Prevention And Treatment Of Postherpetic Neuralgia
A systematic review6 considered 42 RCTs of therapies to prevent or reduce the incidence of postherpetic neuralgia pain. Acyclovir reduced the incidence of postherpetic neuralgia pain at three months .
Famciclovir reduced the duration of postherpetic neuralgia pain better than placebo.3 The time to resolution of pain in patients 50 years of age or older was significantly shorter for two dosages of famciclovir than for placebo .
Systemic steroids have demonstrated no additional benefit. Studies examining amitriptyline, narcotics, capsaicin, anticonvulsants, and percutaneous nerve stimulation for postherpetic neuralgia were of fair to poor quality and no conclusions could be drawn from these.
Who Gets Herpes Zoster
Anyone who has had varicella may subsequently develop herpes zoster. Zoster can occur in childhood but is much more common in adults, especially older people. People with various kinds of cancer have a 40% increased risk of developing zoster. People who have had zoster rarely get it again the chance of getting a second episode is about 1%.
Herpes zoster often affects people with weak immunity.
Are There Alternative Treatments
Some studies show that various alternative treatments, from acupuncture to supplements, can offer relief. The research isnât complete, but some shows promise. Check with your doctor before you try any of these:
TENS . This therapy uses tiny electrical pulses to relieve pain. A TENS unit is about the size of a smartphone and comes with small patches called electrodes. You put them over the painful area and turn the unit on and off as your pain comes and goes.
Traditional Chinese medicine: These treatments aim to restore balance in your body. They include acupuncture, the ancient practice of inserting very thin needles into your skin at specific points. Also, moxibustion and cupping, two types of heat therapy, are supposed to draw out toxins. These treatments may be done in combination.
Creams and other skin treatments: A mixture of liquid dimethyl sulfoxide and idoxuridine, an antiviral drug, may reduce swelling and the number of blisters you have when you put it on your rash. And chlorophyll, the chemical that gives plants their green color, is also used directly on the rash as a cream or saline solution.
Supplements: Youâll find a long list of herbs, pills, and oils that claim to relieve shingles. Most have no research to back them up, but there are a couple of exceptions. Papain, a protein found in papayas, is sold in capsules. And manuka and clover honeys can be put directly on your skin. Very early studies on both show they may be helpful.
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What Are The Clinical Features
Replication and transmission of the virus in the nerves and skin lead to the cardinal features of herpes zosterpain and rash. In some people the rash is preceded by a prodromal phase lasting 48-72 hours or longer, consisting of throbbing pain and paraesthesia in the region of the affected sensory nerve. This may sometimes be confused with other acute medical conditions such as angina, cholecystitis, or renal colic, depending on the dermatome involved. The rash of herpes zoster is typically vesicular, affects a single dermatome, and lasts for three to five days before the lesions pustulate and scab .). In immunocompetent patients, the most frequent site of reactivation is the thoracic nerves followed by the ophthalmic division of the trigeminal nerve , which can progress to involve all structures of the eye.3 If the mucocutaneous division of the VII cranial nerve, which innervates the ear and side of the tongue, or the VIII cranial nerve is involved, the development of lesions in the ear, facial paralysis, and associated hearing and vestibulary symptoms are known as Ramsay Hunt syndrome. Herpes zoster may also cause facial nerve palsy without vesicles occurring in the external meatus. Other rare complications include encephalitis, myelitis, retinitis, and hemiparesis, all of which are more common in immunocompromised patients.4
Rash of herpes zoster
Treatment Of Common Cutaneous Herpes Simplex Virus Infections
DAVID H. EMMERT, M.D., Lancaster General Hospital, Lancaster, Pennsylvania
Am Fam Physician. 2000 Mar 15 61:1697-1704.
Herpes simplex virus infection is increasingly common in the United States. New antiviral medications have expanded treatment options for the two most common cutaneous manifestations, orolabial and genital herpes. Acyclovir therapy remains an effective and often less expensive option. Famciclovir and valacyclovir offer improved oral bioavailability and convenient oral dosing schedules but are more expensive than acyclovir. Patients who have six or more recurrences of genital herpes per year can be treated with one of the following regimens: acyclovir, 400 mg twice daily valacyclovir, 1 g daily or famciclovir, 250 mg twice daily. These regimens are effective in suppressing 70 to 80 percent of symptomatic recurrences. Episodic treatment of recurrent genital herpes is of questionable benefit, but it may be helpful in appropriately selected patients. There is little evidence indicating benefit from treatment of recurrent orolabial herpes, which tends to be mild and infrequent.
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What’s The Evidence For Specific Management And Treatment Recommendations
Adair, JC, Gold, M, Bond, RE. âAcyclovir neurotoxicity: clinical experience and review of the literatureâ. South Med J. vol. 87. 1994. pp. 1227-31.
Beutner, KR, Friedman, DJ, Forszpaniak, C. âValaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adultsâ. Antimicrob Agents Chemother. vol. 39. 1995. pp. 1546
Bowsher, D. âThe effects of pre-emptive treatment of postherpetic neuralgia with amitriptyline: a randomized, double-blind, placebo-controlled trialâ. J Pain Symptom Manage. vol. 13. 1997. pp. 327-31.
