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Shingles (herpes zoster) and post-herpetic neuralgia

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  • During childhood chickenpox, varicella-zoster virus becomes latent in neurons of the dorsal root or trigeminal ganglia. Shingles results years to decades later from a breakdown of viral latency within a ganglion and subsequent virus spread to the skin producing a unilateral dermatomal vesicular rash accompanied by segmental pain. Treatment with famciclovir, valacyclovir, and high dose acyclovir is beneficial if started within the first 3 days of the rash. All three drugs can be given orally, are equally effective, shorten the duration of viral shedding and time to healing of the rash by 1 to 2 days, and lessen the intensity and duration of the acute neuritic pain. Famciclovir and valacyclovir have more convenient dosing schedules (three times daily) compared to acyclovir (five times daily). Mild cases of shingles in younger healthy individuals often do not require any antiviral treatment.

  • Pain in shingles may have burning, lancinating, or allodynic qualities, ranges in intensity from mild to unbearable, and lasts 2 to 8 weeks. Pain treatment varies on the type and intensity of pain experienced. In a few patients, post-herpetic neuralgia develops and the dermatomal pain persists for months to years. Effective treatment of post-herpetic pain is often difficult.

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References and Recommended Reading

  1. Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, et al.: Neurologic complications of reactivation of varicella-zoster virus. N Engl J Med 2000, 342:635–645. Excellent recent clinical and basic science review of shingles and other neurologic complications of varicella-zoster virus.

    Article  PubMed  CAS  Google Scholar 

  2. Ragozzino MW, Meltori LJ, Kurland LT, et al.: Population-based study of herpes-zoster and its sequelae. Medicine 1982, 61:310–316.

    Article  PubMed  CAS  Google Scholar 

  3. Hope-Simpson RE: The nature of herpes zoster: a long term study and a new hypothesis. Proc R Soc Lond [Biol] 1965, 58:9–20. Although from 1965, a classic article that superbly characterized shingles and recognized that shingles and chicken pox were due to the same virus.

    CAS  Google Scholar 

  4. Adour KK: Otological complications of herpes-zoster. Ann Neurol 1994, 35:S62-S64.

    Article  PubMed  Google Scholar 

  5. Hilt DC, Buchholz D, Krumholz A, et al.: Herpes zoster ophthalmicus and delayed contralateral hemiparesis caused by cerebral angiitis: diagnosis and management approaches. Ann Neurol 1983, 14:543–553.

    Article  PubMed  CAS  Google Scholar 

  6. Amile-Lefond C, Kleinschmidt-DeMasters K, Mahalingam R, et al.: The vasculopathy of varicella-zoster virus encephalitis. Ann Neurol 1995, 37:784–791.

    Article  Google Scholar 

  7. McKendrick MW, McGill JI, White JI, Wood MJ: Oral acyclovir in acute herpes zoster. BMJ Clin Res Ed 1986, 293:1529–1532. Class I study from 1986 of 205 elderly patients with shingles demonstrating the value of oral acyclovir.

    CAS  Google Scholar 

  8. Whitley RJ, Weiss H, Gnann JW, et al.: Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized placebo-controlled trial. Ann Intern Med 1996, 125:376–383.

    PubMed  CAS  Google Scholar 

  9. Bean B, Braun C, Balfour HH: Acyclovir therapy for acute herpes zoster. Lancet 1982, 2:118–121.

    Article  PubMed  CAS  Google Scholar 

  10. Peterslund NA, Seyer-Hansen K, Ipsen J, et al.: Acyclovir in herpes zoster. Lancet 1981, 2:827–830.

    Article  PubMed  CAS  Google Scholar 

  11. Tyring S, Barbgarash RA, Nahlik JE, et al.: Famciclovir for the treatment of acute herpes zoster: effects on acute disease and post-herpetic neuralgia. Ann Intern Med 1995, 123:89–96. Class I study from 1995 of 419 adults with shingles demonstrating benefit of oral famciclovir.

    PubMed  CAS  Google Scholar 

  12. Beutner KR, Friedman DJ, Forspaniak C, et al.: Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother 1995, 39:1546–1553.

    PubMed  CAS  Google Scholar 

  13. Balfour HH, Bean B, Laskin OL, et al.: Acyclovir halts progression of herpes zoster in immunocompromised patients. N Engl J Med 1983, 308:1448–1453.

    Article  PubMed  Google Scholar 

  14. McKendrick MW, McGill JI, Wood MJ: Lack of effect of acyclovir on post-herpetic neuralgia. BMJ 1989, 298:431.

    Article  PubMed  CAS  Google Scholar 

  15. Cobo LM, Foulks GN, Liesegang T, et al.: Oral acyclovir in the treatment of acute herpes zoster ophthalmicus. Ophthalmology 1986, 93:763–770.

    PubMed  CAS  Google Scholar 

  16. Tyring S, Engst R, Lassonde MTS, et al.: Famciclovir for the treatment of ophthalmic herpes zoster (HZO). Abstract presented at 38th Interscience Conference on Antimicrobial Agents and Chemotherapy. 1998; San Diego, CA.

