Herpes Zoster Shingles

by | Dec 6, 2017

Ana is an 85 year old who was recently treated for a viral URTI and now presents with a rash on her back of 1 day duration, it is mildly “tingly”.

 

Questions

  1. What are the differentials of this presentation?
  2. What is the pathogen that causes the most likely diagnosis of this?
  3. What is the pharmacological management of thid condition (List 3 – list name, dose, duration, frequency)
  4. What is the treatment window for this condition
  5. What are the PBS criteria for the required medication?
  6. What are the Australian immunisation program offerings for prevention of this? What ages is it offered?
  7. What are the pharmacological options for management of the associated pain?

 

Herpes Zoster
Reactivation of Varicella Zoster

Exam features
Asymmetric rash vesicular in a dermatomal distribution
Intense erythema with papules in affected skin
Preceded by radicular pain with hyperaesthesia
Regional lymphadenopathy

Indications for antivirals
Witin 72 hrs
Greater than 50
Immunocompromosed
Acute severe pain
Involvement of eye or perineum

Medications in herpes zoster
Aciclovir 800mg 5 times per day for 7 days
Famciclovir 500mg tds 5-10 days
Valalciclovir 1000mg tds 7 days

Steroids in shingles
For severe pain use prednisone 50mg daily 7 days then taper

Analgesia in Shingles
Paracetamol
TENS 16hrs per day for 2 weeks
Amitryptilline 75mg nocte
Pregabalin 150mg BD
Gabapentin 300-2400mg daily
Topical lignocaine 5% ointment /SOOV
Nerve blocks
Excision of painful scar

 

 

 

 

References