Episodes of herpes zoster (shingles) are generally self-limited and resolve without intervention; they tend to be more mild in children than in adults. Therapeutic choices generally depend on the host's immune state and on the presentation of zoster. Conservative therapy includes nonsteroidal anti-inflammatory drugs; wet dressings with 5% aluminum acetate (Burow solution), applied for 30-60 minutes four to six times daily; and lotions (eg, calamine). Nonpharmacologic therapies that may be considered for acute zoster-associated pain include sympathetic, intrathecal, and epidural nerve blocks and percutaneous electrical nerve stimulation.
Antiviral agents may decrease the duration of herpes zoster rash, as well as the severity of associated pain. However, such benefits have only been confirmed in patients within 72 hours after the onset of rash. Although these agents may be helpful as long as new lesions are being formed, they are not likely to be of use in patients with lesions that have crusted.
Various topical treatments are available, including topical acyclovir 5% cream, lidocaine, and capsaicin. The latter, applied at least five times a day, depletes neurotransmitters at involved nerve endings. Topical lidocaine can also be used to treat patients with PHN.
Oral corticosteroids are often used in the treatment of shingles despite conflicting information regarding their efficacy. A combination of prednisone and acyclovir may be used. According to guidelines, if the use of orally administered prednisone is not contraindicated, adjunctive treatment may be justified. However, most advocate the use of these agents only in patients older than 50 years.
This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases article Herpes Zoster.
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Cite this: William James. Fast Five Quiz: Shingles - Medscape - Dec 11, 2019.