How is shingles treated?
A cure for shingles is possible once the infection with the varicella zoster virus has cleared up. There are different approaches to treating shingles. Some address the rash, some address the pain, and some address the cause: They help drive the virus out of the body. This may shorten the healing time.
What home remedies can help?
The therapy of shingles belongs in professional hands. In addition to treatment by the doctor, some people use home remedies, for example to alleviate the symptoms. Many find cooling, moist compresses soothing when blisters have already formed. They sometimes help against complaints such as pain and itching.
Honey, sea buckthorn or natural yogurt are also occasionally used to soothe unpleasant itching caused by shingles.
Home remedies have their limits. If the symptoms persist for a long time, do not improve or even get worse, you should always consult a doctor.
What relieves the pain?
The acute pain of shingles can be relieved with painkillers. Sometimes moderately effective drugs such as paracetamol or acetylsalicylic acid (ASA) are sufficient. These also have a fever-reducing effect. They are available without a prescription from pharmacies.
More severe pain often requires stronger painkillers from the opioid group, such as tramadol. Such drugs require a prescription.
Ointments and creams for skin care
Careful skin care is an important part of treatment for shingles (herpes zoster). Disinfectant powders, for example, prevent additional bacteria from settling on the affected skin areas. Depending on the stage, antiseptic, drying or antipruritic lotions, ointments, gels or powders are also recommended. Possible active ingredients include tanning agents, menthol or podicanol.
Antiviral agents
Antiviral drugs directly target the cause of shingles: the varicella-zoster virus. They inhibit the multiplication of the viruses and are therefore called antivirals. Examples from this class of active ingredients are aciclovir, valaciclovir and brivudine.
Antiviral shingles therapy accelerates healing and shortens the duration of pain. The prerequisite is to start it early: Doctors recommend starting antiviral therapy within 72 hours after the rash appears. Normally, the antivirals are taken in tablet form. In the case of a severe course of the disease and in patients with immunodeficiency, the doctor also administers them as an infusion.
Shingles treatment with viro-statics is generally useful. However, in some cases it is not absolutely necessary. This applies, for example, to young patients who do not have a severe form of shingles and in whom complications are not to be expected.
In other cases, however, antiviral therapy is strongly recommended, such as in:
- Patients older than 50 years
- Shingles on the face, head or neck
- Severe courses of herpes zoster
- People at increased risk for complications (such as immunodeficiency).
Other drugs
If the shingles disease affects one ear, some patients also receive cortisone in addition to the viro-statics. It has an anti-inflammatory effect by reducing the body’s own immune response. At present, however, it is still unclear what the advantages and disadvantages of such a combination treatment are.
If a bacterial infection has also developed on the shingles rash, the doctor prescribes an antibiotic. It fights the bacteria and is often applied as an ointment.
Alternative treatments for shingles
Some people use Schuessler salts for shingles, for example Kalium chloratum, Ferrum phosphoricum or Kalium phosphoricum. Homeopathic remedies are also used for herpes zoster.
The concept of homeopathy as well as the use of Schüssler salts is controversial in science. The effect of these remedies has not been conclusively proven.
Treatment of post-zoster neuralgia
The most common complication of shingles is post-zoster neuralgia. It is also called post-zoster or post-herpetic neuralgia. Affected individuals suffer from nerve pain even after the rash has subsided. In addition, their skin is hypersensitive and itchy. In some cases, the symptoms last for months or even years.
The attending physician will prepare an individual therapy plan for each patient. Painkillers are an important component. A distinction is made between two classes of active ingredients, which may also be used in combination:
- Non-opioid painkillers such as acetylsalicylic acid or paracetamol. They are recommended for mild to moderate symptoms and are usually available from pharmacies without a prescription.
- Opioid painkillers such as oxycodone or tramadol. They require a prescription and are only prescribed for moderate to severe pain.
Which painkillers are useful in which dosage varies from patient to patient. Above all, the type and severity of the pain play a role. In addition, the doctor will take into account how well someone responds to a painkiller and what side effects occur.
For persistent (chronic) pain, doctors recommend that their patients seek advice and treatment from a pain therapist, at a pain center or pain clinic.
Further measures for post-zoster neuralgia
In addition to painkillers, antidepressants in low doses are also useful for post-zoster neuralgia. They inhibit the transmission of pain signals in the spinal cord. The doctor also sometimes prescribes antispasmodic drugs: they dampen the excitability of nerve cells. This also helps against the nerve pain.
Capsaicin preparations (for example, as an ointment) are also helpful: Capsaicin is a pungent substance found in chili peppers. It triggers a burning sensation on the skin that temporarily paralyzes the pain receptors. Alternatively, a cream with a local anesthetic (lidocaine) can be applied.
Since chronic pain also puts a strain on the psyche and severely restricts the daily lives of those affected, doctors also recommend psychotherapy or behavioral therapy to accompany drug treatment.