Campbell, BJ, Rowbotham, M, Davies, PS, Jacob, P, Benowitz, NL. âSystemic absorption of topical lidocaine in normal volunteers, patients with post-herpetic neuralgia, and patients with acute herpes zosterâ. J Pharm Sci. vol. 91. 2002. pp. 1343-50.
Chan, EL, Brandt, K, Horsman, GB. âComparison of Chemicon SimulFluor direct fluorescent antibody staining with cell culture and shell vial direct immunoperoxidase staining for detection of herpes simplex virus and with cytospin direct immunofluorescence staining for detection of varicella-zoster virusâ. Clin Diagn Lab Immunol. vol. 8. 2001. pp. 909
Cobo, LM, Foulks, GN, Liesegang, T. âOral acyclovir in the treatment of acute herpes zoster ophthalmicusâ. Ophthalmology. vol. 93. 1986. pp. 763-70.
Elion, GB. âMechanism of action and selectivity of acyclovirâ. AM J Med. vol. 73. 1982. pp. 7-13.
What Should I Discuss With My Healthcare Provider Before Using Acyclovir Topical
You should not use this medicine if you are allergic to acyclovir or valacyclovir .
Acyclovir topical is not approved for use by anyone younger than 12 years old.
Tell your doctor if you have ever had a weak immune system .
It is not known whether this medicine will harm an unborn baby. However, herpes virus can be passed from an infected mother to her baby during childbirth. If you have genital herpes, it is very important to prevent herpes lesions during your pregnancy, so that you do not have a genitallesion when your baby is born.
You should not breastfeed if you have a herpes lesion on or near your breast.
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Is The Zostavax Vaccine Still Being Used
Yes. It is still recommended for preventing shingles and postherpetic neuralgia in healthy people age 50 and older. Zostavax is given as a single-dose shot versus the two-dose shot for Shingrix. Zostavax is less effective than Shingrix in preventing shingles and postherpetic neuralgia .
Zostavax can be considered if you are allergic to Shingrix or if Shingrix is unavailable due to supply shortage and you want some immediate protection from a possible case of shingles and/or postherpetic neuralgia. Because it is a weakened live vaccine, it may be dangerous if you have cancer, HIV, or take steroids, chemotherapy or other medications that suppress your immune system. Ask your healthcare provider if the Zostavax vaccine is an option for you.
Drug Treatment For Genital Herpes
If you are infected with genital herpes, your doctor may prescribe oral antiviral drugs to help ease your symptoms during both a first episode and recurrent episodes. Your doctor may also suggest taking antiviral drugs daily as a suppressive therapy to reduce symptoms and protect partners.
Remember, though, that antiviral drugs do not wipe out the virus completely. It continues to live in your body, so if you stop taking the drugs that suppress it, you may have more frequent or more intense symptom outbreaks, and the risk of your transmitting the virus to others rises.
Three antiviral drugs, all taken by mouth, are used to treat genital herpes:
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Questions To Ask Your Doctor
- Ive had chickenpox. Am I at risk of developing shingles?
- What is the best treatment for my shingles?
- The pain from shingles isnt going away. What can I do to make myself more comfortable?
- Im on treatment for shingles. When should I call my doctor if things dont get better?
- I have shingles and my children havent had the chickenpox vaccine. Should I get them vaccinated?
- Is the shingles vaccine right for me?
- Are there any risks associated with the shingles vaccine?
- Will my post-herpetic neuralgia ever go away?
- If Ive never had the chickenpox, should I still get the shingles vaccination?
Ranunculus Bulbosus: For Bluish Vesicles And Intense Itching
Ranunculus bulbosus for shingles is derived from the plant bulbous buttercup or St Anthonys Turnip. This is a perennially growing plant and belongs to the Buttercup family. Ranunculus bulbosus is prepared from the bulb of this plant. This plant is native of Western Europe and the northern Mediterranean coast. As an introduced weed it grows in eastern and western parts of North America.It is the principle medicine for treating Herpes zoster. It is indicated for herpetic eruptions with itching where the eruptions are vesicular and pustular. It is highly recommended for shingles with blue blisters that are filled with serum. There is an intense burning and itching that gets worse with contact.
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How Should I Identify The Organism
There are multiple detection methods for herpes virus. For the most part, diagnosis of herpes zoster is based on clinical symptoms and distribution of dermatomal rash exhibited by the patient. Diagnostic testing may be performed on fluid from the vesicles or from cerebrospinal fluid. A polymerase chain reaction test, which has the greatest specificity and sensitivity, confirms the presence of VZV DNA. PCR testing is preferred in almost all situations. The direct immunofluorescent antibody test has a lower sensitivity and specificity of 70-76%. Finally, the viral culture, which was previously used, has a low sensitivity of 20% and takes longer to process, and as such it is rarely used.