  17. Johns DR, Gress DR: Rapid response to acyclovir in herpes zoster-associated encephalitis. Am J Med 1987, 82:560–562.

    Article  PubMed  CAS  Google Scholar 

  18. Breton G, Filet AM, Katlama C, et al.: Acyclovir-resistant herpes zoster in human immunodeficiency virusinfected patients: results of foscarnet therapy. Clin Infect Dis 1998, 27:1525–1527.

    PubMed  CAS  Google Scholar 

  19. Wood JM, Johnson RW, McKendrick MW, et al.: A randomized trial of acyclovir for 7 days or 21 days with and without prednisone for treatment of acute herpes zoster. N Engl J Med 1994, 330:986–900.

    Google Scholar 

  20. Esmann V, Geil JP, Kroon S, et al.: Prednisone does not prevent post-herpetic neuralgia. Lancet 1987, 2:126–129.

    Article  PubMed  CAS  Google Scholar 

  21. Watson CP, Vernich L, Chipman M, Reed K: Nortriptyline versus amitriptyline in post-herpetic neuralgia. Neurology 1998, 51:1166–1171.

    PubMed  CAS  Google Scholar 

  22. Watson CP, Evans RJ, Reed K, et al.: Amitriptyline versus placebo in post-herpetic neuralgia. Neurology 1982, 32:671–673.

    PubMed  CAS  Google Scholar 

  23. Kishore-Kumar R, Max MB, Schafer SC, et al.: Desipramine relieves post-herpetic neuralgia. Clin Pharmacol Ther 1990, 47:305–312.

    Article  PubMed  CAS  Google Scholar 

  24. Watson CP, Babul N: Efficacy of oxycodone in neuropathic pain: a randomized trial in post-herpetic neuralgia. Neurology 1998, 50:1837–1841.

    PubMed  CAS  Google Scholar 

  25. Rowbotham M, Harden N, Stacey B, et al.: Gabapentin for the treatment of post-herpetic neuralgia. JAMA 1998, 280:1837–1842.

    Article  PubMed  CAS  Google Scholar 

  26. Killian JM, Fromm GH: Carbamazepine in the treatment of neuralgia: use and side effects. Arch Neurol 1968, 19:129–136.

    PubMed  CAS  Google Scholar 

  27. Rowbotham MC, Davies PS, Howard LF: Topical lidocaine gel relieves post-herpetic neuralgia. Ann Neurol 1995, 37:246–253.

    Article  PubMed  CAS  Google Scholar 

  28. Galer BS, Rowbotham MC, Perander J, Friedman E: Topical lidocaine patch relieves post-herpetic neuralgia more effectively than a vehicle topical patch: results of an enriched enrollment study. Pain 1999, 80:533–538.

    Article  PubMed  CAS  Google Scholar 

  29. Pappagallo M: Controlled clinical trial to test opioids in neuropathic pain. Neurosci Forum 1995, 5:10–13.

    Google Scholar 

  30. Kost RG, Straus SE: Post-herpetic neuralgia: pathogenesis, treatment, and prevention. N Engl J Med 1996, 335:32–42. Although from 1996, an excellent overview of posthepetic neuralgia.

    Article  PubMed  CAS  Google Scholar 

  31. Watson DP, Watt VR, Chipman M, et al.: The prognosis with post-herpetic neuralgia. Pain 1991, 46:195–199.

    Article  PubMed  CAS  Google Scholar 

  32. North RB, Levy RM: Consensus conference on the neurosurgical management of pain. Neurosurgery 1994, 34:756–761.

    Article  PubMed  CAS  Google Scholar 

  33. Kotani N, Kushikata T, Hashimoto H, et al.: Intrathecal methylprednisolone for intractable post-herpetic neuralgia. N Engl J Med 2000 343:1514–1519.

    Article  PubMed  CAS  Google Scholar 

  34. Hayden FG: Antiviral drugs (other than antiretrovirals). In Principles and Practice of Infectious Diseases, edn 5. Edited by Mandell GL, Bennett JE, Dolin R. Philadelphia: Churchhill Livingstone; 2000:460–491. Comprehensive chapter discussing the pharmacokinetics, drug doses, and toxicity of acyclovir, valaciclovir, and famciclovir.

    Google Scholar 

  35. Balfour HH: Antiviral drugs. N Engl J Med 1999, 340:1255–1268. Excellent recent review of adverse effects and pharmacokinetics of acyclovir, valaciclovir, and famciclovir.

    Article  PubMed  CAS  Google Scholar 

  36. Bean B, Aeppli D: Adverse effects of high-dose intravenous acyclovir in ambulatory patients with acute herpes zoster. J Infect Dis 1985, 151:362–365.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Departments of Neurology, Neuroscience, and Microbiology, New Mexico VA Health Care System, 1501 San Pedro Drive, SE, 87108, Albuquerque, NM, USA

    Larry E. Davis MD, FACP & Molly K. King MD

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  1. Larry E. Davis MD, FACP
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  2. Molly K. King MD
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Davis, L.E., King, M.K. Shingles (herpes zoster) and post-herpetic neuralgia. Curr Treat Options Neurol 3, 401–411 (2001). https://doi.org/10.1007/s11940-001-0028-3

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  • DOI: https://doi.org/10.1007/s11940-001-0028-3

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