Aging & Health A to Z
Care & Treatment
Treatment Starts with Prevention
In 2006, a shingles vaccine, Zostavax, was approved in the US. It is given as a single injection (shot). The Centers for Disease Control and Prevention (CDC) recommends that every adult over the age of 60 who has had chickenpox should be vaccinated. Even if you don’t remember whether you had chickenpox, you should be vaccinated anyway, since practically everyone (99% of people) over 60 in this country had chickenpox as children.
Zostavax vaccine reduces the risk of getting shingles by about one-half, and lowers the risk of post-herpetic neuralgia by two-thirds. If you have had the vaccine and still develop shingles, your illness will be milder than if you never received the vaccine. The CDC also recommends that you get the vaccination even if you have already had an episode of shingles, because shingles can come back even if you’ve already had it.
The vaccine only prevents shingles. It won’t help you if you have already become ill with the condition or have a complication like post-herpetic neuralgia.
Zostavax contains weakened live varicella zoster virus, like the chickenpox vaccine. However, it is much more potent. Don’t worry about giving chickenpox to someone if you have just been vaccinated. In the rare cases in which some chickenpox-like blisters form around the injection site, just cover up the spot until the blisters heal. Otherwise, you are not contagious.
Reported side effects are very mild. You may experience redness, soreness, swelling or itching at the injection site and, rarely, headache. This is usually a one-time vaccination – you shouldn’t need another one later, but check with your healthcare professional to make sure a booster shot won’t be needed later.
Despite its benefits, some people should not be vaccinated. Your doctor should not give you the vaccine if you
- have a weakened immune system – because of disease (such as HIV/AIDS), cancer treatment, treatment to prevent rejection of a transplanted organ, long-term steroid treatments, etc
- have active, untreated tuberculosis (TB)
- have experienced an allergic reaction to gelatin or the antibiotic neomycin (both present in tiny amounts in the vaccine). Tell your physician if you have severe allergies.
- have had cancer that affected the bone marrow or lymphatic system (leukemia or lymphoma).
Drugs are available that are often very effective at controlling shingles symptoms. These antiviral drugs actually attack the virus. They include acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). The drugs are taken for seven to 10 days.
The earlier you start taking an antiviral medication, the better. Try to see your doctor as soon as you feel any pain or burning, before the rash appears, so that you can start the pills within 24 hours. The window of opportunity closes about 72 hours after the first signs of the rash. After that, the antiviral drugs are no longer effective for reducing symptoms of shingles or any of the complications that may occur.
If the antiviral drug is taken promptly, it is likely to:
- reduce pain
- reduce the duration of your illness
- stop the disease from getting worse
- reduce the formation of blisters
- reduce the number of viruses in the blisters
- lower the risk of complications.
Medications to Soothe your Symptoms
Your healthcare professional will also prescribe drugs to help you manage your pain, rash, and other symptoms. These include:
- pain relievers such as anti-inflammatory drugs (NSAIDs) or narcotics, depending upon your pain level and its persistence
- antihistamines (to reduce itching – taken by mouth or applied directly to the skin)
- numbing patches and local anesthetics
- corticosteroids (such as prednisone)
- capsaicin cream (a hot pepper extract such as Zostrix)
- antibiotics applied to the skin if you have developed a bacterial infection.
Other drugs that can help control symptoms, especially in cases of long-term discomfort, include:
- tricyclic antidepressants
- gabapentin (Neurontin), an anti-seizure medication.
You may find that some approaches that don’t involve drugs are soothing, for example:
- cool, wet compresses
- soothing baths (such as starch baths or oatmeal baths)
- lotions (calamine lotion)
- bed rest if fever is present.
Updated: March 2012
Posted: March 2012