Shingles Treatment Online

What is shingles?

Shingles (herpes zoster) is a painful rash caused by the same virus that causes chickenpox. After a chickenpox infection the virus remains dormant and can reactivate later in life, typically causing a painful, blistering rash on one side of the body or face.

Early treatment with antivirals, ideally within 72 hours of rash onset, may reduce the severity and duration. Pain management and careful wound care are also important. Some people develop long-lasting nerve pain (postherpetic neuralgia) after the rash clears.

How a telehealth GP can help

A NewDoc GP can assess your symptoms and the rash via video, prescribe antiviral medication if clinically appropriate, and provide guidance on pain management. If the rash is near the eye, ear, or is severe, your GP may recommend urgent in-person review. Your GP can also discuss the shingles vaccine.

Risk factors for shingles

Anyone who has had chickenpox can potentially develop shingles, because the varicella zoster virus remains dormant in nerve tissue. The risk increases significantly with age, and shingles is most common in people over 50. Older age is also associated with a greater risk of complications such as postherpetic neuralgia.

People with weakened immune systems are at higher risk. This includes those with conditions such as cancer or HIV, people receiving immunosuppressive therapy (including organ transplant recipients), and people on long-term steroids. Major physical or emotional stress and chronic illness may also increase the likelihood of reactivation.

Shingles medications: antivirals, nerve pain, and prevention

Australian Therapeutic Guidelines (eTG) recommend oral antiviral therapy started within 72 hours of rash onset to reduce viral shedding, shorten the acute illness, and reduce the risk of postherpetic neuralgia. Three antivirals are PBS-listed:

Antiviral medication — within 72 hours is critical

• Valaciclovir 1 g three times daily for 7 days (Valtrex) — first-line for most patients; better oral absorption than aciclovir allows three-times-a-day dosing rather than five
• Famciclovir 500 mg three times daily for 7 days (Famvir) — alternative first-line; similarly convenient three-times-a-day dosing
• Aciclovir 800 mg five times daily for 7 days (Zovirax) — established antiviral; less convenient dosing but PBS-subsidised and well-tolerated

Antivirals are most effective when started within 72 hours of the rash appearing — speak to a GP as soon as you suspect shingles. Treatment may still be considered after 72 hours for ongoing new lesions, immunocompromised patients, ophthalmic involvement, or severe pain, even where this is outside the standard window.

Pain management — acute and nerve pain

• Paracetamol 1 g four times daily — first-line analgesic for acute shingles pain
• Ibuprofen 200–400 mg three times daily — added where paracetamol alone is insufficient and there are no contraindications
• Calamine lotion or cool compresses — topical relief for itch and burning
• Amitriptyline 10–25 mg nocte — low-dose tricyclic for postherpetic neuralgia; titrated gradually
• Gabapentin 300 mg titrated to 1.8–3.6 g daily or pregabalin 75 mg twice daily titrated to 300 mg twice daily (Lyrica) — PBS-restricted for postherpetic neuralgia; effective for sharp, shooting, or burning nerve pain
• Pain specialist or chronic pain clinic referral — for severe or treatment-resistant postherpetic neuralgia

Opioid analgesics are sometimes used short-term for severe acute pain. Long-term opioid use is not recommended for postherpetic neuralgia.

Shingrix — prevention with the recombinant zoster vaccine

The recombinant zoster vaccine (Shingrix) is the recommended shingles vaccine in Australia. It is given as two doses 2–6 months apart and is more than 90% effective at preventing shingles and postherpetic neuralgia in adults aged 50 and over. Shingrix replaced the older Zostavax live vaccine, which is no longer available.

Under the National Immunisation Program (NIP), Shingrix is free for:

• People aged 65 and over
• Aboriginal and Torres Strait Islander people aged 50 and over
• Immunocompromised people aged 18 and over with specified conditions (e.g. after haematopoietic stem cell transplant, after solid organ transplant, with advanced HIV, with haematological malignancies)

For people aged 50–64 outside NIP eligibility, Shingrix is available privately at community pharmacies and GP clinics. Your GP can discuss eligibility and write a prescription where appropriate. The vaccine itself is administered in person by an immuniser. Even if you have had shingles previously, Shingrix vaccination is recommended to reduce the risk of recurrence.

Tips for managing shingles at home

Rest, good hydration, and avoiding contact sports or activities that may irritate the rash can help recovery. Keep the rash clean and dry, and cover it with a loose, non-adherent dressing where appropriate to reduce contact with others. Wear loose-fitting clothing over affected areas.

Shingles is contagious to people who have not had chickenpox or the chickenpox vaccine. Until the rash has crusted over, avoid close contact with pregnant women, newborns, and immunocompromised people. Hand hygiene after touching the rash is important.

When to seek urgent in-person care

Seek urgent in-person assessment if the rash involves the face, particularly if it is near the eye or affects the tip of the nose, as this can indicate involvement of nerves supplying the eye and may risk vision complications. Shingles affecting the ear can also cause complications and warrants urgent review.

Other reasons to seek prompt in-person care include a widespread rash, signs of bacterial infection (increasing redness, warmth, or pus), high fever, confusion, weakness, or severe pain that is not controlled with simple measures. In an emergency, call 000 or attend your nearest emergency department. For repeat prescriptions of analgesia once stable, a follow-up telehealth appointment may be appropriate.