Oral antivirals for herpes zoster work best when started within 72 hours of rash onset, and are reasonable later if new lesions are still appearing. Treatment is particularly worthwhile in people over 50, those with moderate or severe pain, and anyone who is immunocompromised.
Involvement of the tip or side of the nose (Hutchinson sign), eye symptoms or the ophthalmic division of the trigeminal nerve needs same-day ophthalmology assessment. Immunocompromised patients and those with disseminated rash may need intravenous treatment.
- Start oral aciclovir, valaciclovir or famciclovir within 72 hours of rash onset.
- Consider treatment after 72 hours if new lesions are still forming.
- Refer the same day if the rash involves the eye, the nose tip or the forehead with eye symptoms.
- Offer zoster vaccination once the episode has resolved, where eligible.
Why it matters
The treatment window is short, and patients often present on the third or fourth day.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for family medicine, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free