| Herpes Zoster (Shingles) |
| Etiology |
Varicellar Zoster |
| Transmission |
activation of latent virus |
| Clinical symptoms |
Radicular pain with vesicular eruptions. T5-T10 most
commonly affected, 2nd most common: V1 |
| Treatment with antiviral agent, start
treatment as early as possible |
 | Famciclovir (Famvir): 500 mg orally three times daily for 7 days,
cost about $140 |
| Valacyclovir (Valtrex): 1 g orally three times daily for 7 days,
cost about $80 |
| Prednisone (Deltasone) 30 mg orally twice daily on days 1 through 7;
then 15 mg twice daily on days 8 through 14; then 7.5 mg twice daily on
days 15 through 21 2 (2 to 4) for days 1 through 7, 2 (1 to 3) for days 8
through 14, 1 (1 to 2) for days 15 to 21 |
| May shorten disease, prevent postherpetic neuralgia |
| Immunocompromised, multiple dermatome involved or severely ill:
consider IV Acyclovir 10mg/kg q8 X 7 days. |
|
| Ophthalmic Zoster |
| may cause keratoconjunctivitis or iridocyclitis, cerebral
vasculitis |
|
| Post herpetic Neuralgia |
| 9% of patient has pain persist > 4 weeks |
| Half of them will resolve in 8 weeks |
| < 2% persist > 2 years |
| rare for patients < 50 yo |
|
| Treatment of post herpetic neuralgia |
| Tricyclics: Elavil 10 mg/ day, gradually increase dose |
| Carbamazepine: 200 mg bid, titrate up |
| Neurontin 400 mg q8, titrate up |
| Pimozide 4-12 mg/day in refractory case |
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| References & further reading |
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