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Shingles—officially known as herpes zoster—is an infection of a nerve and the area of skin supplied by the nerve. It is caused by the varicella zoster virus, a virus in the herpes family that also causes chickenpox. After a person has chickenpox, some virus particles remain inactive in the nerve roots next to the spinal cord. Aging and/or weakening of the immune system due to stress or illness can trigger the virus to multiply again (reactivate). The reactivated virus travels along the nerve to the skin to cause shingles.
About 30 percent of people get shingles and the risk increases sharply after 50 years of age. Rates are increasing among adults in the United States and the reason for this is unknown.
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Symptoms and Complications
The main symptoms are mild to severe pain and a characteristic blistering rash, usually on one side of the body. Shingles pain lasts for an average of 32 days, usually easing soon after the rash clears. Malaise, headache, photophobia, abnormal skin sensations, or fever may occur one to five days before the rash. Until the blisters dry and crust over, direct contact with them can spread the virus to other people.
For some people, shingles pain persists or comes back at a later date, a condition known as postherpetic neuralgia. The persistent pain of postherpetic neuralgia can interfere with sleep and is associated with increased anxiety and depression.1
Rarely, shingles can lead to serious complications, including meningitis (inflammation of the membrane around the brain), encephalitis (inflammation of the brain), and difficult-to-treat eye infections that can threaten vision.
Conventional treatment and prevention
Standard, conventional treatment of acute shingles involves drug therapy with antivirals and pain medications.
Antiviral therapy is recommended for people at increased risk for complications, people whose immune systems are compromised, those over 50 years of age, and those with severe pain or severe rash. Antivirals may increase the rate of healing, decrease pain, and help to prevent postherpetic neuralgia, especially when taken within 72 hours of the onset of the rash.10
However, the latest research suggests that many patients treated early with antivirals still experience persistent pain and marked long-term reduction in health-related quality of life.[7,8] The antiviral drugs are generally considered relatively safe and well tolerated. Common side effects include nausea and malaise, and some antivirals can cause kidney failure leading to death and are associated with other serious adverse effects.9
Antivirals alone are often not enough to relieve acute shingles pain. Mild to moderate pain may be controlled with acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), while moderate to severe pain may require strong pain medications (opioids) such as oxycodone or morphine. Side effects of opioids include severe constipation, nausea, vomiting, sedation, dizziness, and addiction/dependence.
Conventional treatment of postherpetic neuralgia typically involves antidepressants and/or anticonvulsants. (Certain types of antidepressants and anticonvulsants also ease nerve pain.) Sleepiness, sedation, dizziness, edema, dry mouth, blurred vision, constipation, and urinary retention are the most common side effects of these drugs.
Shingles and postherpetic neuralgia can be extremely difficult conditions to treat, so prevention is very important. One dose of the herpes zoster vaccine (Zostavax) is recommended by the Advisory Committee for Immunization Practices for all people 60 years and older. The vaccine reduces the incidence of shingles by 51 to 55 percent. If you still get shingles after vaccination, the duration and severity of pain are reduced.
Vaccination also reduces the incidence of postherpetic neuralgia by 67 percent and lessens the risk of serious complications such as eye infections and hospitalizations.
In a clinical trial involving more than 38,000 adults, the prevalence of serious adverse events was similar in the vaccine and placebo groups (1.9 percent and 1.3 percent, respectively). One case of anaphylaxis occurred and no vaccine-related deaths were reported.
The most commonly reported side effects were redness, pain or tenderness, swelling, and itching at the injection site.4 The vaccine contains no preservatives such as thimerasol.5
Natural Strategies for Shingles Prevention
Nutrition is paramount for maintaining a well-functioning immune system. People with low vitamin, mineral, fruit, and vegetable consumption are significantly more likely to get shingles. Keep your immune system strong by eating lots of brightly colored fruits and vegetables, good fats (such as those found in nuts, seeds, and fish); and fermented foods (yogurt, raw sauerkraut).
In addition to eating well, you may want to take advantage of the immune strengthening effects of vitamins C and D for shingles prevention. For ongoing, general immune support, take 2,000 IU per day of vitamin D3 (or more, depending on blood levels of 25-OH-vitamin D; aim for a level of at least 80 nmol/L [32 ng/mL]) and at least 400 mg per day of vitamin C.
Top Home Remedies for Shingles
Vitamin C, a potent antioxidant, also has natural antiviral properties, supports the immune system, and potentially prevents herpes viruses from replicating. Taking high doses of vitamin C may provide relief from shingles nerve pain and treat the rash.
While no studies have specifically examined whether taking high oral doses of vitamin C treats shingles, intravenous vitamin C significantly lessens pain and rash symptoms of acute shingles.[12,13] It also decreases pain in postherpetic neuralgia patients, who, incidentally, have been found to have low levels of vitamin C.
Integrative physicians recommend up to 10,000 mg of vitamin C per day, in divided doses, or to bowel tolerance (when you get diarrhea, you’ve taken too much and need to lower the dose) for 10 days to two weeks during active herpes outbreaks.
Zinc can be taken in high doses (50 mg per day) during a shingles outbreak. Zinc inhibits herpes zoster viral replication and enhances immunity.[17,18] Like vitamin C, people with low levels of zinc are more likely to develop postherpetic neuralgia after having shingles.
Natural Treatments for Postherpetic Neuralgia
Capsaicin, a natural compound in red pepper (capsicum), provides pain relief by activating and, in turn, desensitizing nerve fibers in the skin over time. Topical capsaicin cream provides significant pain relief within two weeks of starting applications to the affected area three or four times daily. Maximal analgesic effect requires at least four weeks of treatment. Capsaicin should not be used until the blisters have completely dried out and are falling off the skin and should be handled using a glove. Application of capsaicin may cause initial discomfort (burning sensation) before the pain-relieving effects kick in.
Acupuncture can help treat postherpetic neuralgia if home remedies are not enough to adequately address the pain. Over 100 studies have examined acupuncture for postherpetic neuralgia and show that it reduces pain and discomfort for most patients and completely clears the symptoms for some individuals.
For further reading on shingles, see these University Health News posts:
1. CMAJ. Nov 9, 2010; 182(16): 1731–1736.
2. CDC. Shingles. For Health Care Prof.
3. JAMA. 2011;305(2):160-166.
4. CDC. Vaccines. Herpes Zoster. Info for Health Care Prof.
5. Zostavax package insert.
6. N Engl J Med 2013; 369:255-263.
7. Med Mal Infect. 2013 Dec;43(11-12):461-6.
8. Pain. 2012 Feb;153(2):342-9.
9. Drugs.com. Acyclovir tablets. FDA Professional Info.
10. Am Fam Physician. 2011 Jun 15;83(12):1432-7.
11. Linus Pauling Institute. Micronutrient Info Ctr. Nutrition and Immunity.
12. Med Sci Monit. 2012 Apr;18(4):CR215-24.
13. Med Sci Monit. 2010 May;16(5):CS58-61.
14. Clin J Pain. 2009 Sep;25(7):562-9.
15. Altern Med Rev. 2006 Jun;11(2):93-101.
16. Br J Nutr. 2011 Sep;106(5):700-7.
17. Clin Ther. 1993 May-Jun;15(3):510-26.
18. BMJ Open. 2014 Nov 12;4(11):e005725.
19. Int J Epidemiol. 2006 Apr;35(2):307-14.
Originally published in February 2016 and updated.