American Journal of Clinical Dermatology

, Volume 14, Issue 2, pp 77–85

Management of Herpes Zoster and Post-Herpetic Neuralgia


  • Emily Yiping Gan
    • National Skin Centre
  • Elizabeth Ai Lian Tian
    • National Skin Centre
    • National Skin Centre
Therapy in Practice

DOI: 10.1007/s40257-013-0011-2

Cite this article as:
Gan, E.Y., Tian, E.A.L. & Tey, H.L. Am J Clin Dermatol (2013) 14: 77. doi:10.1007/s40257-013-0011-2


Herpes zoster and its sequela post-herpetic neuralgia (PHN) are conditions with significant morbidity. PHN is a chronic, debilitating neuropathic pain that can persist long beyond resolution of visible cutaneous manifestations. This paper provides practical guidelines for management of herpes zoster and PHN. For herpes zoster, antivirals should be started, preferably within 72 h of onset, to reduce the severity and duration of the eruptive phase and to reduce the intensity of acute pain. PHN can be treated with either topical or systemic agents. Topical lidocaine and capsaicin are effective. For patients with more severe pain, the following systemic agents can be considered (in decreasing order of recommendation): the anticonvulsants gabapentin and pregabalin, the tricyclic antidepressants amitriptyline, nortriptyline, and desipramine, and, lastly, the opioid analgesics tramadol, morphine, oxycodone, and methadone. For patients at high risk of developing PHN, early initiation of gabapentin or amitriptyline after the onset of herpes zoster is suggested. The new zoster vaccine has been shown to be effective in reducing the incidence of herpes zoster and PHN.

Copyright information

© Springer International Publishing Switzerland 2013