Herpes Zoster Infections
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This is an acute painful blistering viral infection of the skin. It can occur in childhood but is much more common in adults, especially the elderly, sick or immunosuppressed. The primary infection presents as chickenpox (varicella), usually during childhood. Like herpes simplex, the virus persists usually in the anterior horn cells before it is reactivated. Post-herpetic neuralgia is a common complication and defined as persistence or recurrence of pain more than a month after the onset of shingles.
Cause
- Varicella-zoster virus
Symptoms
- Fever
- Severe pain over areas involved
- Headache
- Blisters
Signs
- Fever
- Tender vesicles spread within one or more dermatomes unilaterally
- Regional lymphadenopathy
Investigations
- Usually none
- HIV screen (for recurrence and/or multi-dermatomal cases)
TreatmentTreatment Objectives
- To provide adequate pain relief
- To prevent secondary bacterial infection
- To limit extent of disease spread in immuno-compromised patients
- To prevent complications
Non-pharmacological treatment
- Bed rest
Pharmacological treatment
Evidence Rating: [B]
Mild Herpes Zoster Infection
- Aciclovir cream 5%, topical,
Adults
4 hourly (five times daily) for 4-5 days
Children
4 hourly (five times daily) for 4-5 days
Note: Start immediately the premonitory symptoms are felt or within 48 hours of onset.
And
- Diclofenac, oral,
Adult
50 mg 8 hourly for 7 days
Or
- Ibuprofen, oral,
Children
5-10 mg/kg 6 hourly for 7 days
And
- Povidone iodine 10%, topical,
Adults
Apply to blisters daily till lesions resolve
Children
Apply to blisters daily till lesions resolve
Severe Herpes Zoster Infection
Evidence Rating: [B]
- Aciclovir, oral,
Adults
800 mg 4 hourly (five times daily) for 5-7 days
Children
> 12 years; 800 mg 4 hourly (five times daily) for 5-7 days
6-12 years; 800 mg 6 hourly for 5-7 days
2-6 years; 400 mg 6 hourly for 5-7 days
< 2 years; 200 mg 6 hourly for 5-7 days
And
- Diclofenac, oral,
Adults
50 mg 8 hourly for 7 days
Or
- Ibuprofen, oral,
Children
5-10 mg/kg 6-8 hourly for 7 days
And
- Povidone iodine 10%, topical,
Adults
Apply to blisters daily till lesions resolve
Children
Apply to blisters daily till lesions resolve
Referral Criteria
- Refer complicated cases to a specialist