The Primary Treatment: Oral Antivirals
Before discussing what prescription creams are used for shingles, it is crucial to understand that oral antiviral medications are the most important part of treating the active viral infection. Shingles is caused by the reactivation of the varicella-zoster virus, and topical treatments alone cannot address the systemic nature of the virus.
Prescription oral antivirals are most effective when started within the first 72 hours of the rash's appearance. They work to reduce the severity and duration of the illness and significantly lower the risk of developing long-term complications, such as postherpetic neuralgia (PHN). Common oral antiviral medications prescribed for shingles include Acyclovir (Zovirax), Valacyclovir (Valtrex), and Famciclovir (Famvir).
Prescription Topical Creams and Patches for Shingles Nerve Pain
Once the active viral rash has cleared, some people experience persistent nerve pain known as postherpetic neuralgia (PHN). This is where prescription topical creams and patches become valuable tools for localized pain management. Unlike the oral antivirals that treat the underlying virus, these topical treatments target the damaged nerves that continue to send pain signals.
High-Concentration Lidocaine Patches and Creams
Lidocaine is a local anesthetic that works by numbing the skin and the underlying nerves to relieve pain. Prescription-strength options, like lidocaine patches (Lidoderm) and compounded lidocaine creams, offer higher concentrations for focused relief of localized nerve pain compared to over-the-counter versions.
High-Concentration Capsaicin Patches
Capsaicin, derived from chili peppers, can effectively relieve nerve pain by depleting a chemical (Substance P) that transmits pain signals. Qutenza, a prescription-only, high-concentration capsaicin patch, is applied by a healthcare professional in a clinical setting to treat chronic neuropathic pain, including PHN. Specific application instructions must be followed due to the high concentration.
Other Prescription Topical Options
Other prescription topical options may include EMLA cream, a mixture of lidocaine and prilocaine, which can be used as a topical anesthetic for PHN. Additionally, if the rash's broken skin becomes infected, a doctor might prescribe a topical antibiotic ointment.
Comparison of Prescription and Over-the-Counter Options
| Feature | Prescription Oral Antivirals | Prescription Topical Anesthetics (Lidocaine) | Prescription Capsaicin Patches (Qutenza) | Over-the-Counter Creams (Lidocaine, Capsaicin) |
|---|---|---|---|---|
| Purpose | Treat the active viral infection | Manage localized nerve pain (PHN) | Manage localized, chronic nerve pain (PHN) | Symptomatic relief of minor pain, itching |
| Example | Valacyclovir, Acyclovir | Prescription Lidocaine patches | Qutenza patches | Calamine lotion, low-dose lidocaine |
| Availability | Requires doctor's prescription | Requires doctor's prescription | Applied by a doctor | Widely available without prescription |
| Timing | Best within 72 hours of rash onset | Used after rash has healed for PHN | Used after rash has healed for PHN | Used for symptom management during or after rash |
| Main Target | The varicella-zoster virus | Nerve endings in the skin | Neurotransmitters (Substance P) | Itching and minor pain receptors |
How to Use Prescription Topical Patches Safely
If your doctor prescribes a topical patch, follow these instructions carefully: clean and dry the affected area before applying; do not apply to broken or irritated skin or over heat; avoid prolonged water exposure unless directed; wash hands after handling; adhere to the prescribed wear duration; and store patches safely away from children and pets.
Conclusion
While the search for a simple prescription cream for shingles is common, the reality is more nuanced. The primary medical treatment for the active infection involves taking oral antiviral medication within the first few days of the rash appearing. Prescription topical agents, such as high-concentration lidocaine and capsaicin patches, are powerful tools specifically designed for managing the lingering nerve pain (PHN) that can occur after the initial outbreak has resolved. It is important to consult a healthcare provider for an accurate diagnosis and treatment plan to ensure proper management of both the acute viral phase and any potential long-term nerve complications. For more information on shingles and its management, consult the Centers for Disease Control and Prevention (CDC) website.
