Feature Article

Shingles – how to prevent it, how to treat it

Anthony L Cunningham, John Litt



Zoster vaccine is the most effective strategy to prevent shingles and toameliorate complications such as postherpetic neuralgia. Antiviral treatment is effective in treating shingles attacks if used early.

Key Points

  • Shingles, or herpes zoster, is common, with a lifetime risk of up to 50% in people who live to the age of 85 years.
  • Complications, especially postherpetic neuralgia (PHN), increase significantly in older age groups.
  • Immunisation with zoster vaccine is the most effective strategy to boost immunity and prevent shingles and ameliorate its complications including PHN.
  • Antiviral treatment with famciclovir, valaciclovir or aciclovir has proven efficacy for shingles and is most effective if commenced within 72 hours of rash onset.
  • Analgesia for acute pain should be titrated against the severity of the pain; referral of patients to a pain clinic is recommended if pain is evolving into PHN.