The treatment goals for herpes zoster (shingles) are to relieve symptoms, shorten the duration of the illness, and prevent complications such as postherpetic neuralgia. Treatment strategies typically combine pharmacological and non-pharmacological methods, tailored to the patient's age, immune status, and severity of the condition. Early diagnosis and treatment are crucial, especially when drug intervention begins within 72 hours of the rash appearing, as this can significantly reduce the risk of complications.
Treatment not only addresses current symptoms but also requires long-term follow-up for potential sequelae such as neuralgia. Patients must adhere to the physician's instructions to complete the full treatment course and pay attention to daily care to promote skin healing. The following sections detail the main treatment directions and latest trends in modern medicine, from medication choices and non-pharmacological therapies to lifestyle management.
Currently, the treatment of herpes zoster is divided into two main directions: core pharmacological treatment and supportive therapy. Core pharmacological treatment is based on antiviral medications, combined with analgesics, anxiolytics, or immunomodulators. Supportive therapy includes topical ointments, physical therapy, and lifestyle adjustments. The principles of treatment include:
In special populations such as the elderly or those with other chronic diseases, physicians will assess the risks of drug interactions and side effects, possibly opting for lower doses or additional supportive therapies. Treatment efficacy should be regularly evaluated and adjusted based on symptom changes.
Antiviral medications are the cornerstone of treatment, primarily working to inhibit the replication of the varicella-zoster virus. Oral or intravenous acyclovir is the first-line medication, typically used continuously for 7-10 days. Other options include:
Patients with severely compromised immunity may require higher doses or combination therapy. Studies show that early use of antiviral medications can shorten the duration of the rash and reduce the risk of postherpetic neuralgia by up to 50%.
Postherpetic neuralgia (PHN) is a key focus of treatment. First-line medications include:
Severe cases may require a short course of steroid therapy, but care must be taken to avoid the risk of viral reactivation. Physicians will choose appropriate medication combinations based on pain severity and the patient's medical history.
If bacterial infections or ocular involvement occur, additional antibiotics or ophthalmological specialist treatment is required. In cases of ocular involvement, antiviral eye drops and steroid eye medications may be necessary. Immunomodulators such as thymosin or interferon may be used in specific cases to enhance antiviral responses, but the risks of side effects must be weighed.
Daily care of skin lesions is crucial. It is recommended to use cold compresses to reduce inflammation and apply antibiotic ointments containing neomycin or polymyxin to prevent secondary infections. Contraindications include:
New types of dressings, such as hydrocolloid dressings, can promote wound healing, especially suitable for patients with chronic diseases like diabetes.
Physical therapists will design nerve relaxation training, including:
Cognitive behavioral therapy (CBT) has been shown to improve psychological adjustment in chronic pain patients and is recommended to be used alongside pharmacological treatment.
Patients should wear loose clothing to reduce friction and gently cleanse the affected area with warm water daily. The diet should include increased B vitamins and antioxidant-rich foods, such as dark leafy vegetables and whole grains, to promote nerve repair. Avoid spicy foods and alcohol, as these may trigger pain sensitization.
Stress can suppress immunity, so mindfulness meditation or yoga is recommended to lower cortisol levels. Regular sleep of 7-8 hours is crucial and can be achieved by:
For severe insomnia, physicians may prescribe short-term sleeping pills, but monitoring for the risk of drug dependence is necessary.
Current research focuses on:
Anti-inflammatory drugs in clinical trials, such as JAK inhibitors, have shown the ability to reduce acute phase neuroinflammatory responses. AI-assisted pain assessment systems are also being developed to more accurately adjust treatment plans.
The herpes zoster vaccine (e.g., Shingrix) has been shown to reduce incidence by 50% and the risk of postherpetic neuralgia by 70%. Future second-generation vaccines may incorporate immune checkpoint inhibitors to enhance protection for the elderly. Research is ongoing into the combined use of vaccination and therapeutic vaccines.
The following situations require immediate medical attention:
Chronic pain management requires evaluation by both neurology and dermatology, and severe cases may need referral to pain treatment centers for spinal cord stimulators or nerve block therapy.
Antiviral medications (such as acyclovir) must be used within 72 hours after the rash appears to effectively inhibit viral replication. Delayed treatment may lead to sequelae such as neuralgia. This therapeutic time window is based on the speed of viral activation and the progression of skin lesions as outlined in clinical guidelines.
What over-the-counter medications can patients with postherpetic neuralgia use to alleviate pain?Over-the-counter options include topical patches with anti-inflammatory ingredients or lidocaine-containing topical anesthetic gels, but moderate to severe pain still requires a physician's prescription for nerve stabilizers or tricyclic antidepressants. The skin should be cleaned before applying topical medications and direct contact with broken skin should be avoided.
If someone has been vaccinated against chickenpox, do they still need antiviral treatment if they develop herpes zoster?Yes, the vaccine can reduce the incidence and severity of herpes zoster, but it cannot completely prevent it. Once diagnosed, antiviral treatment should still be administered based on the severity of symptoms, especially for those with compromised immune function, where physicians may increase the dosage or extend the treatment duration.
Why is it necessary to continue using neuralgia medications for several weeks after the herpes zoster rash has crusted over?Postherpetic neuralgia (PHN) may persist for months after the skin has healed, as the virus has already damaged neurons and pain signal transmission. Continued medication can regulate abnormal nerve discharges and shorten the duration of chronic pain; physicians will adjust the types and dosages of medications based on pain assessments.
Can patients with herpes zoster take normal baths or undergo heat therapy?During the acute phase, hot water immersion or heat application should be avoided, as high temperatures may exacerbate inflammation and pain. It is recommended to gently cleanse with water below 38°C and keep the affected area ventilated and dry. In the chronic phase, low-temperature heat therapy may be used after consulting a physician to relieve indirect pain caused by muscle tension.
%201.svg)
Copyright © 2025 MedFrontiers. All Rights Reserved.
