Furthermore, herpes zoster presentations in the immunocompromised population can be complicated by disseminated disease and visceral organ involvement. Neuroactive agents eg, TCAs [ 6 ].
Prevention of herpes zoster and PHN via prophylactic vaccination with the herpes zoster vaccine is the best strategy to prevent or reduce the morbidity of these conditions. Prognostic factors in herpes zoster oticus ramsay hunt syndrome. Steel has worked as writer for more than four years and has contributed content to eHow and Pluck on Demand.
However, it is unclear if antiviral therapy prevents PHN because of conflicting study results, which are due in part to different methodologies of pain assessment, definitions of PHN, and length of follow-up [ ].
Antiviral therapy for herpes zoster may decrease the length of time for new vesicle formation, the number of days to attain complete crusting, and the days of acute discomfort. Patients with disseminated disease or severe immunosuppression or who are unresponsive to therapy should be transferred to a higher level of care.
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Antiviral therapy has been demonstrated to halt progression and dissemination of acute herpes zoster in immunocompromised patients, even when initiated more than 72 hours after rash onset.
Patients with mild to moderate pain may respond to over-the-counter analgesics. To achieve this response, capsaicin cream must be applied to the affected area three to five times daily. Diagnosis and therapy of herpes zoster ophthalmicus. Prednisolone was also associated with greater pain relief.
See 'Pregnant women' above. In addition, both agents have greater bioavailability than acyclovir and thus require less frequent dosing. The evidence of benefit notwithstanding, there remains some debate about the use of antivirals in this setting. Ideally, therapy should be initiated within 72 hours of symptom onset.
Eur J Health Econ. For immunocompetent patients, a 7- to day course of acyclovir or a 7-day course of one of the newer agents is probably appropriate; longer courses may be needed in immunocompromised patients. Herpes zoster", section on 'Recurrent zoster' and "Diagnosis of varicella-zoster virus infection". The duration of steroid use should not extend beyond the period of antiviral therapy. There have been no systematic attempts to investigate the prevalence of PHN, and estimates of the point prevalence have ranged fromto 1 million in the United States [ 78 ].
Immune reconstitution inflammatory syndrome. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. An overview" and "Famciclovir: About 20 percent of patients with herpes zoster develop postherpetic neuralgia.
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Progressive outer retinal necrosis in immunocompetent patients treated initially for optic neuropathy with systemic corticosteroids. The use of oral steroids had no effect on the development or duration of PHN.