Shingles: Herpes Zoster Treatment

  • Treatment

    Pregnant women with HZ may need to be hospitalized either to delay delivery or to treat serious complications. An HZ infection during pregnancy appears to have no negative effects on either the mother or baby, regardless of the trimester in which it occurs. Nevertheless, pregnant women who develop an HZ infection during the third trimester are usually hospitalized in hopes of delaying delivery for five to seven days after the start of their illness. On rare occasions, serious complications such as pneumonia and encephalitis may develop and need to be treated.

    Individuals with weakened immune systems need intravenous drug treatment. Therefore, hospitalization is necessary. People with weakened immune systems (for example, cancer patients, organ transplant recipients, and HIV+ people) are at high risk for severe and prolonged HZ infections. They are also at risk for complications of HZ. Treatment consists of intravenous drugs, and may also include alternative drugs in certain circumstances.

    Opthalmic zoster, or a shingles infection involving one eye, is a serious complication of shingles. If untreated, it can lead to blindness in one eye. If you have a zoster rash on your face near your eye, particularly if you have a lesion on the tip of your nose, seek medical care immediately from your doctor or in an emergency room. The prompt iniation of IV antiviral medications can save your eyesight. Individuals with weakened immune systems, such as those with HIV/AIDS, are at highest risk of developing this complication.

    Avoid contact with susceptible individuals until skin lesions have crusted over Table 04. Herpes zoster is not typically transmitted between people. However, individuals with weakened immune systems and no history of chickenpox can sometimes develop a primary varicella  infection after exposure to HZ. Additionally, if a person has had chickenpox, the varicella virus is more likely to reactivate upon exposure, causing an infection.

    Add cool tap water or Burow’s solution (Domeboro) to compresses or a washcloth and hold atop skin lesions to assist with healing. Burow’s solution is an astringent that soothes and cools inflamed, painful, or itchy skin. Add burow’s or water to a compress or washcloth, and apply to the HZ lesions for 20 minutes at a time. This can help to soften the blisters and remove the fluid and crusts. Soaking the lesions in this manner also helps to prevent bacterial infections that can occur with open sores. It’s important to keep in mind that regular soaps and antiseptic solutions may be irritating during an active infection.

    Take acetaminophen as needed for pain and discomfort. Your doctor may also prescribe a narcotic medication such as Tylenol 3 (acetaminophen plus codeine) to reduce pain during the most active stage of the HZ infection. Frequent applications of cold packs may also help to relieve pain (except in people for whom cold triggers extra sensitivity).

    Wear loose, cotton clothing to avoid irritation and discomfort when sores are present and painful. This is especially helpful for people whose pain and skin sensitivity persists even after the active infection has healed. Loose clothing or cotton fabrics are the considered the least irritating.

    Table 4.  Self-Care For HZ Infections

    Call your doctor as soon as you suspect a possible HZ infection
    Avoid contact with susceptible individuals until sores have crusted over
    Use oral analgesics as needed for pain
    Use wet compresses for 20 minutes several times a day to assist with healing
    Apply cold or ice packs to lesions if helpful
    Avoid regular soaps and antiseptics during an active infection
    Wear loose, cotton clothing
    Contact your doctor if pain persists, worsens, or recurs after 30 days
    Contact your doctor if your lesions aren?t healing
    Contact your doctor if you experience any unpleasant side effects during treatment
    Contact your doctor or pharmacist if you miss a pill during treatment and don?t know what to do

    Your doctor is the best source of information on the drug treatment choices available to you.

    Surgery can alleviate the pain of HZ. Surgery is typically reserved for the most severe infections that don’t respond to treatment. It is rarely performed, however, because it may worsen rather than relieve the pain associated with HZ. On the other hand, many patients have found relief with a procedure known as a sympathetic nerve block. During this procedure, a drug to numb and reduce pain is directly injected just above the highest location of the rash. Three injections are made on alternate days.

    Intravenous drugs may be required for people with weakened immune systems. Antiviral therapy is used for people with weakened immune systems (e.g., those with HIV or transplant recipients), but is given intravenously. The only drug that is approved for this use is acyclovir. Like any drug used to fight infection, it is possible to build up a resistance to acyclovir to the point where the drug will no longer be effective against certain organisms or viruses. In these cases, a drug called foscarnet is used instead.

    If you are pregnant and have HZ, your doctor may try to delay delivery until five to seven days after the start of HZ. Optimally, all women of reproductive age should receive a varicella-virus vaccine before they attempt to become pregnant. While HZ rarely presents a risk to a pregnant mother or child, if the mother does become ill, the doctor will usually try to delay delivery to prevent transmission to the newborn. Pregnant women who are very ill and develop complications (such as pneumonia) require hospitalization and intravenous drug therapy.

    Although HZ can be very serious, most infections clear within 1 week to 10 days, and are totally healed within 3 weeks. In most people, infections will clear within 1 week to 10 days, and will be totally healed within 3 weeks. Total healing means that all of the lesions have crusted over and fallen off. Note that it is possible for some scarring and slight changes in skin color to occur; especially in the elderly and in dark-skinned people.

    Although it’s unlikely, the varicella virus can reactivate and cause a second HZ infection. This is thought to occur in about 2% to 4% of all people during their lifetime.

    Contact your doctor if pain or other symptoms persist, worsen, or recur during or after treatment. Complications of HZ infections are very common. Postherpetic neuralgia (PHN) is the most serious and debilitating complication of HZ, and is defined as pain that persists after an HZ infection. If you experience pain 30 days or longer after your infection, you may have PHN, and you should call your doctor. Fortunately, there are antidepressant drugs, topical anesthetics, and antiinflammatory agents that may be taken to decrease the pain of PHN and make the condition more tolerable.

    Ophthalmic zoster (HZ that appears on the face), myelitis (inflammation of the spinal cord or bone marrow), and meningitis (inflammation of the membranes of the brain) have also been reported. In individuals with very severely weakened immune systems, HZ can spread to the lungs and other parts of the skin (disseminated zoster).

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