Herpes zoster and postherpetic neuralgia

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Zoster and postherpetic neuralgia (PHN) are common conditions that have a significant impact on quality of life. Patients over the age of 50 years and those who are immunocompromised are at increased risk. The risk to the fetus is felt to be negligible with localized zoster in pregnancy. In cases in which the clinical diagnosis is unclear, immunofluorescent staining should be considered. Early antiviral therapy should be initiated in patients over the age of 50 years, those who are immunosuppressed, those with severe acute zoster and those with ophthalmic zoster. PHN can be difficult to treat; studies have shown that valacyclovir or famciclovir started within 72 h of rash onset, amitriptyline started within 48 h of rash onset and epidural local anesthetic with steroid given within the first 2 months may decrease the incidence of PHN. Pregabalin, narcotics, the lidocaine patch, topical capsaicin and intrathecal local anesthetic and steroid may help zoster-associated pain. A new zoster vaccine looks promising; a large double-blind study showed that vaccination halved the incidence of zoster and, in those who developed zoster, it reduced the incidence of PHN by two-thirds at 3 months and by three-quarters at 6 months.

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