Treatment of herpes zoster.
OBJECTIVE
To review the evidence regarding treatment of herpes zoster (HZ) in the short-term, focusing on the prevention of postherpetic neuralgia (PHN).


METHODS
The evidence relating to treatment of HZ is derived mainly from randomized controlled trials (level I evidence).


RESULTS
Antiviral drugs might have some effect on the severity of acute pain and on the duration of skin lesions. Corticosteroids also alleviate acute pain. Oral antiviral medication reduces the risk of eye complications in patients with ophthalmic HZ. There is no convincing evidence that antiviral medication reduces the risk of PHN. Some studies, however, have shown that famciclovir and valacyclovir shorten the duration of PHN. The effectiveness of amitriptyline or cutaneous and percutaneous interventions in preventing PHN has not been proven.


CONCLUSIONS
Oral antiviral drugs should be prescribed to elderly HZ patients with high risk of PHN. Moreover, these drugs should be prescribed to all patients at the first signs of ophthalmic HZ, irrespective of age or severity of symptoms.
Opstelten
Wim
W
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. W.Opstelten@umcutrecht.nl
Eekhof
Just
J
Neven
Arie Knuistingh
AK
Verheij
Theo
T
D015075:2-Aminopurine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000212:Acyclovir / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000077595:Famciclovir; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006562:Herpes Zoster / Q000188:drug therapy*; D006563:Herpes Zoster Ophthalmicus / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D051474:Neuralgia, Postherpetic / Q000188:drug therapy* / Q000517:prevention & control; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors; D000077483:Valacyclovir; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use
D000998:Antiviral Agents; D005938:Glucocorticoids; D015075:2-Aminopurine; D011239:Prednisolone; D014633:Valine; D000077483:Valacyclovir; D000077595:Famciclovir; D000212:Acyclovir