Shingles, also known as herpes zoster, is a painful rash that develops on one side of the body. It is caused by the varicella-zoster virus, the same virus that causes chickenpox. After a person recovers from chickenpox, the virus remains dormant in the body. Years later, it can reactivate as shingles. While there is no cure for shingles, medications can help shorten the duration of the illness and reduce complications.
What is shingles?
Shingles is characterized by a unilateral rash that follows the path of a sensory nerve. It often starts as a burning pain in that area, followed by a red rash that develops into fluid-filled blisters. The rash usually clears up within 2 to 4 weeks. Other symptoms may include:
- Itching
- Tingling
- Fever
- Chills
- Headache
- Sensitivity to light
Shingles most commonly occurs on the torso and flank, but can develop anywhere on the body. It typically only affects a single area on either the left or right side. Shingles can be extremely painful, especially in older adults. Complications can include postherpetic neuralgia, eye problems, hearing loss, and facial paralysis.
What causes shingles?
After a person recovers from chickenpox, the varicella-zoster virus remains inactive in the body, hidden away in the nerve cells and dorsal root ganglia. Years or decades later, the virus may reactivate, often when a person’s immune system is weakened by stress, medication, illness, or aging. When reactivated, the virus travels along nerve fibers to the skin, causing the shingles rash.
Anyone who has had chickenpox is at risk for developing shingles. About 1 in 3 Americans will get shingles at some point. The risk increases with factors like:
- Older age (over 50)
- Diseases that impair immunity, like HIV or cancer
- Medications that suppress the immune system
- Cancer therapies like radiation or chemotherapy
- Organs transplant with immunosuppressant therapy
How long does shingles last without treatment?
Without treatment, most cases of shingles will heal within 2 to 4 weeks. However, symptoms can last anywhere from 2 to 6 weeks. Some people deal with shingles pain or complications for months or years.
The shingles rash and blisters typically go through several stages:
- 1-4 days: Tingling, burning pain, possibly fever or chills.
- 1-5 days: Red rash and fluid-filled blisters form.
- 7-10 days: Blisters begin to dry out and crust over.
- 2-4 weeks: Rash resolves, blisters have crusted over.
For some people, shingles follows this typical progression. But the duration can vary depending on factors like the person’s age and health. In some cases, it may take up to 6 weeks for the rash to completely clear.
How long does shingles last with antiviral medication?
Antiviral medicines like acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir) can help shorten the duration of shingles. These medications fight the varicella-zoster virus to limit the severity and complications of the infection.
When started within 72 hours of the shingles rash appearing, antiviral drugs can:
- Reduce the length and severity of shingles
- Accelerate rash healing
- Decrease the risk of postherpetic neuralgia (PHN)
- Lower the chance of vision or hearing loss
With prompt antiviral treatment, most cases of shingles resolve within 7 to 10 days. One study found that people who started antivirals within 72 hours experienced shingles rashes for an average of:
- 10 days without treatment
- 8 days with early treatment
Antivirals are most helpful if started immediately at the first signs of shingles. The benefits tend to decline if initiated more than 72 hours after the rash appears.
How long to continue antiviral treatment?
Most experts recommend continuing antiviral medication for 7 days. Some doctors may extend treatment to 10 days for patients over 50 years old or those with severe symptoms.
Taking antiviral medication for the full course is important to fully suppress the virus, heal the rash faster, and reduce the risk of complications. Stopping medication early can allow the virus to flare up again.
How long does shingles pain last with medication?
Antiviral drugs can help reduce acute nerve pain during a shingles outbreak. However, specialized medications are often needed to control longer-term shingles pain:
- Corticosteroids: These anti-inflammatory drugs can alleviate shingles pain and rash severity when combined with antivirals. They may be taken orally or injected directly into lesions.
- Pain relievers: Over-the-counter options like acetaminophen, ibuprofen, or aspirin can help manage mild to moderate shingles pain.
- Numbing agents: Lidocaine medicated patches, gels, or sprays can temporarily numb shingles pain.
- Anti-seizure drugs: Medications like gabapentin help calm overactive nerves and reduce neuropathic pain.
- Antidepressants: Certain antidepressants like amitriptyline are effective at relieving nerve pain.
- Opioid painkillers: In severe cases, opioids like oxycodone may be used for short-term pain relief. They have risks of side effects and addiction.
With prescription pain management, most patients see shingles pain gradually improve within 2 to 3 weeks. However, some people may deal with painful after-effects like postherpetic neuralgia for months or years after the rash heals.
Postherpetic Neuralgia
Postherpetic neuralgia (PHN) is persistent nerve pain that lingers after a shingles rash heals. It affects up to one-third of shingles patients aged 50 and over.
PHN can cause burning, stabbing, or electric-shock pain that continues for months or years. Prompt treatment with antivirals may reduce the risk of developing PHN.
For persistent PHN pain, medications like antidepressants, anticonvulsants, topical numbing agents, or nerve blocks may provide relief. PHN often resolves eventually but can persist for years in some people.
Lifestyle and home remedies
In addition to medication, certain at-home remedies can help soothe shingles pain and accelerate healing:
- Cool compresses can ease itching and pain.
- Colloidal oatmeal baths relieve skin irritation.
- Wet dressings of gauze soaked in Burow’s solution reduce crusting of blisters.
- Calamine lotion and other OTC creams calm itching.
- Over-the-counter pain relievers like acetaminophen, ibuprofen, or aspirin can help mild pain.
- Resting, reducing stress, and staying hydrated support healing.
- Avoiding close contact with others prevents viral spread until rash is scabbed over.
Check with your doctor before using any new topical creams, especially on the face. Keep lesions clean and dry to avoid bacterial infection.
When to see a doctor
Consult a doctor right away if you suspect shingles. Antiviral medication should be started within 72 hours of the rash appearing for best results. Prompt treatment can minimize nerve damage and complications.
See a doctor immediately if any of the following occur:
- Rash is near the eyes – can cause eye infections and vision loss
- Blisters are infected – increased pain, swelling, redness, pus, fever
- Extreme pain or neurological symptoms – may prompt stronger pain medication
- Rash is widespread or internal – requires aggressive treatment
- Existing medical conditions – increased risk of complications
Make sure to follow up with your doctor until the rash has completely resolved. Let them know if you have any lingering pain so it can be properly managed.
How to prevent shingles
While shingles cannot be completely prevented, the shingles vaccine helps reduce risk by boosting immunity to the varicella-zoster virus. The CDC recommends two doses of Shingrix vaccine for people aged 50 and older, even if they’ve had shingles before.
Other preventive tips include:
- Treating illnesses promptly to keep immune system strong
- Reducing stress through relaxation techniques
- Avoiding immunosuppressive medications when possible
- Eating a balanced diet and getting adequate sleep
Shingles treatment guidelines are still evolving as newer medications become available. Staying informed through trusted health resources can ensure you receive the most up-to-date care.
Conclusion
With prompt antiviral treatment, most cases of shingles resolve within 7 to 10 days. However, some people deal with painful after-effects like postherpetic neuralgia for longer. Starting medication within 72 hours offers the best chance to shorten shingles duration and minimize complications.
In addition to antiviral drugs, specialized medications can help manage shingles pain both during the acute outbreak and for potential postherpetic neuralgia. Lifestyle remedies like cool compresses, wet dressings, and rest may further aid healing.
While shingles cannot be fully prevented, the shingles vaccine offers important protection for older adults. Seeking early treatment maximizes recovery outcomes. Stay in close contact with your doctor while recovering to ensure proper care.