Shingles treatment continues to evolve

Nov 06, 2024

Key takeaways:

Shingles.It’s a word that stings just coming out of your mouth. And it’s certainly an illness you want to avoid.

There are time-tested treatments for the disease that’s associated with chickenpox – namely an effective vaccine. But new research from the University of Pennsylvania and New York University (NYU) gives hope to people who have suffered eye complications from shingles.“It’s promising,” says Fred Burke, MD, an emergency medicine physician who provides care at OSF HealthCare.

Shingles basicsDr. Burke says shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. Chickenpox is common in children, who typically suffer from a blistering rash for four to seven days.“That virus will lie dormant in the nerve cells of the body. For some unknown reason, it gets activated later in life,” causing shingles, Dr. Burke says. “Generally, that’s in people 50 and over. You’ll get a localized blistering rash. It’s painful. It can last for three to five weeks. We treat it with antiviral medication.”Catching the disease early is key.“If the rash has already crusted over, the antiviral medication won’t be effective,” Dr. Burke says. “You can treat the pain, but you have to just ride it out.”You’re not contagious at that point, Dr. Burke says, but you’ll want to rest.

Aside from older adults, people with a compromised immune system – for example, someone with cancer or a transplanted organ – are at a higher risk for shingles. The disease spreads through the air – like when you cough on someone – or by direct contact.In some cases, the pain from shingles can linger for months or years, Dr. Burke says. It’s called neuropathic pain, and there’s medicine available for that too. Meningitis and facial paralysis are other shingles complications.Shingles can also impact the eyes, causing redness, swelling, itching and impaired vision. This is called herpes zoster ophthalmicus (HZO).

“We treat that with antiviral medication. We consult an ophthalmologist because the person may also need steroids,” Dr. Burke says. “It’s good to treat this quickly because it can lead to vision loss.”

Treating eye complications

That’s where the new research comes in.Elisabeth J. Cohen, MD, a professor of ophthalmology at NYU, did the study after she was impacted by shingles-related vision loss. The research looked at the antiviral treatment valacyclovir, which is typically short term.

“The researchers showed that using valacyclovir for a year can decrease the risk of new or worsening eye disease by 26 percent at 18 months after initiating treatment. Patients treated with valacyclovir also were 30 percent less likely than those not receiving the treatment to have multiple HZO flare-ups at a year or a year-and-a-half later,” a news release announcing the research results says.

“I was very, very impressed,” Dr. Burke says after reading the results.

Importance of vaccinesLike any new research, more study is needed of long-term use of valacyclovir. In the meantime, Dr. Burke says vaccines for chickenpox and shingles are 90% effective.

The United States Centers for Disease Control and Prevention says children under 13 should get two doses of the chickenpox vaccine – one at 12 to 15 months and the other at four to six years. People 13 and older who never got chickenpox or the vaccine should also get two doses 28 days apart.But be warned: Dr. Burke says if you don’t get chickenpox as a child, you can still get shingles as an adult.

“It’s the same virus,” that’s associated with both ailments, he says. “So if you catch it from someone [as an adult], you’ll probably get chickenpox first. And you could get shingles later.”

Meanwhile, Dr. Burke says the two-shot shingles vaccine is for healthy people 50 and older and people 19 and older who are immunocompromised.

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