Advertisement

American Journal of Clinical Dermatology

, Volume 6, Issue 5, pp 317–325 | Cite as

Current Management of Herpes Zoster

The European View
  • Antonio VolpiEmail author
  • Gerd Gross
  • Jana Hercogova
  • Robert W. Johnson
Review Article

Abstract

The overall incidence of herpes zoster in Europe is approximately 3 per 1000 people per year and more than 10 per 1000 people per year in those aged >80 years. Post herpetic neuralgia (PHN) is a common debilitating complication of herpes zoster, particularly in patients aged >50 years, in persons with severe pain or rash at presentation, and in those with significant prodromal symptoms.

Antiviral drugs can effectively control acute symptoms and, if used early enough in the course of the illness, can help prevent the development of PHN and other complications. However, despite this, many patients do not receive such treatment. The economic impact of zoster and PHN is largely underestimated in Europe. Furthermore, there is considerable variation throughout Europe in the management of herpes zoster. Use of antiviral therapy including the newer potent antiviral agents such as brivudin, which requires less frequent administration than acyclovir, is improving patient outcomes in some European countries. However, in many countries, patient awareness of herpes zoster and, as a result, overall antiviral use is low.

Guidelines recommending the use of antiviral agents, particularly in patients at risk of developing PHN, are available but are not widely used. More needs to be done to educate the general public and increase awareness among primary healthcare providers of the benefits of timely and appropriate pharmacological therapy in patients with herpes zoster.

Keywords

Herpes Zoster Acyclovir Antiviral Therapy Varicella Zoster Virus Post Herpetic Neuralgia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

This manuscript was supported by an educational grant from Menarini, Italy and was prepared with editorial assistance by Mary Hines, Wolters Kluwer Health.

Antonio Volpi has undertaken educational or consultancy activities with Menarini, GlaxoSmithKline, Allen, Novartis, and Guidotti. Gerd Gross and Jana Hercogova have received assistance from and have undertaken educational or consultancy activities with Menarini. Robert W. Johnson has undertaken educational or consultancy activities with Menarini, Novartis, GlaxoSmithKline, Merck, Reliant and Yamanouchi.

