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Therapeutic Approach

Herpes zoster (HZ) is a primarily neuro-cutaneous papulovesicular dermatomal reactivation of the varicella-zoster virus. HZ can be triggered by advancing age, immunosuppression, and other risk factors, with disease severity and dissemination dependent on immune status and comorbidities. Therapeutic options are directed toward symptom duration (with first-line systemic antiviral efficacy best within 72 hours of eruption onset), pain severity, and specific target organ or disseminated progression. Topical antiviral therapy holds little utility in the management of acute HZ, and adjuvant systemic analgesic use is debatable in acute uncomplicated HZ cases. Postherpetic neuralgia (PHN) may be managed by titrating dosages of agents like gabapentin at the outset of acute HZ symptoms to spur appropriate efficacy in the chronic pain window. The landscape of HZ management has changed significantly in the past 2 decades with the advent of HZ vaccines, notably because they are the only effective data-driven agents to consistently decrease the incidence and resultant morbidity of HZ and PHN. See Table 141-1.

Table 141-1Herpes Zoster Treatment Table

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