Herpes zoster

Injury	Disease	Nutrition	Poison

Symptoms	Surgery	Test	Special Topic

Herpes zoster

Alternative Names:

Shingles
Treatment:

Herpes zoster usually resolves spontaneously, and may not require treatment except for symptomatic relief, such as pain medication.

Acyclovir is an antiviral medication that may be prescribed to shorten the course, reduce pain, reduce complications, or protect an immunocompromised individual. Desciclovir, famciclovir, valacyclovir, and penciclovir are similar to acyclovir and may be used to treat herpes zoster.

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For the greatest effect, acyclovir-like medications should be started within 24 hours of the appearance of pain or burning sensation, and preferably before the appearance of the characteristic blisters.

Typically, the drugs are given in oral doses four times greater than those recommended for herpes simplex or herpes genitalia. Severely immunocompromised individuals may require intravenous acyclovir therapy.

Corticosteroids, such as prednisone, may occasionally be used to reduce inflammation and risk of post-herpetic neuralgia. They have been shown to be most effective in the elderly population. Corticosteroids have certain risks that should be considered before using them.

Analgesics, mild to strong, may be needed to control pain. Antihistamines may be used topically (direct application to the body) or orally to reduce itching. Zostrix, a cream containing capzasin (an extract of pepper), may possibly prevent post-herpetic neuralgia.

Cool wet compresses can be used to 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 infection of others -- especially pregnant women.

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. Eye lesions may lead to permanent blindness and require emergency medical care.

Complications:

Post herpetic neuralgia
Secondary bacterial skin infections
Recurrence (rare)
Generalized infection, organ visceral lesions, encephalitis or sepsis in immunosuppressed persons
Blindness (if lesions occur in the eye)
Deafness
Loss of taste
Facial paralysis

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.