There are different medications for shingles. However, how well they work depends largely on when they are taken. FOCUS Online explains which shingles symptoms you should know and why rapid therapy is so important.

Shingles, medically known as herpes zoster, can be successfully treated in most cases. However, this is not as easy as with the other, very common herpes infections, the cold sores. Here anti-viral ointments or tinctures are simply applied to the blisters and after a few days the skin lesions have dried up and disappeared.

Treatment for shingles is not that simple. There are effective zoster medications, but not primarily for local treatment, but for systemic therapy, i.e. as tablets or infusions. Their active ingredients slow down the multiplication of the triggering pathogens, the varicella-zoster virus (chickenpox virus).

Their effect is all the better the sooner they are used after the first changes caused by the rash. That should be within the first 72 hours. That’s why it’s so important to go to the doctor at the first sign of shingles and have nerve pain in the chest area and an incipient skin rash clarified.

Those affected also often feel in the case of shingles

About two days later, the skin tingles in a certain area, such as the abdomen, back or forehead. The affected area of ​​skin reddens slightly, small bumps appear, which in turn form blisters after a few hours. They may burst open within the next few days, later drying up and crusting over. Burning pain and tenderness to touch occur in the affected area of ​​skin.

The advantages of the antiviral therapy, which usually starts quickly:

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Herpes zoster medication requires a prescription. The current guidelines recommend four active ingredients:

The tablets must be taken strictly according to the doctor’s instructions for at least a week – depending on the active ingredient, seven to ten days, three to five times a day, while brivudin only once a day.

All active ingredients are well tolerated. Only some users may experience headaches and nausea. Patients receiving certain cytostatics such as 5-fluorouracil should not take brivudine because interactions are possible.

Various studies have examined which of the drugs is most effective against shingles. In most cases, the antivirals perform almost equally well. However, the effectiveness of tablets with famciclovir, valaciclovir and brivudine compared to aciclovir against acute zoster pain and postherpetic neuralgia seems to be somewhat more effective, as the Paul Ehrlich Society for Chemotherapy and the German Association for Combating Viral Diseases note.

Aciclovir is, so to speak, the classic among the three drugs. It was approved in the 1970s, the other antivirals only in the 1990s. Brivudine is the newest drug of the mentioned.

Oral therapy with antivirals is sometimes not enough. Aciclovir is then administered intravenously, and the patient usually stays in the hospital for a few days. This parenteral application is recommended in complicated cases, especially when:

In certain cases, the treatment with antiviral drugs is supplemented by other drugs, indications are zoster ophthalmicus (zoster on the eye) or zoster oticus (zoster on the ear). This treatment can be important because the complications can have serious consequences:

In order to treat the underlying inflammation, experts therefore recommend glucocorticoids in the form of tablets, i.e. cortisone, in addition to the antivirals, depending on the extent of the shingles. Sometimes cortisone can also be applied locally as a gel or drops. A check-up by the ophthalmologist or the ENT doctor is definitely important.

The second pillar of therapy for zoster deals with the typical nerve pain. Early treatment can prevent the pain from worsening and developing post-herpetic neuralgia, which means that the pain persists for weeks or months after the skin lesions have healed.

The pain treatment is based on the three-stage WHO scheme, the criteria are pain intensity and duration. The doctor determines this, for example, with a rating scale from 0 to 10, where 0 stands for no pain and 10 for the strongest. Pain medications such as ibuprofen, paracetamol, diclofenac and naproxen are recommended in stage 1. Levels 2 and 3 include weak to strong acting opioids.

The skin area affected by zoster should also be treated externally, i.e. topically. This can prevent an additional bacterial infection from forming through the skin lesions and causing scars to form as they heal.

Antiseptic and cooling solutions are suitable here, especially in the first stage when the blisters appear. Because the skin areas often burn so much, many patients find cooling particularly pleasant. If the blisters have already burst and become encrusted, antiseptic gels are more suitable.

Shingles is not always without consequences. The most common consequence is PZN or post-herpetic neuralgia. Blisters and skin lesions have healed, but burning, stabbing pains remain. They can be massive and severely limit the quality of life. Around every second zoster patient who is over 60 years old has to reckon with the complication, among older people this risk even increases to 70 percent.

In addition to painkillers, certain antidepressants can be useful. They partially dampen the transmission of pain. Anticonvulsants, i.e. active ingredients for the treatment of epileptic diseases, may also be useful.

In addition, local therapy such as a capsaicin patch is an option for post-herpetic neuralgia. The substance that gives peppers and chili peppers their typical spiciness can affect the pain receptors in the skin and thus reduce the pain. Special patches for local anesthesia, such as lidocaine, can also provide relief. Of course, these local measures are only possible if the blisters have healed well – and in consultation with the pain specialist or neurologist. Because the PZN should definitely be treated by these specialists.

But even if the zoster has disappeared with the help of these measures and the PZN has subsided – surviving shingles does not protect you from getting zoster again. Because there is no definitive cure for zoster. The antiviral drugs stop the multiplication of the zoster pathogen. Remaining varicella can also simply retreat back into the nerve nodes. In rare cases, such as when constant stress puts a strain on the immune system or a serious illness, shingles can occur again. The recurrence rate of shingles is still around six percent, as a study by the Mayo Clinic was able to show.

The risk of recurring shingles was particularly increased for those who had long-lasting pain when they first contracted herpes zoster, women over 50 years of age and people with immunodeficiency. The zoster vaccination is therefore an important option, not only to limit this risk, but also to avoid developing shingles in the first place. The Standing Vaccination Committee (Stiko) of the Robert Koch Institute therefore recommends an inactivated vaccine to people over 60 years of age, which is administered twice, at intervals of two to six months.