Shingles Treatment: When to Switch Medications and Monitor Health Risks

I am currently taking medication for shingles, but the chickenpox keeps appearing?

Hello, Doctor.
On March 1st, I experienced pain in my right back and developed a rash.
On March 4th, I was diagnosed with shingles and started treatment with acyclovir.
However, as of today, March 6th, three days later, the area of blisters on my right back has not decreased; in fact, more blisters have appeared, including some on my right lower abdomen that were not there before.
Should I switch to valacyclovir or famciclovir, or should I complete the current treatment regimen and then have my doctor evaluate the situation? Additionally, I came across some studies and articles online suggesting that individuals with shingles have a higher risk of developing cancer later on.
Should I consider undergoing additional health screenings in the future? I would appreciate your response to these questions.
Thank you!

Mr. Jiang, 40~49 year old female. Ask Date: 2023/03/06

Dr. Wu Yuxin reply Dermatology

You may consider switching to the new generation of antiviral medications, as they have better bioavailability; however, they are not covered by insurance and are not directly related to cancer incidence.

Reply Date: 2023/03/06

More Info

Shingles, or herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus, which also causes chickenpox. The treatment for shingles typically involves antiviral medications, such as acyclovir, valacyclovir, or famciclovir, which can help reduce the severity and duration of the symptoms if started early.
In your case, you began treatment with acyclovir on March 4, and by March 6, you noticed that the rash and blisters were not improving and were even spreading. This situation raises a few important considerations regarding your treatment and overall health management.

1. Switching Medications: If you are not seeing improvement after three days of acyclovir treatment, it may be reasonable to consider switching to valacyclovir or famciclovir. These medications are also effective against shingles and may have better bioavailability, meaning they can be more effective at lower doses. However, it is essential to consult with your healthcare provider before making any changes to your medication regimen. They can evaluate your specific situation, including the extent of your rash and any other symptoms you may be experiencing, to determine the best course of action.

2. Monitoring Health Risks: Regarding your concern about the potential long-term health risks associated with shingles, including an increased risk of certain cancers, it is important to note that while some studies suggest a correlation between shingles and an increased risk of certain conditions, the overall risk remains relatively low for most individuals. However, it is wise to maintain regular health check-ups, especially if you have other risk factors or underlying health conditions. Discussing your concerns with your healthcare provider can help you determine if additional screenings or tests are necessary based on your medical history and current health status.

3. Follow-Up Care: After starting antiviral treatment, it is crucial to monitor your symptoms closely. If you experience worsening pain, increased rash, or new symptoms, you should contact your healthcare provider promptly. They may recommend additional treatments, such as pain management strategies or topical therapies, to alleviate discomfort associated with shingles.

4. Preventive Measures: In addition to antiviral treatment, consider discussing preventive measures with your healthcare provider. The shingles vaccine is recommended for older adults and those with certain risk factors, as it can significantly reduce the risk of developing shingles and its complications.

In summary, if you are not seeing improvement with acyclovir after three days, it is advisable to consult your healthcare provider about possibly switching to another antiviral medication. Additionally, while there may be concerns about long-term health risks associated with shingles, regular health check-ups and discussions with your provider can help address these concerns effectively. Always prioritize open communication with your healthcare team to ensure you receive the best possible care tailored to your needs.

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