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Can Fam Physician
Vol. 54, No. 3, March 2008, pp.373 - 377
Copyright © 2008 by The College of Family Physicians of Canada
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Clinical Review

Treatment of herpes zoster

Wim Opstelten, MD PhD, Just Eekhof, MD PhD, Arie Knuistingh Neven, MD PhD and Theo Verheij, MD PhD
Dr Opstelten is a general practitioner and Dr Verheij is a Professor of General Practice, both at Utrecht University in The Netherlands. Drs Eekhof and Knuistingh Neven are general practitioner-epidemiologists, both at Leiden University in The Netherlands

Correspondence to: Dr Wim Opstelten, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; e-mailW.Opstelten{at}umcutrecht.nl

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

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

MAIN MESSAGE 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.

CONCLUSION 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.




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