Dear Dr. Roach: I was diagnosed with shingles after a few days of a painful rash. The doctor recommended acyclovir, gabapentin and prednisone. Do these really help? — M.F.
Answer: Shingles is when the chickenpox virus reappears in a specific area of the body, such as in a beltlike distribution on the torso. In fact, the word “shingles” comes from “cingulatum,” the Latin word for “belt.” But it can appear on any area of the body.
Shingles damages the nerves, and is usually painful, with a degree of pain that can range from mild to excruciating. Some people have intense itching in addition to or instead of pain.
Treatment with an antiviral agent — acyclovir or one of its newer and more potent cousins, such as valacyclovir (Valtrex) — is effective at reducing symptoms if started within 72 hours of the onset of rash, preferably immediately. Gabapentin is an agent to reduce nerve pain. It takes time to build up to an effective dose, and some physicians prefer to use shorter-acting pain medication for the pain of shingles itself. The most recent studies on prednisone, a potent anti-inflammatory steroid, have failed to show benefit, and I no longer prescribe it.
The dreaded complication of shingles is postherpetic neuralgia, which can last for weeks, months or even years after the damage to the nerves is caused by shingles. The older a person is, the more likely she is to get it, and the longer it tends to last. I cannot emphasize strongly enough how bad postherpetic neuralgia can be: I have seen healthy older adults become bedbound due to PHN. Early treatment with gabapentin or other pain medications is indicated.
It’s much better to prevent shingles than it is to treat it. The new shingles vaccine is highly effective at preventing shingles and more effective at preventing or reducing the severity of PHN. Two doses are recommended for adults 50 and over.
