This American Family Physician question-and-answer review covers herpes zoster and postherpetic neuralgia. About one in three people will develop herpes zoster, which usually causes a painful, blistering rash in one dermatome that settles in 2 to 4 weeks. Postherpetic neuralgia, pain persisting beyond 90 days, is the commonest complication and occurs in 10% to 18% of people with shingles. Older adults and immunocompromised people are at higher risk.
Treatment of the acute illness uses an antiviral such as aciclovir, valaciclovir or famciclovir, with or without analgesia. For postherpetic neuralgia, the review lists gabapentinoids, serotonin-noradrenaline reuptake inhibitors and tricyclic antidepressants as first-line, with topical agents as adjuncts. It says the illness and its complications are largely preventable with recombinant zoster vaccine, with two doses recommended for adults 50 and over, and for adults 19 and over who are immunocompromised, in US guidance.
This is a review of US-based recommendations. Which vaccine is available in India, at what cost and under what schedule are not addressed here, and Indian guidance should be checked.
- Consider an antiviral for shingles, following your local guidance on who qualifies and when.
- Offer pain control early, and plan for neuralgia lasting beyond 90 days.
- For persistent neuralgia, options include a gabapentinoid, an SNRI or a tricyclic; choose by comorbidity and side effects.
- Raise recombinant zoster vaccine with eligible older and immunocompromised patients, and check local availability and cost.
Why it matters
Prevention by vaccination changes the conversation from managing complications to avoiding them.
Don't overread it
This is a review of US recommendations; availability, cost and schedule in India need local confirmation.
The statistics, in plain English
The 10% to 18% range for neuralgia reflects differences between studies and between age groups. The risk is higher in older patients, so the average understates it in an 80-year-old and overstates it in a 40-year-old.
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