Herpes zoster or shingles is the infection of nerves due to reactivation of varicella zoster virus. It presents with fever, malaise, pain or paraesthesia along the affected nerve or dermatome, followed by vesicular skin rash. Lesions crust and heal within 2-4 weeks. It can be associated with tender regional lymph nodes.
Medications:
- Tab. Axovir 800 (Acyclovir 800 mg) 1 tablet 4 times a day for 7 days.
- Cream Cloviderm (Acyclovir 5% w/w) for to applied over the skin rash.
- Tab. Novamox 500 (Amoxicillin 500 mg) 1 tablet thrice a day for 7 days (for secondary infection).
- Alternative anti-viral – Tab. Valcivir 1000 (Valacyclovir 1000 mg) 1 tablet thrice a day for 7 days.
- Alternative anti-viral – Tab. Famtrex 500 (Famciclovir 500 mg) 1 tablet thrice a day for 7 days.
- Immunocompromised patient – Inj. Acivir (Acyclovir 500 mg) 10 mg/kg i.v. every 8 hours for 10 days.
Supplementary treatments:
- Tab. Combiflam (Paracetamol 500 mg, Ibuprofen 400 mg) 1 tablet thrice a day for 7 days.
- Tab. Pregalin 75 (Pregabalin 75 mg) 1 tablet at bedtime.
- Lotion Lactocalamine (contains Zinc Oxide) – apply over itchy areas as needed.
- Vaccination – Inj. Zostavax (live attenuated Varicella zoster vaccine) i.m. for patients older than 50 years. Delay vaccination until acute shingles has resolved prior to vaccination (~8 weeks). Vaccination reduces risk of herpes zoster incidence by 60% and post-herpetic neuralgia by 65%.
General advice:
- Avoid contact with active shingles or chicken pox.
- Do not share towels or clothing. Wash them in hot water and sun dry.
- Consider prophylaxis if exposure in high-risk groups.
Investigations:
- Diagnosis is mainly clinical.
- Vesicle fluid can tested for varicella zoster PCR or direct immunofluorescence antigen test.
Referral:
Consider referring to physician in case of persistent symptoms or if patient fails to respond to the treatment. Urgent referral to ophthalmologist may be needed in case of herpes zoster opthalmicus.