Shingles (herpes zoster)
EBM Guidelines
Sep 3, 2021 • Latest change Jan 8, 2024
Table of contents
Extract
- Diagnosis is usually based on the clinical picture.
- Antiviral medication should be considered case by case, particularly if less than 3 days have elapsed since the eruption of the rash.
- Antiviral medication should always be started for patients with immunodeficiency, if the disease is located in the trigeminus area, if the patient is older (over 60) or if the clinical picture is severe.
- Remember to ensure effective analgesic treatment of acute shingles pain and any postherpetic neuralgia.
Linked evidence summaries
- Oral acyclovir might possibly reduce the incidence of postherpetic neuralgia but the evidence is insufficient. Valaciclovir and famciclovir may be better than aciclovir in reducing herpes-zoster-associated pain.D↑
- Gabapentin at doses of 1200 mg or more is reasonably effective for some people with painful neuropathic pain conditions.A↑
- Oral tramadol (100 to 400 mg a day) may be more effective than placebo for the treatment of neuropathic pain.C
- Live attenuated herpes zoster vaccine (LZV) and recombinant herpes zoster vaccine (RZV ) are effective in preventing herpes zoster in older adults.A
- There is insufficient direct evidence from specialised trials to prove the efficacy of vaccine for preventing postherpetic neuralgia beyond its effect on reducing herpes zoster, although vaccination is efficacious and safe for preventing herpes zoster and thus reduce the incidence of postherpetic neuralgia in adults aged 60 years or older.D
Search terms
Acquired Immunodeficiency Syndrome, Acyclovir, Aged, Amitriptyline, Antiviral Agents, B02*, Carbamazepine, Chickenpox, Dermatitis, Dermatology, Diabetes Mellitus, Eye, Eye Diseases, G53.0*, G53.0*B02.20, HIV Infections, Herpes Zoster, Herpes zoster, Herpesviridae Infections, Hyperesthesia, Immunosuppression, Infectious diseases, Internal medicine, Leukemia, Neuralgia, Neuralgia, Postherpetic, Neutropenia, Postherpetic neuralgia, Trigeminal Neuralgia, Uveitis, antineoplastic agent treatment, bone marrow depression, famciclovir, steroid medication, zoster pain