Treatment of herpes zoster in the immunocompetent host
- Mary A Albrecht, MD
Mary A Albrecht, MD
- Associate Professor of Medicine
- Harvard Medical School
Varicella-zoster virus (VZV) infection causes two clinically distinct forms of disease . Primary infection with VZV results in varicella, also known as chickenpox, characterized by vesicular lesions in different stages of development on the face, trunk, and extremities. Herpes zoster, also known as shingles, results from reactivation of endogenous latent VZV infection within the sensory ganglia. This clinical form of the disease is characterized by a painful, unilateral vesicular eruption, which usually occurs in a restricted dermatomal distribution . Although herpes zoster can occur at any age, it is mainly a disease of adults >60 years of age.
The treatment of herpes zoster will be reviewed here. The epidemiology, clinical manifestations, diagnosis, and prevention of herpes zoster are discussed elsewhere. (See "Epidemiology and pathogenesis of varicella-zoster virus infection: Herpes zoster" and "Clinical manifestations of varicella-zoster virus infection: Herpes zoster" and "Varicella-zoster virus infection in pregnancy" and "Vaccination for the prevention of shingles (herpes zoster)" and "Prevention and control of varicella-zoster virus in hospitals".)
UNCOMPLICATED HERPES ZOSTER
The clinical manifestations of uncomplicated herpes zoster typically include a dermatomal vesicular rash, and acute neuritis, which precedes or occurs simultaneously with the rash. The rash is generally limited to one dermatome, but can occasionally affect two or three neighboring dermatomes. Some patients can also have a few scattered vesicles located at some distance away from the involved dermatome. (See "Clinical manifestations of varicella-zoster virus infection: Herpes zoster".)
The management of herpes zoster includes:
●Antiviral therapy to hasten healing of cutaneous lesions and to decrease the duration and severity of acute neuritis. Whether antiviral therapy decreases the risk of post-herpetic neuralgia (PHN) is less clear. (See 'Antiviral therapy' below.)
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- UNCOMPLICATED HERPES ZOSTER
- Antiviral therapy
- - ≤72 hours after onset
- - >72 hours after onset
- - Choice of agent
- - Special populations
- Pregnant women
- Immunocompromised hosts
- Analgesia for acute neuritis
- Adjuvant therapies
- Secondary bacterial infection
- Patient monitoring
- Recurrent zoster
- COMPLICATED ZOSTER
- Herpes zoster ophthalmicus
- Acute retinal necrosis
- Ramsay Hunt syndrome
- Neurologic complications
- POSTHERPETIC NEURALGIA
- PREVENTING TRANSMISSION TO OTHERS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS