Gabapentin (Neurontin) and pregabalin (Lyrica) can be used for treatment of postherpetic neuralgia.Īmitriptyline, nortriptyline (Pamelor), and desipramine can be used for pain relief in patients with postherpetic neuralgia (number needed to treat = 3 95% confidence interval, 2 to 4). The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends two doses of adjuvant recombinant varicella zoster virus accine for adults 50 years and older, including those who have already had the live varicella zoster virus vaccine.Īlthough herpes zoster typically is diagnosed clinically, if laboratory confirmation is needed, polymerase chain reaction testing of vesicle or other fluids is preferred for diagnosis because of its high sensitivity (95%) and specificity (100%).Īcyclovir, valacyclovir (Valtrex), and famciclovir are effective treatments for herpes zoster and ideally should be started within 72 hours of the appearance of the rash to decrease the duration of symptoms and severity of pain.Ĭapsaicin 8% patches, applied for 30 to 90 minutes, provide effective pain relief for patients with postherpetic neuralgia. Two varicella zoster virus vaccines decrease the incidence of herpes zoster and are approved for adults 50 years and older. Treatment is focused on symptom control and includes topical lidocaine or capsaicin and oral gabapentin, pregabalin, or tricyclic antidepressants. It is defined as pain in a dermatomal distribution sustained for at least 90 days after acute herpes zoster. Postherpetic neuralgia is the most common complication, occurring in about one in five patients.
Herpes zoster can be treated with acyclovir, valacyclovir, or famciclovir, ideally within 72 hours of the development of the rash.
The rash is usually unilateral, confined to a single dermatome, and typically progresses to clear vesicles that become cloudy and crust over in seven to 10 days.
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Patients may present with malaise, headache, low-grade fever, and abnormal skin sensations for two to three days before the classic maculopapular rash appears. Patients with conditions that decrease cell-mediated immunity are 20 to 100 times more likely to develop herpes zoster. There are an estimated 1 million cases in the Unites States annually, with an individual lifetime risk of 30%.
Herpes zoster, or shingles, is caused by reactivation of varicella zoster virus, which causes chickenpox.
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