Shingles (Herpes Zoster) is a painful, blistering rash caused by the reactivation of the varicella-zoster virus, the same virus responsible for chickenpox. The rash typically appears on one side of the body, following a nerve pathway, and causes intense burning, stinging, or aching sensations. While prescription medication treats the underlying virus, topical applications are primarily used for localized symptom management and comfort. These products do not cure the infection but provide relief from the pain and itching associated with the outbreak.
Prescription Topical Antivirals
While the standard and most effective treatment for shingles involves oral antiviral medications, such as valacyclovir or acyclovir, these are prescribed by a doctor. Oral antivirals work systemically to inhibit the replication of the varicella-zoster virus. They are most beneficial when started within 72 hours of the rash’s initial appearance, which can shorten the duration of the rash and reduce the risk of long-term nerve pain.
In some clinical situations, a healthcare provider may prescribe a compounded topical cream that combines an antiviral agent, like acyclovir or penciclovir, with a numbing agent. Penciclovir cream functions by interfering with the viral DNA polymerase, thereby slowing the virus’s ability to multiply within the skin cells. These localized treatments are applied directly to the lesions but are not considered a substitute for the systemic action of oral medication for typical shingles cases.
Over-the-Counter Numbing and Pain Relief Creams
Topical analgesics are often the most sought-after products for shingles because they directly address the severe nerve pain that characterizes the condition. These creams work by interfering with the pain signals sent from the damaged nerves in the skin to the brain. They offer a temporary, localized numbing effect that can significantly improve daily comfort and sleep quality.
Lidocaine is a common agent that works by temporarily blocking sodium channels in the nerve cell membranes. This action prevents the influx of sodium ions, stopping the conduction of electrical impulses and effectively numbing the area of application. Over-the-counter creams and patches typically contain a 4% concentration of lidocaine, while a more potent 5% strength is available by prescription. Apply lidocaine creams only to intact skin, avoiding open or weeping blisters, and use the lowest effective dose to prevent systemic absorption.
Another topical agent sometimes used for nerve pain is capsaicin, the compound that gives chili peppers their heat. Capsaicin works by activating and then desensitizing specific pain receptors, leading to a depletion of Substance P, a chemical messenger that transmits pain signals. Capsaicin can cause an initial, intense burning sensation and is generally recommended for post-herpetic neuralgia (PHN), the chronic nerve pain that persists after the shingles rash has fully healed. It should not be used on active, blistered skin due to the risk of severe irritation and pain.
Soothing and Protective Lotions
Beyond pain relief, the active shingles rash often requires products that soothe the intense itching, dry out weeping blisters, and protect the compromised skin barrier. These non-narcotic treatments help prevent secondary bacterial infection and promote healing. Their primary role is to manage the discomfort associated with the skin lesions themselves.
Calamine lotion, a classic remedy, is a pink, watery suspension containing zinc oxide and ferric oxide. It provides a cooling sensation upon evaporation and functions as an astringent, helping to dry out fluid-filled blisters and reduce mild itching. Calamine should be dabbed gently onto the rash with a cotton swab and used sparingly, as excessive application can sometimes slow the natural drying and scabbing process.
Colloidal oatmeal is another recommended soothing agent. Its effectiveness comes from components like beta-glucans and avenanthramides, which exhibit anti-inflammatory and antioxidant properties. Colloidal oatmeal helps to calm irritated skin and forms a protective film on the skin’s surface, which can help lock in moisture and alleviate pruritus.
For lesions that have begun to crust or dry, applying a thin layer of plain petroleum jelly can be beneficial. The jelly creates a protective barrier that prevents the lesions from sticking to clothing or bandages, minimizing trauma to the healing skin. This barrier also helps maintain a moist wound environment conducive to healing and reduces the likelihood of permanent scarring.
Safe Application and Ingredients to Avoid
Using topical treatments on skin compromised by a viral rash requires careful attention to application technique and ingredient selection. Before applying any product, hands should be thoroughly washed to prevent the introduction of bacteria to the open or blistered skin. Treatments should be applied gently by dabbing rather than rubbing, which can rupture blisters and increase pain.
Topical steroids, such as hydrocortisone cream, should be avoided unless explicitly directed by a healthcare provider. These products suppress the local immune response in the skin, which can potentially allow the varicella-zoster virus to replicate more freely and worsen the infection. The rash is already a sign of a compromised local immune defense, making steroid use risky.
Avoid products containing heavy fragrances, dyes, or alcohol, as these ingredients are common irritants that can sting or inflame already sensitive skin. Routine application of antibiotic creams is also generally discouraged unless a doctor confirms a secondary bacterial infection is present. Using unnecessary antibiotics can lead to skin sensitization or contribute to antibiotic resistance.