Fast Five Quiz: Herpes Zoster Facts vs Fiction

William James, MD


September 22, 2021

Episodes of herpes zoster are generally self-limited and resolve without intervention; they tend to be more benign and mild in children than in adults. An enormous number and variety of therapeutic approaches have been proposed over the years, most of which are probably ineffective.

Antivirals are recommended within 72 hours of herpes zoster rash onset. However, antiviral therapy may be capable of reducing zoster pain even when started beyond the traditional 72-hour therapeutic window. Thus, antiviral therapy should be considered for acute zoster treatment regimens, regardless of the time of presentation.

Clinical trials showed that oral acyclovir, famciclovir, and valacyclovir reduce viral shedding and accelerate resolution of symptoms (eg, pain) in uncomplicated herpes zoster. Valacyclovir and famciclovir have greater bioavailability than acyclovir and thus require less frequent dosing.

The use of oral or epidural corticosteroids in conjunction with antiviral therapy has been found to be beneficial in treating moderate to severe acute zoster but to have no effect on the development or duration of postherpetic neuralgia.

If a patient is experiencing severe pain at any point at or beyond the appearance of crusted vesicles, the clinician should strongly suspect that postherpetic neuralgia has developed. Once established, the pain is notoriously difficult to alleviate with traditional analgesics, including narcotics. Consequently, treatment of postherpetic neuralgia is complex; a multifaceted, patient-specific approach is important.

Once postherpetic neuralgia has developed, various treatments are available, including the following:

  • Neuroactive agents (eg, tricyclic antidepressants)

  • Anticonvulsant agents (eg, gabapentin, pregabalin)

  • Narcotic and nonnarcotic analgesics, both systemic (eg, opioids) and topical

Read more information about the treatment of herpes zoster.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases article Herpes Zoster.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.