From: ClinicalPearl@...
Date: April 1, 2009 9:46:16 AM EDT
To: glennskow@...
Subject: EMedHome Clinical Pearl

The New EMedHome Clinical Pearl is: Treatment of Herpes Zoster

Treatment of Herpes Zoster

• Antivirals: Antiviral agents reduce the duration of viral shedding, hasten rash healing, reduce the severity and duration of acute pain, and reduce the risk of progression to PHN. Antiviral treatment is specifically recommended for patients older than 50 years, those who have moderate or severe pain or rash, and those with involvement of nontruncal dermatomes (eg, the face) (1).
  
  It is often said that antivirals are not effective if prescribed more than 72 hours after onset of symptoms. In fact, in clinical trials, treatment has been initiated within 72 hours of rash onset, but this is an arbitrarily selected time point (1). Such a rapid initiation of treatment is often not feasible in clinical practice. Although the benefits of treatment that is begun later have not been studied, antiviral treatment should be considered even in patients who present more than 72 hours after rash onset, particularly in the presence of new vesicle formation or complications.
  
  
• Corticosteroids: Corticosteroids do not have any effect on PHN. In combination with antiviral therapy, they modestly reduce the severity and duration of acute symptoms (1-3). Corticosteroids are associated with a considerable number of adverse effects and hence should be used only in patients with severe symptoms at presentation or in whom no major contraindications to corticosteroids exist.

References:
(1) Sampathkumar P, et al.  Herpes Zoster (Shingles) and Postherpetic Neuralgia Mayo Clin Proc 2009;84:274-280.
(2) Harpaz R, et al. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices  MMWR Recomm Rep 2008;57(RR-5):1-30.
(2) Yawn BP, et al. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction  Mayo Clin Proc 2007; 82: 1341-1349.

 

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