After the rash clears up, you may still experience itching and a burning sensation in the areas where the rash was.
Shingles is a viral infection caused by the varicella zoster virus, the same virus that causes chickenpox. The Centers for Disease Control and Prevention (CDC) estimates that
Shingles causes a rash that often lasts 2 to 4 weeks. Even after it goes away, you might still experience itching and pain in the areas where you had a shingles rash. This is called postherpetic neuralgia, and it’s the most common long-term complication of shingles.
Let’s discuss what postherpetic neuralgia feels like, why it happens, how long it can last, and how it’s treated.
Postherpetic neuralgia is typically felt at the site of your shingles rash. Even after the rash clears up, you might feel one or more of the following on your skin in the same general area where your rash appeared:
- burning and sharp sensation
- deep, stabbing pain
- sensitivity to temperature changes
- tingling or numbness
- persistent itching
Postherpetic neuralgia can feel different for different people. In some cases, you might have only itching without pain. In this case, the condition is also called postherpetic pruritis.
Researchers don’t fully understand why some people develop itching or pain at the site of a shingles rash while others don’t.
People at higher risk for postherpetic neuralgia
- with diabetes
- who are age 50 or over when they get shingles
- have a suppressed immune system at the time of infection, whether due to medication or an autoimmune condition
- have a severe shingles infection
- whose shingles infection involved their eyes
The itching from your shingles rash will most likely resolve after a few weeks. In some cases, though, the itching and burning
Postherpetic neuralgia can be difficult to treat. Your doctor may need to try several treatment strategies to try to help manage your symptoms.
- lidocaine patch
- creams containing capsaicin
- capsaicin patch
- over-the-counter pain relievers, such as acetaminophen (Tylenol)
If these treatments don’t resolve the pain and itching, your doctor may prescribe oral medications or injectable medication off-label to help. These types of medications aim to block pain signals that go from your body to your brain.
They may include:
- NMDA antagonist drugs for pain relief (memantine or ketamine are some examples)
- tricyclic antidepressant medication
- steroid injections
- Botox injections
A note on off-label use
Off-label drug use means that a drug approved by the Food and Drug Administration (FDA) for one purpose is taken for a different purpose that hasn’t been approved. However, a doctor can still prescribe the drug for that purpose. The FDA regulates the testing and approval of drugs, but not how doctors prescribe drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care.
Oral medications and injectables typically have a higher risk of noticeable side effects than first-line treatment options, so you might first want to try less invasive options and see if they work.
If you have recovered from shingles but are still experiencing itching or burning, it’s best not to wait to contact a doctor. If your doctor is able to treat your symptoms earlier in the course of the condition, you may have a better outlook.
Older adults and people who have suppressed immune systems are at a greater risk of developing this complication. If you fall into either or both of these categories, it’s important that a medical professional checks in with you when you have shingles, as well as afterward.
The American Academy of Dermatology Association recommends that anyone with a shingles rash seek treatment within 3 days. Treatment with antiviral medication may reduce your chances of long-term complications, including postherpetic neuralgia.
Speak with a doctor if you’re experiencing any of the following:
- new shingles rash or other shingles symptoms
- burning sensation where your shingles rash used to be
- skin sensitivity to changes in temperature
- severe pain occurring 1 to 3 months after a shingles rash has cleared up
- any shingles rash on your face
Itching at the site of a shingles rash is not uncommon. Many people experience this type of pain in the months after their skin heals on the surface and the shingles rash has gone away. For some people, this itching may not fully go away, but medication can be help with managing it.
If you currently have shingles and are concerned about developing postherpetic neuralgia, you should speak with your doctor. Antiviral medication for the shingles infection may be able to prevent you from developing shingles complications, including itching and pain that lasts long after your shingles has gone.