Shingles is a painful rash that happens when the chickenpox virus wakes up in your body years later. Researchers looked at 50 patients with shingles to see how different treatments worked. Everyone started antiviral medicine (the main treatment) within three days of getting the rash. The good news: only 8% developed long-lasting nerve pain, and 2% got a skin infection. The study suggests that starting treatment quickly is important for preventing complications, though the researchers note this was a small study and bigger studies are needed to confirm these findings.

The Quick Take

  • What they studied: How well different antiviral medicines work for shingles and whether vitamin B12 helps prevent complications like long-lasting nerve pain
  • Who participated: 50 adults (average age 63 years, 58% women) treated for shingles at a hospital between July 2019 and October 2020. Most had other health conditions like diabetes or high blood pressure
  • Key finding: Only 8% of patients developed postherpetic neuralgia (long-lasting nerve pain after shingles), and starting antiviral treatment within 3 days of symptom onset appeared to help prevent this complication
  • What it means for you: If you get shingles, getting to a doctor quickly for antiviral medicine may significantly reduce your chances of developing painful nerve damage that lasts for months. However, this was a small study, so talk to your doctor about your individual risk

The Research Details

Researchers reviewed medical records of 50 patients who were treated for shingles at a hospital over about 16 months. They collected information about each patient’s age, other health conditions, which antiviral medicine they received, whether they took vitamin B12, and what complications developed. They compared outcomes between different age groups and different treatment types to see if any patterns emerged.

This type of study is called a retrospective review, which means researchers looked backward at what already happened rather than following patients forward in time. All patients in this study received antiviral treatment within 72 hours (3 days) of their rash appearing, which is considered the standard of care for shingles.

This study design helps doctors understand real-world treatment patterns and outcomes in actual clinical practice. By looking at what happened to these 50 patients, researchers could identify whether certain treatments seemed to work better than others and whether timing of treatment mattered. This information helps guide how doctors treat future shingles patients.

This study has some important limitations to understand: it’s small (only 50 patients), it looked at records from one hospital, and it’s retrospective (looking backward). The researchers couldn’t randomly assign patients to different treatments, so some differences might be due to other factors they didn’t measure. The findings are interesting but not definitive—larger, more controlled studies would provide stronger evidence.

What the Results Show

The most important finding was that early antiviral treatment (started within 3 days of rash onset) was associated with a low rate of postherpetic neuralgia (PHN), the painful nerve condition that can last for months after shingles. Only 8% of the 50 patients developed PHN, which is lower than rates reported in some other studies.

All 50 patients received one of three antiviral medicines: acyclovir, valacyclovir, or brivudine. The complication rates differed between groups—0% with acyclovir, 5.3% with valacyclovir, and 21.1% with brivudine—but these differences were not statistically significant, meaning they could have happened by chance with such a small group.

Secondary bacterial infections (when bacteria infect the shingles rash) occurred in only 2% of patients, which is quite low. Older patients (age 65 and above) had more complications (16%) compared to younger patients (4%), though this difference wasn’t statistically significant either.

The study found that vitamin B12 supplementation did not appear to make a difference in complication rates—patients who received it had similar outcomes to those who didn’t. This was somewhat surprising since vitamin B12 is sometimes given for shingles in some countries. Researchers also noted that liver function tests (ALT levels) were significantly lower in older patients, which may reflect age-related changes in metabolism.

The 8% rate of postherpetic neuralgia in this study is notably lower than rates reported in many other studies, which often range from 10-50% depending on patient age and other factors. This suggests that the early antiviral treatment (all patients started within 3 days) may have been protective. The finding aligns with existing medical knowledge that starting antiviral therapy quickly is important for preventing complications.

This study has several important limitations: (1) It’s small—only 50 patients, which makes it harder to detect real differences between treatment groups; (2) It’s from one hospital, so results may not apply everywhere; (3) It’s retrospective, meaning researchers couldn’t control which patients got which treatments; (4) The study period was relatively short (16 months); (5) Researchers couldn’t prove that one medicine caused fewer complications than another—they could only observe associations; (6) The study didn’t randomly assign patients to different treatments, so differences might be due to other unmeasured factors.

The Bottom Line

If you develop shingles (a painful rash, usually on one side of your body), see a doctor as soon as possible—ideally within 3 days of the rash appearing. Starting antiviral medicine quickly appears to significantly reduce your risk of developing long-lasting nerve pain. Ask your doctor which antiviral medicine is best for you. Based on this study, vitamin B12 supplementation may not be necessary, but discuss this with your healthcare provider. (Confidence level: Moderate—this is a small study, but it aligns with existing medical guidance about early treatment)

This research is most relevant for: (1) Adults over 50, who are at highest risk for shingles; (2) People with weakened immune systems; (3) People with chronic conditions like diabetes or high blood pressure; (4) Anyone who develops a painful rash that might be shingles. This study is less relevant for young, healthy people with strong immune systems, who rarely develop shingles. If you’ve had chickenpox, you’re at risk for shingles later in life.

If you start antiviral treatment within 3 days of developing shingles, you may see improvement in symptoms within 7-10 days. The rash typically crusts over and heals within 2-4 weeks. The key benefit of early treatment is preventing postherpetic neuralgia—the long-lasting nerve pain that can persist for months or even years if complications develop. Starting treatment early gives you the best chance of avoiding this complication.

Want to Apply This Research?

  • If you develop shingles, track: (1) Date rash first appeared; (2) Date you started antiviral medicine; (3) Daily pain level (1-10 scale); (4) Which areas of body are affected; (5) Any signs of infection (increased redness, warmth, pus); (6) Any lingering nerve pain 4+ weeks after rash appears
  • Set a reminder to see a doctor immediately if you develop a painful rash on one side of your body—don’t wait. Use the app to log your symptoms and treatment start date so you can track whether early treatment helped prevent complications. Share this information with your doctor at follow-up visits.
  • Track pain levels daily for the first 4 weeks, then weekly for 3 months. Note any persistent nerve pain after the rash heals. If you’re over 50, consider discussing the shingles vaccine with your doctor to prevent shingles from developing in the first place. Use the app to set annual reminders to discuss shingles prevention with your healthcare provider.

This research summary is for educational purposes only and should not replace professional medical advice. Shingles is a serious condition that requires medical evaluation and treatment. If you develop symptoms of shingles (painful rash, usually on one side of the body), contact your healthcare provider immediately. Do not delay seeking medical care based on this article. Treatment decisions should be made in consultation with your doctor, who can assess your individual health situation, age, medications, and risk factors. This study was small (50 patients) and conducted at a single hospital, so results may not apply to all populations. Always follow your doctor’s recommendations for treatment and follow-up care.