Herpes zoster

Herpes zoster is treated with oral antiviral medications. Cool wet compresses can be used in the acute vesicular stage. Several oral medications are available to control pain. Zostavax vaccine is available for prevention.

Vaccines

The herpes zoster virus vaccine is indicated for adults age 60 years and older. A live vaccine may be administered to patient’s who have had chickenpox or been vaccinated against chickenpox. Patient’s with a previous episode of herpes zoster may also be given the vaccine. The vaccine reduces the risk of developing herpes zoster, reduces the severity and duration of the disease and presents complications.

Zostavax an attenuated live vaccine that reduced the incidence of shingles by 51% in a study of adults aged 60 and older. The vaccine reduced the number of cases of postherpetic neuralgia by 66.5%, and reduced the severity and duration of pain and discomfort associated with shingles, by 61.1%.

zostavax

Zostavax

 

Oral antiviral medications

Acyclovir, valacyclovir and famciclovir are active against varicella zoster virus. Best results are obtained if treatment is started within 72 hours of the onset of skin lesions. Consider treating any patient with lesions in the acute vesicular stage. The medications are safe and well-tolerated and may provide benefit when initiated after 72 hours. Antivirals attenuate the disease. They shorten the time to heal, decrease pain and possibly limit postherpetic neuralgia. Take the oral medication with a full glass of water.

The dosages are as follows:

Acyclovir 800 mg 5 times a day for 7-10 days. Acyclovir may be administered intravenously.

Valacyclovir 1 g 3 times a day floor 7-10 days

valacyclovir

Famciclovir 500 mg 3 times a day for 7-10 days

Wet compresses

Soak cloth such as T-shirt material in cold water. Apply the very wet compress to intensely red and vesicular lesions. Compresses will macerate the vesicles and suppressed inflammation. They are soothing and therapeutic. Stopped compress and when lesions have lost the intense erythema. Continued treatment may overdrive the skin.

wet-compress

Wet compresses are effective for the acute infection and maybe used for two or three days

Prednisone

Prednisone has been used by clinicians for years to treat acute inflammation, shortened time to heal and limit the duration of pain. There is little evidence that oral steroids limit post herpetic neuralgia. Prednisone can be taken as a single dose in the morning or in a divided dose twice a day. Atypical dose schedule would be 30 mg twice a day for 7 days followed by 15 mg twice a day for 7 days followed by 15 mg in the morning for 7 days.

prednisone

Prednisone

 

Pain medications

Acetaminophen, ibuprofen, Naprosyn, codeine, oxycodone and tramadol are some of the medications used to treat acute and chronic pain.

oxycodone

Oxycodone is strong pain medication

 

Anticonvulsants

Gabapentin and pregabalin are used as first line treatment to treat acute pain and postherpetic neuralgia. They are moderately effective.

neurontin

Gabapentin (Neurontin)

 

Try cyclic antidepressants

Nortriptyline, amitriptyline and desipramine have been used for years to treat both acute pain and postherpetic neuralgia. Medications are taken at bedtime at a low dose and increased as tolerated. Many clinicians start with anticonvulsants and use try cyclic antidepressants if for some reason anticonvulsants are not tolerated or fail to provide relief.

nortriptyline

Nortriptyline

 

Lidocaine patches

Lidocaine patches effectively suppress the pain of post herpetic neuralgia. The patches may be cut to size and applied to affected areas. They are generally used for about 12 hours each day.

lidocane-patch

Lidocane patches