References

  1. 1.
    Ragozzino MW, Melton LJ, Kurland LT, et al. Population-based study of herpes zoster and its sequelae. Medicine (Baltimore). 1982; 61 (5): 310–6Google Scholar
  2. 2.
    Edmunds WJ, Brisson M, Rose JD. The epidemiology of herpes zoster and potential cost-effectiveness of vaccination in England and Wales. Vaccine. 2001; 19 (23-24): 3076–90PubMedCrossRefGoogle Scholar
  3. 3.
    Coplan P, Black S, Rojas C, et al. Incidence and hospitalization rates of varicella and herpes zoster before varicella vaccine introduction: a baseline assessment of the shifting epidemiology of varicella disease. Pediatr Infect Dis. 2001; 20 (7): 641–5CrossRefGoogle Scholar
  4. 4.
    Guess HA, Broughton DD, Melton LJ, et al. Epidemiology of herpes zoster in children and adolescents: a population-based study. Pediatrics. 1985; 76 (4): 512–7PubMedGoogle Scholar
  5. 5.
    Thomas SL, Hall AJ. What does epidemiology tell us about risk factors for herpes zoster?. Lancet Infect Dis. 2004; 4 (1): 26–33PubMedCrossRefGoogle Scholar
  6. 6.
    Kost RG, Straus SE. Postherpetic neuralgia: pathogenesis, treatment, and prevention. N Engl J Med. 1996; 335 (1): 32–42PubMedCrossRefGoogle Scholar
  7. 7.
    Hope-Simpson RE. Postherpetic neuralgia. J R Coll Gen Pract. 1975; 25 (157): 571–5PubMedGoogle Scholar
  8. 8.
    Donahue JG, Choo PW, Manson JE, et al. The incidence of herpes zoster. Arch Intern Med. 1995; 155 (15): 1605–9PubMedCrossRefGoogle Scholar
  9. 9.
    Jumaan AO, Yu O, Jackson LA, et al. Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992–2002. J Infect Dis. 2005; 191 (12): 2002–7PubMedCrossRefGoogle Scholar
  10. 10.
    Edmunds WJ, Brisson M. The effect of vaccination on the epidemiology of varicella zoster virus. J Infect. 2002; 44 (4): 211–9PubMedCrossRefGoogle Scholar
  11. 11.
    Lin F, Hadler JL. Epidemiology of primary varicella and herpes zoster hospitalizations: the pre-varicella vaccine era. J Infect Dis. 2000; 181 (6): 1897–905PubMedCrossRefGoogle Scholar
  12. 12.
    Hambleton S, Gershon AA. Preventing varicella-zoster disease. Clin Microbiol Rev. 2005; 18 (1): 70–80PubMedCrossRefGoogle Scholar
  13. 13.
    Gnann JW, Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med. 2002; 347 (5): 340–6PubMedCrossRefGoogle Scholar
  14. 14.
    Gnann JW. Varicella-zoster virus: atypical presentations and unusual complications. J Infect Dis. 2002; 186 Suppl. 1: S91–8PubMedCrossRefGoogle Scholar
  15. 15.
    Johnson RW. The future of predictors, prevention, and therapy in postherpetic neuralgia. Neurology. 1995; 45 Suppl. 8: S70–S2PubMedCrossRefGoogle Scholar
  16. 16.
    Dubinsky RM, Kabbani H, El-Chami Z, et al. Practice parameter: treatment of postherpetic neuralgia: an evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2004; 63 (6): 959–65PubMedCrossRefGoogle Scholar
  17. 17.
    Aravi RB, Soong SJ, Weiss HL, et al. Phase specific analysis of herpes zoster associated pain data: a new statistical approach. Stat Med. 2001; 20 (16): 2429–39CrossRefGoogle Scholar
  18. 18.
    Meister W, Neiss A, Gross G, et al. A prognostic score for postherpetic neuralgia in ambulatory patients. Infection. 1998; 26 (6): 359–63PubMedCrossRefGoogle Scholar
  19. 19.
    Gershon AA. Epidemiology and management of postherpetic neuralgia. Semin Dermatol. 1996; 15 (2 Suppl. 1): 8–13PubMedGoogle Scholar
  20. 20.
    Balfour HH. Varicella zoster virus infections in immunocompromised hosts: a review of the natural history and management. Am J Med. 1988; 85 (2A): 68–73PubMedGoogle Scholar
  21. 21.
    Schmader KE. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Clin J Pain. 2002; 18 (6): 350–4PubMedCrossRefGoogle Scholar
  22. 22.
    Jung BF, Johnson RW, Griffin DR, et al. Risk factors for postherpetic neuralgia in patients with herpes zoster. Neurology. 2004; 62 (9): 1545–51PubMedCrossRefGoogle Scholar
  23. 23.
    Schmader K, Studenski S, MacMillan J, et al. Are stressful life events risk factors for herpes zoster?. J Am Geriatr Soc. 1990; 38 (11): 1188–94PubMedGoogle Scholar
  24. 24.
    Dworkin RH, Banks SM. A vulnerability-diathesis-stress model of chronic pain: herpes zoster and the development of postherpetic neuralgia. In: Gatchel RJ, Turk DC, editors. Psychosocial factors in pain: critical perspectives. New York: The Guilford Press, 1999: 247–69Google Scholar
