Shingles (Acute Herpes Zoster)

Patient Summary

Is this FDA-cleared for this use?

No. The FDA cleared medicinal leeches in 2004 only for venous congestion in microsurgical reconstruction (K040187). Use for shingles is not FDA-evaluated and is not supported by any controlled study.

What evidence exists?

Shingles is treated with an antiviral medicine, ideally started within 72 hours after the rash appears, together with pain relief. This is standard care and it comes first. No controlled study has tested leech therapy for shingles. The few published reports each describe a single patient who received leeches together with other treatments, so they cannot show that leeches helped. A 2007 leech therapy handbook, one of the two main reference books of this society, says leech therapy has established itself as a viable alternative for shingles but states that scientific study data are not available; the same handbook advises against leech therapy during acute infections and against use on inflamed or ulcerated skin. ASH does not treat that passage as evidence that leeches work or are safe during the rash. Leeches must never be placed on or near shingles blisters or crusts. The recombinant zoster vaccine greatly lowered the risk of shingles in large trials.

Main risks

• Delay of antiviral treatment, which works best when started within 72 hours of the rash
• Weakness and impaired wound healing when leech therapy is used during an acute infection (reported in the 2007 handbook)
• Local skin infection of the bite sites or, rarely, Aeromonas infection from leech gut bacteria
• Spread of the shingles virus: fluid from open blisters can infect people who have never had chickenpox
• Bleeding and oozing from each bite site for several hours, sometimes up to 24 hours
• Itching, redness, and irritation at the bite sites lasting days to weeks
• Allergic reaction to leech saliva (uncommon)
• Scarring, color changes, or keloids at bite sites
• Anemia if blood loss is repeated

Who should not consider this

• Anyone with shingles blisters, crusts, or broken skin: leeches must never be placed on or near the rash
• Anyone who has not yet been examined by a doctor for the rash or has not started antiviral treatment
• People with a rash near the eye, on the forehead or the tip of the nose, or near the ear, or with facial weakness, hearing loss, or dizziness
• People with a weakened immune system, for example during chemotherapy or with HIV infection
• People with fever or another acute infection
• Patients taking blood thinners such as warfarin, apixaban, rivaroxaban, dabigatran, or heparin
• Patients with hemophilia or other inherited bleeding disorders
• Patients with anemia
• People with diabetes or another condition that slows wound healing
• Pregnant patients (leech therapy is not done during pregnancy)

What to ask your clinician

• Is this shingles, and should I start an antiviral medicine now? (It works best within 72 hours of the rash.)
• Is my rash near my eye, nose, or ear, and do I need an eye or ear specialist today?
• Am I at higher risk of complications (older age, weakened immune system, diabetes)?
• What can I do for the pain, and what should I do if the pain lasts after the rash heals?
• How do I protect other people while my blisters are open, and when am I no longer contagious?
• Am I eligible for the recombinant shingles vaccine, and when should I get it?
• What evidence exists for leech therapy in shingles, and why would it be added to standard care? (No controlled study was found for this page.)

When to seek urgent care

• A new painful rash or blisters on one side of the body: see a doctor as soon as possible, ideally within 72 hours, to start antiviral treatment
• Rash, pain, or redness on the forehead, around the eye, or on the tip of the nose, eye pain, or blurred vision (possible shingles of the eye, which can threaten sight: see a doctor or eye specialist at once)
• Rash in or around the ear, hearing loss, dizziness, or weakness of one side of the face (possible Ramsay Hunt syndrome)
• Shingles with a weakened immune system, a rash spreading widely over the body, or fever
• Confusion, severe headache, or trouble breathing
• Spreading redness, warmth, pus, red streaks, or increasing pain around blisters or bite sites
• Bleeding from a bite site lasting more than 24 hours or soaking through dressings
• Hives, facial or tongue swelling, throat tightness, or breathing difficulty