Treatment

Treatment of VZV has no universally accepted protocol. The goal of treatment should be to inactivate the virus, control pain, reduce severity of the vesicular eruption, and reduce complications (including postherpetic neuralgia). Oral treatment with antiviral agents [acyclovir (14), valacyclovir (15), or famciclovir (16)] should be continued for 7 to 10 days. Patients should receive 800 mg acyclovir orally five times a day, 500 mg famciclovir orally three times a day, or 1 g valacyclovir orally three times a day. Although antiviral drugs reduce duration of pain and development of vesicles, addition of oral 40 to 60 mg prednisone orally twice per day further reduces the inflammatory reaction, further controls pain, and reduces both the severity and the duration of vesicular eruption. We have only anecdotal evidence that treatment with corticosteroid agents may reduce incidence of postherpetic neuralgia, but these drugs do reduce pain, promote healing of the vesicular eruptions, and are an appropriate adjuvant to treatment. Many treatments have been suggested for postherpetic neuralgia, but proof of their effectiveness is lacking. The U.S. Food and Drug Administration (FDA) has approved a topical lidocaine patch for treating postherpetic neuralgia, but a recent study questions its effectiveness.

A recent (2005) prospective multicenter study (24) tested the hypothesis that vaccination against VZV would decrease the incidence, severity, or both of herpes zoster and postherpetic neuralgia among older adults. They found that the zoster vaccine markedly reduced morbidity from herpes zoster and postherpetic neuralgia among older adults. On May 25, 2006, the Food and Drug Administration (FDA) licensed Zostavax, a new vaccine to reduce the risk of shingles (herpes zoster) for use in people 60 years of age and older.a

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