대상포진 Herpes Zoster; shingles

Varicella-zoster virus (VZV) infection

대상포진 Herpes Zoster;  shingles

herpes zoster in the immunocompetent host

GOALS OF THERAPY 

— Important goals of antiviral therapy are to :

1.Lessen the severity and duration of pain associated with acute neuritis

2.Promote more rapid healing of skin lesions

3.Prevent new lesion formation

4.Decrease viral shedding to reduce the risk of transmission

5.Prevent post-herpetic neuralgia

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antiviral therapy

면역정상환자

1] 50세 이상

-standard dose; 7일

Acyclovir 800 mg five times daily

Famciclovir 500 mg three times daily

Valacyclovir 1000 mg three times daily

-Administration of acyclovir within 48 to 72 hours of the onset of rash 

2] 50세 이하

we generally give antiviral therapy 

to patients <50 years of age with 

herpes zoster who present 

within 72 hours of clinical symptoms

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Analgesia for acute neuritis 

Nonsteroidal anti-inflammatory drugs

acetaminophen 

weak opioid analgesic (eg, codeine or tramadol)

stronger opioid analgesics (eg, oxycodone or morphine) 

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gabapentin [neurontin]

a new diagnosis of herpes zoster, 

the use of gabapentin 

was not more effective 

than placebo as adjuvant therapy for acute neuritis

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Use of glucocorticoids 

-we do not recommend the routine use of corticosteroids in addition to antiviral therapy.

-improve the quality of life, 

-the time to healing of lesions, 

-to reduce the incidence of post-herpetic neuralgia

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Use of tricyclic antidepressants 

-amitriptyline

-we do not recommend the addition of tricyclic antidepressants 

for the prevention of post-herpetic neuralgia 

based on the available data

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COMPLICATED HERPES ZOSTER

1.Herpes zoster ophthalmicus

2.Secondary bacterial infection

3.Post-herpetic neuralgia

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HERPES ZOSTER DURING PREGNANCY 

-maternal herpes zoster infection has not been associated with the development of congenital varicella

-no evidence to suggest that the pregnant female is at increased risk for complicated disease

-antiviral therapy in a pregnant women 

-severe zoster rash (eg, >50 lesions)

-to promote more rapid healing

-acute neuritis to lessen the severity and duration of pain