Management strategies for herpes zoster and postherpetic neuralgia.

Evidence-based strategies for the management of herpes zoster and postherpetic neuralgia (PHN) include the use of antiviral agents in acute zoster and specific analgesics in PHN. Antiviral agents are effective in reducing the severity and duration of acute herpes zoster when given within 72 hours of rash onset, but they do not prevent PHN. Anticonvulsants, tricyclic antidepressants, opioids, and topical treatment modalities such as lidocaine-containing patches and capsaicin cream offer moderate pain relief to some patients with PHN, but they may be associated with adverse events that limit their use. Therefore, prevention of herpes zoster and PHN with prophylactic vaccination using the zoster virus vaccine is an effective strategy to reduce the morbidity of these conditions. Treatment modalities are available, however, that may shorten the duration of acute herpes zoster and alleviate the pain of PHN.