By Chinedu Akpa. B. Pharm. Freelance Health Writer. Medically reviewed by: A. Odutola, MB.BS. PhD. FRCSEd.
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Herpes zoster blisters on the right torso of a black man.
There is no cure for shingles.
Typically, the condition resolves without needing any medical interventions. Most of these self-limiting cases are found in children because shingles tend to be more benign in them than in adults.
Medications are needed in severe cases to speed healing and reduce the risk of complications. [4] Some of the medications include:
There are a variety of these, including: [4]
The acyclovir cream is usually applied several times a day as a topical antiviral agent. Lidocaine cream, gel or spray as well as capsaicin cream and patch are used to numb or interrupt the pains in the areas of the body where rashes are present.
The use of steroids in the treatment of shingles remains a subject of debate. [4]
Studies have reported that a combination of a steroid and an antiviral agent (acyclovir) gave a better result in terms of hastening the resolution of acute nerve inflammation (neuritis) and improving the general quality of life of patients when compared to the use of oral antiviral agent only. [5] Another study used a steroid injection along with a standard dose of oral antiviral medication, a local anesthetic agent and a pain reliever. When compared to steroid-only treatment, the study found a one-month improvement in zoster-related pain. [6]
The use of steroids should be reserved for moderate to severe cases because of its attendant side effects such as immune suppression.
One of the side effects of shingles is pain, which can be so severe that an opioid may be used. Additionally, shingles pain needs to be controlled at an early stage of the infection in order to prevent one of the most common post-infection effects of shingles, called post herpetic neuralgia (PHN). This is a type of pain which involves nerves that persists long after your shingles have healed. [4]
Three categories of pain medications can be used, they are:
The use of these agents in the management of general nerve pain has been well established but only a few of them have been evaluated in the management of severe zoster related pain. [4]
The use of oral acyclovir and its variants (famciclovir, valacyclovir) have been found to be very useful in the treatment of varicella zoster. [4]
The antiviral agents improve the general quality of life of patients by reducing the duration of zoster symptoms, prevent or decrease post herpetic symptoms, and also prevent the appearance of new symptoms. To maximize the effect of the antiviral agents, they should be started within 72 hrs upon the appearance of shingles symptoms. However, they can be started beyond this time. [4]
Post-herpetic neuralgia (PHN) simply means pain (usually severe) that outlasts the healing of a herpes zoster infection.
The management of PHN deserves a special mention because of how difficult it is to treat once it is established. As a matter of fact, it has been found to be difficult to reduce the pain with traditional analgesics, including opioids. [4]
So far, the only reliably available method of treating PHN is to prevent it from occurring by treating severe zoster (within 72 hrs after observing symptoms) and its associated pain. Treating already established PHN with antiviral agents has been shown to be ineffective. [4]
A pain specialist should be consulted to help you manage this kind of pain.
Traditionally, when discussing disease prevention, the focus often starts with routines such as washing hands, maintaining distance, wearing a nose mask, and practicing good hygiene overall.
While all these still apply as measures to prevent one from contracting zoster virus, vaccines are often the best method to prevent one from contracting such diseases.
Varivax is a vaccine that has been useful in protecting both children and adults from contracting VZV. It is usually administered to children as young as 12 months old or older. [7]
In children (12 months to 12 years of age) the first dose of Varivax is usually administered between 12 and 15 months. There should be a minimum of 3 months between the first and second dose. The second is given when a child is between 4 to 6 years of age.
Adolescents (13 years or greater) and adults should be administered two doses of the vaccine with a minimum of 4 weeks interval between the two.
According to Merck, the manufacturers of the vaccine, certain caution should be observed before and after receiving the vaccine. [7] These include:
Zostavax is recommended for people who are aged 50 years and above. It is given as a single dose vaccine. However, it has been discontinued in some countries because its effectiveness starts to diminish five years after the initial doses. Because it is manufactured using a live, weakened zoster virus organism, it is not recommended for use in immunocompromised individuals. [8]
Shingrix is a better choice because it is made with non-live zoster virus (recombinant zoster virus) making it a-go-to vaccine for immunocompromised individuals and its protection lasts longer. [8]
Shringrix is recommended for use in people age 50 years and above and immunocompromised people aged 18 years and over. It is recommended to be administered twice, 2-6 months apart, or 1-2 months apart in immunocompromised people. [8]
No, you cannot have shingles without chickenpox because the virus that causes chickenpox is responsible for shingles.
No, you cannot get shingles from someone who has shingles because shingles only appear after chickenpox.
Yes, you can get chickenpox from someone who has shingles if you have never had chickenpox or the vaccine before.
Stress does not directly cause shingles but it can be a trigger because stress can compromise your immune health.
Yes, though it's rare.
Shingles, or herpes zoster, is a painful condition with potentially severe complications, particularly in vulnerable people such as the elderly and immunocompromised individuals. While data on its prevalence in Africa is scarce, the higher risk of the condition associated with factors like HIV emphasises the need for awareness and timely management.
Prevention through vaccination, particularly with Shingrix, is an important method of reducing the burden of the disease.
Early diagnosis and prompt treatment using antiviral agents, pain control measures, and preventive care are essential to reduce the impact of shingles and its complications, thereby improving the quality of life of those at risk.
← Symptoms, Diagnosis and Complications
1. Hussey HS, Abdullahi LH, Collins JE, Muloiwa R, Hussey GD, Kagina BM. Varicella zoster virus-associated morbidity and mortality in Africa: a systematic review protocol. BMJ Open. 2016 Apr 20;6(4):e010213. doi: 10.1136/bmjopen-2015-010213. Available from here.
2. Statista. Countries with highest prevalence of HIV in 2000 and 2023. [Internet]. July 29, 2024. Cited December 22, 2024. Available from here.
3. Nair PA, Patel BC. Herpes Zoster. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan- [Updated 2023 Sep 4]. Cited December 22, 2024. Available from here.
4. Medscape. Herpes Zoster Treatment and Management. [Internet]. Updated July 1, 2021. [Cited December 22, 2024]. Available from here.
5.Whitley RJ, Weiss H, Gnann JW, Tyring S, Mertz GJ, Pappas PG, Schleupner CJ, Hayden F, Wolf J, Soong SJ. Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial. Ann Intern Med. 1996 Sep 1;125(5):376-83. doi: 10.7326/0003-4819-125-5-199609010-00004. Abstract available from here.
6. JM van Wijck A, Opstelten W, Moons KGM, van Essen GM, Stolker RJ, Kalkman CJ, Verheij TJM. The PINE study of epidural steroids and local anaesthetics to prevent postherpetic neuralgia: a randomised controlled trial. Lancet 2006 January 21. Available from here.
7. Merck vaccines. Varivax (Varicella Virus Vaccine Live). [Internet. n. d]. Cited December 23, 2024. Available from here.
8. National Center for Immunisation Research and Surveillance Australia. Zoster (shingles) vaccines (Shingrix® [RZV] and Zostavax® [ZVL]) – Frequently asked questions. [Internet. n.d.]. Cited December 23, 2024. Available from here.
Related: Shingles in Africans: Symptoms, Diagnosis and Complications
Published: January 4, 2024
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