  25. 25.
    Scott FT, Leedham-Green ME, Barrett-Muir WY, et al. A study of shingles and the development of postherpetic neuralgia in East London. J Med Virol. 2003; 70 Suppl. 1: S24–30PubMedCrossRefGoogle Scholar
  26. 26.
    Wood MJ, Slinkla S, Fiddian AP, et al. Treatment of acute herpes zoster: effect of early (< 48 h) versus late (482–72 h) therapy with acyclovir and valaciclovir on prolonged pain. J Infect Dis. 1998; 178 Suppl. 1: S81–4PubMedCrossRefGoogle Scholar
  27. 27.
    Schmader K. Herpes zoster in older adults. Clin Infect Dis. 2001; 32 (10): 1481–6PubMedCrossRefGoogle Scholar
  28. 28.
    Gross G, Schofer H, Wassilew S, et al. Herpes zoster guideline of the German Dermatology Society (DDG). J Clin Virol. 2003; 26 (3): 277–89PubMedCrossRefGoogle Scholar
  29. 29.
    Kuraishi Y, Takasaki I, Ncjima H, et al. Effects of the suppression of acute herpetic pain by gabapentin and amitriptyline on the incidence of delayed postherpetic pain in mice. Life Sci. 2004; 74 (21): 2619–26PubMedCrossRefGoogle Scholar
  30. 30.
    Davis LE, King MK. Shingles (herpes zoster) and post-herpetic neuralgia. Curr Treat Options Neurol. 2001; 3 (5): 401–11PubMedCrossRefGoogle Scholar
  31. 31.
    Wood MJ, Kay R, Dworkin RH, et al. Oral acyclovir therapy accelerates pain resolution in patients with herpes zoster: a meta-analysis of placebo-controlled trials. Clin Infect Dis. 1996; 22 (2): 341–7PubMedCrossRefGoogle Scholar
  32. 32.
    Tyring S, Belanger R, Bezwoda W, et al. A randomized, double-blind trial of famciclovir versus acyclovir for the treatment of localized dermatomal herpes zoster in immunocompromised patients. Cancer Invest. 2001; 19 (1): 13–22PubMedCrossRefGoogle Scholar
  33. 33.
    Shen MC, Lin HH, Lee SS, et al. Double-blind, randomized, acyclovir-controlled, parallel-group trial comparing the safety and efficacy of famciclovir and acyclovir in patients with uncomplicated herpes zoster. J Microbiol Immunol Infect. 2004; 37 (2): 75–81PubMedGoogle Scholar
  34. 34.
    Beutner KR, Friedman DJ, Forszpaniak C, et al. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother 1995; 39 (7): 1546–53PubMedCrossRefGoogle Scholar
  35. 35.
    Tyring SK, Beutner KR, Tucker BA, et al. Antiviral therapy for herpes zoster: randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Arch Fam Med. 2000; 9 (9): 863–9PubMedCrossRefGoogle Scholar
  36. 36.
    Andrei G, Snoeck R, Reymen D, et al. Comparative activity of selected antiviral compounds against clinical isolates of varicella-zoster virus. Fur J Clin Microbiol Infect Dis. 1995; 14 (4): 318–29CrossRefGoogle Scholar
  37. 37.
    Crea AEG, Iafrate EM, Evangelista S, et al. Cellular and human pharmacokinetics of brivudin, a new antiherpetic drug. In: Recent research developments in drug metabolism & disposition. Trivandrum (India): Transworld Research Network, 2004: 27–37Google Scholar
  38. 38.
    Wassilew SW, Wutzler P. Oral brivudin in comparison with acyclovir for herpes zoster: a survey study on postherpetic neuralgia. Antiviral Res. 2003; 59 (1): 57–60PubMedCrossRefGoogle Scholar
  39. 39.
    Wassilew S. Brivudin compared with famciclovir in the treatment of herpes zoster: effects in acute disease and chronic pain in immunocompetent patients: a randomized, double-blind, multinational study. J Fur Acad Dermatol Venereol. 2005; 19 (1): 47–55CrossRefGoogle Scholar
  40. 40.
    Wassilew SW, Wutzler P. Oral brivudin in comparison with acyclovir for improved therapy of herpes zoster in immunocompetent patients: results of a randomized, double-blind, multicentered study. Antiviral Res. 2003; 59 (1): 49–56PubMedCrossRefGoogle Scholar
  41. 41.
    Keam SJ, Chapman TM, Figgitt DP. Brivudin (bromovinyl deoxyuridine). Drugs. 2004; 64 (18): 2091–7PubMedCrossRefGoogle Scholar
  42. 42.
    Johnson R, Patrick D, editors. In: Improving the management of varicella, herpes zoster and zoster-associated pain: recommendations from the IHMF Management Strategies Workshop [online]. Available from URL: http://www.ihmf.org/library/monograph/mlLpdf [Accessed 2005 Sep 21]
  43. 43.