Treatment Of Acute Herpes Zoster
A meta-analysis of five randomized controlled trials considered the time to complete resolution of acute herpes zoster pain.1 When treatment was initiated within 48 hours, complete resolution of pain occurred sooner than with placebo . This also was true when treatment was initiated between 48 and 72 hours .
A single RCT2 compared valacyclovir with acyclovir . This study found that the mean times to complete resolution of pain were 44 days for valacyclovir and 51 days for acyclovir when treated within 48 hours .2 When treatment was initiated between 48 and 72 hours after the onset of symptoms, the mean times to complete resolution of pain were 36 days for valacyclovir and 48 days for acyclovir .
Another RCT3 compared two dosage regimens of famciclovir with placebo in 419 adults treated within 72 hours of symptom onset. Famciclovir slightly accelerated the rate of lesion healing compared with placebo .
In a single RCT4 with 55 patients, famciclovir was shown to have equal effectiveness to acyclovir . This small and possibly underpowered study found that there was no significant difference regarding the median time to full lesion crusting, the rate of full crusting at day 28, the median time to resolution of acute pain, or the rate of acute pain at 28 days.
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Shingles On Your Face
Shingles usually occurs on one side of your back or chest, but you can also get a rash on one side of your face.
If the rash is close to or in your ear, it can cause an infection that could lead to:
- loss of hearing
- issues with your balance
- weakness in your facial muscles
Shingles inside your mouth can be very painful. It may be difficult to eat and may affect your sense of taste.
A shingles rash on your scalp can cause sensitivity when you comb or brush your hair. Without treatment, shingles on the scalp can lead to permanent bald patches.
How Long Does Shingles Last
From the time you begin to feel symptoms until the rash has totally disappeared can take three to five weeks.
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What Is The Best Treatment For Herpes Zoster
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If Ive Had Chickenpox Once In My Life Can I Get It Again
Its rare to get chickenpox twice in your life. Once youve had chickenpox, youre usually immune to it for the rest of your life. However, its not totally impossible. If you have a severely weakened immune system , you can get chickenpox a second time. If youve had chickenpox, you are more likely to get shingles at some point in your life than a repeat bout of chickenpox.
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How Do You Prevent Shingles
Vaccination is a safe and effective way to protect against shingles in most people. The shingles vaccine should not be given to people who are immunocompromised.
For more information on shingles immunisation, see Shingles immunisation service.
Shingles is less contagious than chickenpox. The risk of spreading the disease is low if the rash is covered. When the rash has developed crusts, you are no longer infectious.
If you have shingles, you should:
- cover the rash
- avoid touching or scratching the rash
- wash your hands often to prevent the virus from spreading.
Avoid contact with these people until the rash has developed crusts:
- pregnant women who have never had chickenpox or the chickenpox vaccine
- premature or low birthweight babies
- children who have not had chickenpox or the chickenpox vaccine
- people with weakened immune systems, such as people who:
- have had chemotherapy
- are taking other medicines that weaken their immune system
- have had a transplant
- are living with HIV.
How Serious Is Herpes Zoster
The rash is accompanied by severe pain, which, in some people, does not subside after healing but persists for months or years. This prolonged zoster associated pain, usually defined as pain persisting for more than four months after the rash has healed, is known as postherpetic neuralgia and is the most common complication of herpes zoster. The pain can be debilitating, exacerbated by the slightest touch, and lead to loss of employment, depression, and social isolation. Identification of patients at risk of developing postherpetic neuralgia is therefore crucial, as they stand to gain most from treatment. Several clinical and laboratory parameters have been suggested and evaluated as risk factors predicting postherpetic neuralgia , but they are by no means exhaustive.56
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What Causes Herpes Zoster
After primaryinfectionvaricellaVZV remains dormant in dorsal root ganglianerve cells in the spine for years before it is reactivated and migrates down sensory nerves to the skin to cause herpes zoster.
It is not clear why herpes zoster affects a particular nerve fibre. Triggering factors are sometimes recognised, such as:
- Pressure on the nerve roots
- Radiotherapy at the level of the affected nerve root
- Spinal surgery
- An injury
- Contact with someone with varicella or herpes zoster
Who Should Be Vaccinated With Shingrix
The Shingrix vaccine is recommended for those 50 years of age and older who are in good health.
You should get the Shingrix vaccine even if:
- You have had shingles already.
- You have been previously vaccinated with Zostavax .
- You do not know for sure if youve ever had chickenpox.
Ask your healthcare provider, who knows your entire health history, if getting this vaccine is right for you.
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Why Trust Verywell Health
As a seasoned health writer, Jennifer Nied understands how vital quality product recommendations are for treating symptoms safely and effectively at home. For over 10 years, she has reviewed products, interviewed experts, scrutinized ingredients, and pored over research studies and claims, to help readers like you understand what works for your specific conditions. Every product in this piece was selected taking into account recommendations from doctors, published research, and real customer reviews.
Additional reporting to this story by Simone Scully
Simone Scully is a New York-based writer and editor with years of experience writing about health, wellness, science, and lifestyle. Her byline has appeared at Healthline, Well+Good, Narratively, Romper, Motherifigures magazine, Nautilus, Narratively, AskMen, among other places.
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