B02.0-3/B02.7-9
DESCRIPTION
Dermatomal eruption of vesicles on an erythematous base due to varicella zoster virus (lies dormant in nerve ganglia following chickenpox).
GENERAL MEASURES
- Isolate patient from immunocompromised or pregnant non-immune individuals (who may develop severe chickenpox).
- Offer HIV test, especially to patients.
MEDICINE TREATMENT
Antiviral therapy, indicated for herpes zoster:
- in immunocompetent individuals - only of benefit within 72 hours of onset, and
- in immunocompromised patients - beyond 72 hours, provided that there are active lesions.
- Antiviral, (active against herpes zoster) e.g.:
- Aciclovir, oral, 800 mg five times daily for 7 days (4 hourly missing the middle of the night dose).
For pain:
Pain is often very severe and requires active control. A combination of different classes of analgesics is often necessary.
- Paracetamol, oral, 1 g 4–6 hourly when required.
- Maximum dose: 15 mg/kg/dose.
- Maximum dose: 4 g in 24 hours.
AND/OR
During acute presentation if pain is severe and not adequately controlled:
- Tramadol, oral 50mg 6 hourly (Doctor prescribed).
- If response not adequate, increase dose to 100mg 6 hourly.
To treat post-herpetic neuralgia:
Initiate treatment with adjuvant therapy early.
- Amitriptyline, oral, 25 mg at night (Doctor prescribed).
- Titrate as necessary to a maximum of 75 mg.
REFERRAL
- Herpes zoster with secondary dissemination or neurological involvement.
- Ocular involvement (if the tip of the nose is involved then ocular involvement is more likely).
- Uncontrolled pain.