Herpes Zoster
Alternative names:
shingles
Treatment:
Herpes zoster usually resolves spontaneously, and may not require treatment except for symptomatic relief.
Acyclovir is an antiviral medications that may be prescribed to shorten the course, reduce pain, reduce complications or protect an immunocompromised individual. For the greatest efficacy acyclovir should be started within 24 hours of the appearance of pain or burning sensation and preferably before the appearance of the characteristic blisters. Typically it is given in oral doses four times those recommended for herpes simplex or herpes genitalia. Severely immunocompromised individuals such as those with AIDS may require IV acyclovir therapy.
Corticosteroids such as prednisone may occasionally be used to reduce inflammation but have the drawback of interfering with immune function.
Analgesics, mild to strong, may be needed to control pain. Antihistamines may be used topically or orally to reduce itching and pain. Zostrix, a cream containing capzasin (an extract of pepper), can be used to prevent post-herpetic neuralgia.
Cool wet compresses may reduce pain. Soothing baths and lotions such as colloidal oatmeal bath, starch baths or lotions, and calamine lotion may help to relieve itching and discomfort. Rest in bed until fever resolves.
Keep the skin clean, and do not re-use contaminated items. Nondisposable items should be washed in boiling water or otherwise disinfected before re-use. The person may need to be isolated while lesions are oozing to prevent infecting others.
Expectations (prognosis):
Herpes zoster usually clears in 2 to 3 weeks and rarely recurs. Involvement of motor nerves may cause a temporary or permanent nerve palsy. Neuralgia (continued nerve pain) may persist for years in 50% of those over 60 years old who have shingles, particularly if the trigeminal nerve was affected.
Complications:
- post herpetic neuralgia
- secondary bacterial skin infections
- recurrence (rare)
- generalized infection, organ (visceral) lesions, encephalitis, or sepsis (in
immunosuppressed persons)
Calling your health care provider:
Call your health care provider if the symptoms indicate herpes zoster, particularly if you are immunosuppressed or if symptoms persist or worsen.
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