Herpes Zoster - Dr. Callahan

Complications of Zoster

1. Ramsay Hunt Syndrome (CNVII involvement, facial palsy, unilateral motor weakness, altered taste on ant 2/3 of tongue, deafness / vestibular problems - look in the ear!)
2. Herpes Zoster Ophthalmicus - CNV involvement - Hutchinson sign - need to do slit lamp and fluorescein exam - Ophtho follow-up!
   
3. Postherpetic Neuralgia (10-15%) can be difficult to treat! - Incidence not affected by any medication regimen
   
4. Disseminated Disease - diagnose with PCR, start IV acyclovir and admit.
   
5. Aspectic meningitis
6. Bacterial superinfection
7. Bell's Palsy
8. Transverse Myelitis
9. Motor neuropathy

Indications for Treatment

1. Age > 50
   
2. Moderate or sever pain
3. Severe rash
4. Involvement of the face or eye
5. Other complications of Herpes Zoster
   
6. Immunocompromised
7. Within 72 hours of onset is preferred (but if new lesions are being formed, there still may be benefit)

Medical Management

• Antivirals - hasten resolution and decrease severity of acute pain

1. Acute zoster- Valacyclovir 1 g TID for 7 days (preferable  for higher drug activity, ease of dosing) or Acyclovir 800 mg 5 times/day for 7-10 days (if no insurance)
   
2. Valtrex or Famvir are preferred for Herpes Zoster (but cost is a concern - acyclovir is less expensive)

• Steroids? Simple answer "NO." -  Harm likely outweighs benefit during ACUTE phase.

• Pain Management:

1. NSAIDs
2. Opiods
3. Capsaicin (may be useful for post-herpetic neuralgia)
   
4. Gabapentin (may be useful for post-herpetic neuralgia)
   
5. Lidocaine pathches one intact skin