Herpes Zoster
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Reactivation of varicella-zoster virus (VZV) that has remained dormant within dorsal root ganglia, often for decades after the patient’s initial exposure to the virus in the form of varicella (chickenpox), results in herpes zoster.
Although it is usually a self-limited dermatomal rash with pain, herpes zoster can be far more serious; in addition, acute cases often lead to postherpetic neuralgia (PHN).
Signs and symptoms
The clinical manifestations of herpes zoster can be divided into the following 3 phases:
- Preeruptive phase (preherpetic neuralgia)
- Acute eruptive phase
- Chronic phase (PHN)
Diagnosis
Diagnosis of herpes zoster is based primarily on the history and physical findings. In most cases, confirming the diagnosis via laboratory testing has no utility. In select patient populations, however— particularly immunocompromised patients—the presentation of herpes zoster can be atypical and may require additional testing.
Treatment
- Clean lesion with chlorhexidine 4-6 times a day
- If pus around or redness then
- Mupirocin cream or ointment
- Tab Amoxicillin-clavulanic acid (Augmentin) 625mg BD for 5 days
- Betamethasone (Betnovate) local cream
- Tab Acyclovir 200mg