What are the topical treatment options for herpes zoster (shingles)?

Updated: Jan 25, 2019
  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

There are a variety of topic treatments, including topical acyclovir 5% cream, lidocaine, and capsaicin. [81, 82] The latter, applied at least 5 times a day, depletes neurotransmitters at involved nerve endings. Topical lidocaine can also be used to treat patients with PHN. [83] For acute HZO, a good approach is wet-to-dry dressings with sterile saline solution or Burow solution (a pharmacologic preparation made of 5% aluminum acetate dissolved in water), which should be applied to the affected skin for 30-60 minutes 4-6 times daily. A modified form of Burow solution is commercially sold as Domeboro powder packets, which need to be dissolved in water. The acyclovir cream is often applied 5 times a day for 4 days. Calamine lotion, a mixture of zinc oxide with about 0.5% iron (III) oxide, may be used as an antipruritic agent. It is also used as a mild antiseptic to prevent infections that can be caused by scratching the affected area, as well as an astringent for weeping or oozing blisters. There is, however, no proof that calamine lotion has any real therapeutic effect on rashes and itching. Topical ozone therapy may be beneficial in diminishing pain and shortening the course, with few if any adverse effects. [84]


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