What is an appropriate management strategy for acute zoster?
Studies of antiviral treatment, such as famcyclovir and valacyclovir, have shown that early treatment shortens the time of pain associated with the acute attack, in essence reducing the incidence of PHN. Antivirals are recommended for those over the age 50 or for anyone with a more complicated or extensive initial presentation such as facial involvement, severe rash, poorly controlled pain, or those who are immunocompromised. Corticosteroids such as prednisone and early sympathetic nerve block can have valuable analgesic effects during acute zoster. Epidural administration of local anesthetic and steroid may reduce both the severity of HZ pain and chance of developing PHN. The use of low-dose amitriptyline during acute zoster may reduce PHN according to some studies. Once PHN develops, pain can be aggressively managed with a combination of systemic analgesics, using the same general approach as for other types of neuropathic pain, as well as topical agents like a lidocaine patch.