Herpes Zoster (Shingles)

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Caused by a reactivation of Varicella Zoster virus infection.

Antiviral treatment should be started as soon as possible, ideally within 72 hours of onset of the shingles rash, for the treatment to be most effective. However, after this time, antiviral medications may still be helpful if new blisters are appearing. The three antiviral medicines used are acyclovir, valaciclovir or famciclovir. Acyclovir is the cheapest of them but has to be taken more frequently.

The pain of shingles can be very severe, and medications to reduce pain are frequently needed. The best options are the nonsteroidal anti-inflammatory medicines (e.g, ibuprofen). Topical lotions, such as calamine lotion are helpful in reducing the pain and itching of the lesions, thus avoiding traumatic sores and consequent keloid formation.

Following an attack of shingles, a person may experience continued pain for more than three months after the onset of the rash and this is referred to as post-herpetic neuralgia. In addition to pain medicines, tricyclic antidepressants, such as amitriptyline, are effective in controlling the pain. 

 

Medicine

Adult Dose

Frequency

Duration

 

aciclovir

800mg

5 times a day

for 7 days

or

valaciclovir

1000mg

3 times a day

for 7 days

Give analgesia:

 

Medicine

Adult Dose

Frequency

 

paracetamol

500mg – 1g

3-4 times a day (max 4 grams a day)

or

ibuprofen**

200mg-400mg

3-4 times a day (max 1200mg per day)

**be aware of contraindications and cautions for anti­ inflammatory medicines, in people with renal impairment or gastrointestinal ulcer

Or

Add:

Medicine

Adult Dose

Frequency

amitriptyline

25mg

once at night, review

and Skin care:

 

Medicine

Adult Dose

Frequency

 

calamine

topically

as often as required

and

povidone iodine

topical

daily for wound care as required

Patients should be started on Cotrimoxazole prophylaxis

Refer immediately if there is ophthalmic or pulmonary involvement. Secondary infection (bacterial) may require treatment.

Post-Herpetic Neuralgia

This is pain that occurs after the rash is fully resolved:

 

Medicine

Adult Dose

Frequency

 

amitriptyline po

25-75mg, increased to 150mg if required

every night as required

and

carbamazepine po

100mg-200mg, increased over 10 days to a max of 400mg (dose divided into 3)

every night