Herpes Zoster/Shingles

Patients often report a history of a painful, tingling, or burning sensation that develops before a rash appears. This pain, which can be severe, typically affects a single dermatome - either a side of the body or face. Key risk factors include older age, weakened immune systems (due to illness or medication), and a prior history of chickenpox. 

The rash begins as red patches, developing into fluid-filled blisters along a single dermatome (skin area) that do not cross the midline. The blisters eventually crust over. Common areas include the torso or face, where the ophthalmic division of the trigeminal nerve may be involved.

The cornerstone of Herpes Zoster treatment includes antiviral medications, particularly within 72 hours of rash onset, to limit viral replication and severity. Acyclovir 800 mg, five times daily for five days, valacyclovir 1 gm three times daily for five days, and famciclovir 500 mg three times daily for seven days are the antiviral drugs used to treat herpes zoster. 

Topical antibiotic creams like mupirocin or soframycin help to prevent secondary bacterial infection. Analgesics help to relieve the pain. Occasionally, severe pain may require an opioid medication. Topical lidocaine and nerve blocks may also reduce pain.

Post-herpetic neuralgia commonly occurs in elderly patients, and once the lesions have crusted, they can use:

• 3 to 5% phenol in cream or ointment 2-6 times daily.

• Capsaicin 0,075% cream 3 to 4 times daily

• Amitryptiline 75 mg nightly or

• Carbamazepine 600-800 mg once daily or

• Amitryptiline 75 mg nightly + thioridazine 25 mg 4 times daily.

Try any of these for at least 4-6 weeks before deciding whether they are effective. If ineffective:

• Gabapentin 300 or 400 mg tablets. Start with one tablet, increasing with one tab daily to 900 or 1200 mg daily.

•  Pregabalin 75 mg tablets. Start with 2 tablets, increase in a week to 150 mg daily if necessary.