Shingles, a viral infection caused by the varicella-zoster virus, manifests as a painful rash. While there is no cure, topical creams can help manage symptoms by providing localized relief from pain and itching.
Categories of Topical Shingles Treatments
Topical treatments for shingles are categorized by their primary function. Some creams target pain, including neuropathic pain, by desensitizing nerve endings or numbing the affected area. Other solutions alleviate itch and irritation, common complaints with the rash, by soothing the skin and reducing inflammation. Antiviral creams aim to inhibit viral replication, though oral antivirals are typically the primary treatment for shingles.
Over-the-Counter Creams for Shingles
Over-the-counter (OTC) creams offer relief for shingles symptoms, focusing on pain or itch. Lidocaine creams and patches provide a numbing effect for localized pain by blocking nerve signals in the skin. OTC lidocaine patches typically contain 4% lidocaine and can be applied up to three times daily for up to eight hours per application.
Capsaicin cream, derived from chili peppers, works by depleting Substance P, a chemical messenger in nerve cells that transmits pain signals to the brain. While it can cause an initial burning sensation, this usually diminishes with continued use, and it can help reduce nerve-related pain.
Calamine lotion is a traditional remedy that helps alleviate itching and discomfort by providing a cooling sensation and drying out oozing blisters. It can be applied after blisters have scabbed over.
Menthol and camphor are other ingredients often found in OTC creams that offer a cooling and soothing effect, helping to distract from itching and minor pain. Low-strength hydrocortisone cream (typically 0.5% or 1%) can reduce inflammation and itching due to its corticosteroid properties. However, it should be used with caution on open or broken skin.
Prescription Creams for Shingles
For more severe or persistent symptoms, a healthcare professional may prescribe stronger topical treatments. Higher-strength lidocaine formulations, such as 5% lidocaine patches (e.g., Lidoderm), are available by prescription and can provide more significant pain relief, especially for postherpetic neuralgia (PHN), which is nerve pain that can linger after the shingles rash has healed. These patches are applied once daily for up to 12 hours.
Topical antiviral creams like acyclovir or penciclovir exist, but oral antiviral medications are generally preferred for shingles to shorten the outbreak’s duration and severity. Topical antivirals are less common in typical shingles management compared to systemic options.
For severe, persistent neuropathic pain, compounded creams containing specialized ingredients like amitriptyline, ketamine, or gabapentin might be prescribed. These formulations are tailored to individual needs and target specific pain pathways.
Safe Application and Important Considerations
Proper application of topical creams is essential for effectiveness and safety. Always wash your hands thoroughly with soap and water before and after applying any cream to prevent infection and contamination. Apply the cream thinly and gently to the affected areas, avoiding excessive rubbing. It is important to avoid applying creams to broken skin, open blisters, or mucous membranes (eyes, mouth, nose) unless specifically instructed by a healthcare professional.
Monitor the treated area for potential side effects such as increased irritation, redness, or allergic reactions. If any severe reaction occurs, discontinue use and consult a doctor. While topical absorption is usually minimal, inform your doctor about all medications you are using, including OTC creams, to avoid potential interactions. Before using a new product, especially if you have sensitive skin, perform a patch test on a small, inconspicuous area of skin, like the inner arm, to check for adverse reactions.
When to Consult a Healthcare Professional
Seeking timely medical advice is important for a proper shingles diagnosis and comprehensive treatment. If you suspect you have shingles, consult a healthcare provider within 72 hours of the rash appearing. Early diagnosis allows for prompt initiation of oral antiviral medications, which can significantly reduce the severity and duration of the outbreak and lower the risk of complications such as postherpetic neuralgia.
Medical attention is also necessary if symptoms worsen, the rash spreads, or signs of bacterial infection develop, such as increased redness, swelling, pus, or fever. If the rash affects the eye or nose, immediate consultation with a doctor is crucial to prevent potential vision damage. Persistent pain after the rash has cleared, known as postherpetic neuralgia, warrants a doctor’s visit for pain management strategies. Individuals with weakened immune systems should seek immediate medical care if they develop shingles, as they are at higher risk for severe symptoms and complications.