The recommended antiviral
treatments are valacyclovir 1,000 mg by mouth 3 times
daily for 7 days, famciclovir 500 mg by mouth 3 times
daily for 7 days, or acyclovir 800 mg by mouth 5 times
daily for 7 to 10 days.
Famciclovir and valacyclovir
compared with acyclovir have the advantage of better
absorption, resulting in higher antiviral activity and less
frequent dosing.
It is worth noting that patients taking
antiviral medications should be encouraged to stay well
hydrated because all 3 antiviral drugs have been
associated with increased creatinine levels in poorly
hydrated patients.
Also, patients should be advised to
avoid consumption of alcohol, which has diuretic
properties and interacts with pain medications. General
recommendations for the timing of treatment are to
initiate treatment within 72 hours of rash onset.
However, if 4 days has passed since onset of the rash
and new lesions are still appearing at the time of clinical
presentation, treatment should be considered.
There is likely minimal benefit of antiviral therapy in the patient
who has lesions that have encrusted.
วววววววHZ may have unusual presentations such as zoster
multiplex, which occurs in multiple contiguous or
noncontiguous dermatomes.
Zoster sine herpete, a
variant form of shingles, is diagnosed based on clinical
presentation.
Zoster sine herpete is an uncommon
manifestation of herpes zoster virus infection and
presents with pain in a dermatomal distribution
without the rash of cutaneous zoster.
Therefore, in the absence of a rash, clinicians should pursue a
diagnostic workup.
Positive immunoglobulins
A and M are serologic indicators to help diagnosis,
although there are challenges to interpreting the
results because they can be indications of primary
infection, reinfection, or reactivation.