title: Management of herpes zoster and post-herpetic neuralgia.
abstract: Herpes zoster and its sequela post-herpetic neuralgia (PHN) are conditions with significant morbidity. PHN is a chronic, debilitating neuropathic pain that can persist long beyond resolution of visible cutaneous manifestations. This paper provides practical guidelines for management of herpes zoster and PHN. For herpes zoster, antivirals should be started, preferably within 72 h of onset, to reduce the severity and duration of the eruptive phase and to reduce the intensity of acute pain. PHN can be treated with either topical or systemic agents. Topical lidocaine and capsaicin are effective. For patients with more severe pain, the following systemic agents can be considered (in decreasing order of recommendation): the anticonvulsants gabapentin and pregabalin, the tricyclic antidepressants amitriptyline, nortriptyline, and desipramine, and, lastly, the opioid analgesics tramadol, morphine, oxycodone, and methadone. For patients at high risk of developing PHN, early initiation of gabapentin or amitriptyline after the onset of herpes zoster is suggested. The new zoster vaccine has been shown to be effective in reducing the incidence of herpes zoster and PHN.
authors: National Skin Centre, 1 Mandalay Road, Singapore 308205, Singapore.
authors: Emily Yiping
authors: EY
authors: Gan
authors: Elizabeth Ai Lian
authors: EA
authors: Tian
authors: Hong Liang
authors: HL
authors: Tey
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D005260:Female; D006562:Herpes Zoster / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D051474:Neuralgia, Postherpetic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D010147:Pain Measurement; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods*
chemical_list: D000305:Adrenal Cortex Hormones; D000701:Analgesics, Opioid; D000998:Antiviral Agents