infectious diseases
Herpes Zoster
Treatment of Herpes Zoster
Symptomatic treatment Antivirals (acyclovir,famciclovir,valacyclovir), especially for patients who are immunocompromised Wet compresses are soothing, but systemic analgesics are often necessary. For Treatment , an ophthalmologist should be consulted. For Treatment with oral antivirals decreases the severity and duration of the acute eruption and decreases the rate of serious complications in patients who are immunocompromised; it may decrease the incidence of postherpetic neuralgia. In patients who are immunocompetent, antiviral therapy is often reserved for those who are ≥ 50 years in whom benefit is greatest. Treatment is also indicated in patients with severe pain, facial rash especially around the eye, and in patients who are immunocompromised. Treatment of herpes zoster should start as soon as possible, ideally during the prodrome, and is less likely to be effective if given>72 hours after skin lesions appear, especially in the absence of newly forming lesions.Famciclovirandvalacyclovirhave better bioavailability with oral dosing thanacyclovir, and therefore for herpes zoster, they are generally preferred. Corticosteroids do not decrease the incidence of postherpetic neuralgia. For less severely immunocompromised patients, oralfamciclovir,valacyclovir, oracycloviris a reasonable option;famciclovirandvalacyclovirare preferred. For patients who are severely immunocompromised, intravenousacycloviris recommended. Some experts recommend treatment beyond 7 to 10 days, lasting until all lesions are crusted, for immunocompromised patients. Although data concerning the safety ofacyclovirandvalacyclovirduring pregnancy are reassuring, the safety of antiviral therapy during pregnancy is not firmly established. Because congenital varicella can result from maternal varicella but rarely results from maternal zoster, the potential benefit of treatment of pregnant patients should outweigh possible risks to the fetus. Pregnant patients with severe rash, severe pain, or ophthalmic zoster can be treated, preferably withacyclovir, because there is longer experience with its use in pregnancy as compared to other medications, althoughvalacyclovirremains an option. There are little data regarding the safety offamciclovirin pregnancy, so it is not generally recommended in pregnant women. Management of postherpetic neuralgia can be particularly difficult. Treatments includegabapentin,pregabalin, cyclic antidepressants, topicalcapsaicinorlidocaineointment, and botulinum toxin injection. Opioid analgesics may be necessary. Intrathecalmethylprednisolonemay be of benefit. 