral drugs acyclovir, valacyclovir, and famciclovir can be used to treat shingles. These drugs may shorten the course of the illness. Their use results in more rapid healing of the blisters when drug therapy is started within 72 hours of the onset of the rash. In fact, the earlier the drugs are administered, the better, because early cases can sometimes be stopped. If taken later, these drugs are less effective but may still lessen the pain. Antiviral drug treatment does not seem to reduce the incidence of post-herpetic neuralgia, but recent studies suggest famciclovir may cut the duration of post-herpetic neuralgia in half. Side effects of typical oral doses of these antiviral drugs are minor with headache and nausea reported by 8-20% of patients. Severely immunocompromised individuals, such as those with cancer, may require intravenous administration of antiviral drugs. Preventive administration of acyclovir to seropositive patients (people who have evidence in their blood of past infection with varicella) who undergo leukemia induction or bone marrow transplant not only effectively prevents herpes zoster recurrence but also reduces the severity of chemotherapy-induced mucositis. Therefore, acyclovir prophylaxis should be considered in seropositive patients, especially if they have had a recurrence during previous chemotherapy cycles.

Alternative and complementary therapies

Cool, wet compresses may help reduce pain. If there are blisters or crusting, applying compresses made with diluted vinegar will make the patient more comfortable. The patient can mix one-quarter cup of white vinegar in two quarts of lukewarm water, and use the compress twice each day for 10 minutes. The patient should stop using the compresses when the blisters have dried up.

Soothing baths and lotions such as colloidal oatmeal baths, starch baths or lotions, and calamine lotion may help to relieve itching and discomfort. The skin should be kept clean, and contaminated items should not be re-used. While the lesions continue to ooze, the person should be isolated to prevent infecting other susceptible individuals.

Later, when the crusts and scabs are separating, the skin may become dry, tight, and cracked. If that happens, the patient can rub on a small amount of plain petroleum jelly three or four times a day.

There are non-medical methods of prevention and treatment that may speed recovery. For example, getting lots of rest, eating a healthy diet, exercising regularly, and minimizing stress are always helpful in preventing disease. Supplementation with vitamin B₁₂ during the first one to two days and continued supplementation with vitamin B complex, high levels of vitamin C with bioflavonoids, and calcium, are recommended to boost the immune system. Herbal antivirals such as echinacea can be effective in fighting infection and boosting the immune system. Patients should consult physician before taking supplements.

Although no single alternative approach, technique, or remedy has yet been proven to reduce the pain, there are a few options which may be helpful. For example, topical applications of lemon balm (Melissa officinalis) or licorice (Glycyrrhiza glabra) and peppermint (Mentha piperita) may reduce pain and blistering. Homeopathic remedies include Rhus toxicodendron for blisters, Mezereum and Arsenicum album for pain, and Ranunculus for itching. Practitioners of Eastern medicine recommend self-hypnosis, acupressure, and acupuncture to alleviate pain. All of these or similar alternative therapies should be discussed with the treating physician before using.

See Also Antiviral therapy

Resources

BOOKS

Berger, Joseph. Cecil Textbook of Medicine, 21st Ed. Philadelphia: W.B. Saunders Company, 2000.

Lockie, Andrew. The Family Guide to Homeopathy: Symptoms and Natural Solutions. Prentice Hall Press, 1989.

Thomsen, Thomas Carl. Shingles. Cross River Press, 1990.

PERIODICALS

Balfour, Henry H. "Varicella Zoster Virus Infections in Immunocompromised Hosts." American Journal of Medicine 85 (29 August 1988): 68-72.

Bilgrami, S. et al. "Varicella zoster virus infection associated with high-dose chemotherapy and autologous stem-cell rescue." Bone Marrow Transplant 23 (March 1999): 469-74.

Kawasaki, H. et al. "Herpes zoster infection after bone marrow transplantation in children." Journal of Pediatrics 128 (March 1996):353-58.

Rusthoven, J. J. et al. "Varicella-zoster infection in adult cancer patients. A population study." Archives of Internal Medicine 148 (July 1988):1561-1566.

Perren, Timothy J., et al. "Prevention of Herpes Zoster in Patients by Long-Term Oral Acyclovir After Allogeneic Bone Marrow Transplantation." American Journal of Medicine 85 (29 August 1988): 99-101.

Wood, Martin J., et al. "Efficacy of Oral Acyclovir Treatment of Acute Herpes Zoster." American Journal of Medicine 85 (August 29, 1988): 79-83.

ORGANIZATION

American Academy of Dermatology. 930 N. Meacham Road, PO Box 4014, Schaumberg, IL 60168-4014. (708) 330-0230. http://www.aad.org. 29 June 2001.

David Greenberg, M.D.