American Journal of Clinical Dermatology

, Volume 14, Issue 2, pp 77–85 | Cite as

Management of Herpes Zoster and Post-Herpetic Neuralgia

  • Emily Yiping Gan
  • Elizabeth Ai Lian Tian
  • Hong Liang Tey
Therapy in Practice


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.



No funding was provided for preparation and writing of this paper. None of the authors has any conflict of interest to declare.


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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Emily Yiping Gan
    • 1
  • Elizabeth Ai Lian Tian
    • 1
  • Hong Liang Tey
    • 1
  1. 1.National Skin CentreSingaporeSingapore

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