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Feature Article

Shingles: an update on treatment

David W Smith

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Abstract

Shingles is often a painful and debilitating condition. This article will review its clinical features and give an update on the options available for treatment.

Key Points

  • Laboratory confirmation of shingles should be done when there is significant doubt, in complicated disease, in immunocompromised patients and when the infection poses a serious risk to contacts.
  • The diagnosis is best achieved by detection of the virus in samples from the skin lesions. Try to swab areas of recent onset: vesicles are a better source than papules or crusted lesions.
  • Skin lesions on the nose are predictive of corneal involvement. All patients with lesions around the eye should be treated promptly, and urgent ophthalmologic review should be sought if there is any suspicion of direct ocular involvement.
  • In general, the benefits of antiviral therapy on acute zoster and chronic pain are confined to patients treated within 72 hours of onset of rash. The exception is zoster ophthalmicus where treatment up to seven days after onset reduces ocular complications.
  • Valaciclovir and famciclovir are equivalent, and both are superior to aciclovir, for treating shingles.
  • Severe pain in the acute phase seems to increase the risk of postherpetic neuralgia. Therefore, pain should be monitored closely and adequate pain relief should be provided, up to and including opiates.
  • Postherpetic neuralgia is usually described as a boring, aching, burning or stabbing pain. It is also characterised by abnormal sensation and may be triggered by minor stimuli.

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