Diagnosis and Conventional Treatment
Shingles. The typical symptoms of shingles – pain, rash, and blisters extending along a limited area or strip on one side of the body – are very characteristic, so doctors are often able to make the diagnosis based on the clinical presentation (Mayo Clinic 2011; Albrecht 2012c). In people whose immune system is functioning normally, the rash is usually present only on one side of the body (Albrecht 2012c). In immunocompromised individuals, more unusual presentations can sometimes be observed (Gnann 2002). An example of this is abdominal zoster, in which serious abdominal pain occurs hours to days before the rash (Gnann 2002).
In situations when the diagnosis is not certain, a doctor may take a piece of tissue or collect some material from the blisters to look for the varicella-zoster virus, which will confirm the diagnosis (Mayo Clinic 2011; Albrecht 2012d). Doctors can also look for antibodies to the varicella-zoster virus in the blood, which both confirms previous infection (necessary for shingles to occur) and assesses susceptibility to future outbreaks (Albrecht 2012d).
Herpes. Often, doctors can similarly diagnose herpes simplex infections based on the appearance of the sores (Ehrlic 2011a; American Academy of Dermatology 2012; Albrecht 2012e). However, confirmatory laboratory testing is sometimes needed (Albrecht 2012e). Much like shingles, herpes infections can be confirmed by taking material from the blisters and looking for the presence of either HSV-1 or HSV-2 (Mell 2008; Albrecht 2012e).
The standard treatment for both shingles and herpes is antiviral medication. The main antiviral medications used for shingles are acyclovir (Zovirax®), famciclovir (Famvir®), and valacyclovir (Valtrex®) (Albrecht 2012f). All three medications can be taken orally and reduce pain and speed healing of the lesions; though famciclovir and valacyclovir are often preferred because they require less frequent dosing (three times per day as opposed to five for acyclovir) (Albrecht 2012f).
Currently, these medications are recommended for patients over the age of 50 who do not present complications and come to the doctor within 72 hours after the onset of symptoms (Albrecht 2012f). Efficacy in patients under the age of 50 has not been studied as thoroughly (Albrecht 2012f). The utility of acyclovir more than 72 hours after the lesions appear is unknown in otherwise healthy individuals. In addition, the benefits of therapy are thought to be minimal after lesions have formed a crust. Treatment with antiviral drugs should be initiated in all immunocompromised patients, even in those who present to the doctor more than 72 hours after their lesions have appeared (Albrecht 2012f).
Patients with shingles may get pain relief from non-steroidal anti-inflammatory drugs or acetaminophen, which can be used alone or in combination with weak opioids, such as codeine and tramadol (Albrecht 2012f). Another treatment option is to use local creams that contain the compound capsaicin (Zostrix®). Capsaicin is the ingredient in peppers that generates the sensation of “heat” in the mouth. When formulated into a cream or ointment, it can be applied to areas of the body that are still painful after the shingles blisters are gone to reduce pain. When applied, capsaicin creams generate a mild “burning” sensation. Capsaicin causes the release of a neurotransmitter (Substance P) from nerve cells, and its repeated application depletes the nerve stores of the compound, reducing pain transmission (McCleane 2000; Fashner 2011; Sayanlar 2012).
In rare cases of severe or complicated manifestations of herpes, such as massive outbreaks of sores or herpes encephalitis, intravenous antivirals may be needed (Mell 2008, Albrecht 2012g).