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