    Anonymous. Guidelines for the management of shingles. Report of a working group of the British Society for the Study of Infection (BSSI). J Infect. 1995; 30 (3): 193–200Google Scholar
  44. 44.
    Lyrica summary of product characteristics [online]. Available from URL: http://www.emea.eu.int/humandoes/flumans/EPAR/lyrica/lyrica.htm [Accessed 2005 Sep 22]
  45. 45.
    Lilie HM, Wassilew S. The role of antivirals in the management of neuropathic pain in the older patient with herpes zoster. Drugs Aging. 2003; 20 (8): 561–70PubMedCrossRefGoogle Scholar
  46. 46.
    Jackson JL, Gibbons R, Meyer G, et al. The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia: a meta-analysis. Arch Intern Med. 1997; 157 (8): 909–12PubMedCrossRefGoogle Scholar
  47. 47.
    Herne K, Cirelli R, Lee P, et al. Antiviral therapy of acute herpes zoster in older patients. Drugs Aging. 1996; 8 (2): 97–112PubMedCrossRefGoogle Scholar
  48. 48.
    Eaglstein WH, Katz R, Brown JA. The effects of early corticosteroid therapy on the skin eruption and pain of herpes zoster. JAMA. 1970; 211 (10): 1681–3PubMedCrossRefGoogle Scholar
  49. 49.
    Whitley RJ, Weiss H, Gnann JW, et al. Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Ann Intern Med. 1996; 125 (5): 376–83PubMedGoogle Scholar
  50. 50.
    Wood MJ, Johnson RW, McKendrick MW, et al. A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med. 1994; 330 (13): 896–900PubMedCrossRefGoogle Scholar
  51. 51.
    Gil A, San-Martin M, Carrasco P, et al. Epidemiology of severe varicella-zoster virus infection in Spain. Vaccine. 2004; 22 (29-30): 3947–51PubMedCrossRefGoogle Scholar
  52. 52.
    Johnson RW. Pain following herpes zoster: implications for management. Herpes. 2004; 11 (3): 63–5PubMedGoogle Scholar
  53. 53.
    Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005; 352 (22): 2271–84PubMedCrossRefGoogle Scholar
  54. 54.
    Management of acute herpes zoster. In: Algorithms for managing varicella and herpes zoster (1 May 2002). IHMF Management Guideline Series [online]. Available from URL: http://www.ihmf.org/Library/monograph/s11.pdf [Accessed 2005 Sep 20]
  55. 55.
    Algorithms for management of varicella and herpes zoster [online]. Available from URL: http://www.ihmf.org/guidelines/remmndl.asp [Accessed 2005 Feb 15]
  56. 56.
    Immunisation against infectious disease 1996. ‘The Green Book’. Chapter 34: Varicella (updated January 2004) [online]. Available from URL: http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopies/Green-Book/GreenBookGenerallnformation/GreenBookGenera]Article/fs/en?.CONTENTID=4097254ch;=isTfGX [Accessed 2005 Feb 16]
  57. 57.
    International Herpes Management Forum: Regional Management Forums [online]. Available from URL: http://www.ihmf.org/globallinks/wldita.asp [Accessed 2005 Jul 22]
  58. 58.
    Volpi A, Caputo R, Martino P, et al. Linee guida per la gestione del paziente con Herpes Zoster. G Ital Dermatol Venereol 1998; 133 (4): 308–11Google Scholar
  59. 59.
    Moorthy RS, Weinberg DV, Teich SA, et al. Management of varicella zoster virus retinitis in AIDS. Br J Ophthalmol. 1997; 81 (3): 189–94PubMedCrossRefGoogle Scholar
  60. 60.
    Johnson R, Levin M. Knowledge of shingles symptoms, risks, and treatments low among adults: widespread shingles education efforts may reduce long-term complications. In: Proceedings of the 11th International Association for the Study of Pain World Congress on Pain; 2005 Aug 21–26; Sydney Knowledge of shingles symptoms, risks, and treatments low among adults: widespread shingles education efforts may reduce long-term complicationsGoogle Scholar
  61. 61.
    PRODIGY Guidance — shingles and postherpetic neuralgia [online]. Available from URL: http://www.prodigy.nhs.uk/guidance.asp?.gt=Shingles/postherpetic%20pain [Accessed 2005 Feb 16]

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • Antonio Volpi
    • 1
    Email author
  • Gerd Gross
    • 2
  • Jana Hercogova
    • 3
  • Robert W. Johnson
    • 4
  1. 1.Department of Public HealthUniversity of RomeRomeItaly
  2. 2.Department of Dermatology and VenereologyUniversity of RostockRostockGermany
  3. 3.Department of Dermatology and VenereologyCharles UniversityPragueCzech Republic
  4. 4.Pain Management Clinic, Bristol Royal InfirmaryUniversity of BristolBristolUK

Personalised recommendations