Pediatric Herpes Zoster Medication

  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 11, 2011
 

Medication Summary

Conservative treatments are standard, because the natural course of a pediatric herpes zoster (shingles) infection is short, benign, and self-limited.

Topical lidocaine is occasionally used to treat patients with postherpetic neuralgia. Current evidence is insufficient to recommend topical lidocaine as a first-line agent in the treatment of postherpetic neuralgia with allodynia.[19] Postherpetic neuralgia pain relief may be difficult to achieve. Combination therapies have shown promise, but clinical evidence in support is limited.[20]

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Antiviral agents

Class Summary

Antiviral therapy for herpes zoster may decrease the length of time for new vesicle formation, the number of days to attain complete crusting, and the days of acute discomfort. Initiate treatment as soon as possible because treatment is most effective within 72 hours of eruption. Valacyclovir and famciclovir are not approved by the US Food and Drug Administration (FDA) for pediatric use to treat herpes zoster (shingles), and acyclovir is more commonly used.

The mechanism of action includes the nucleoside analogs initially being phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate. These molecules inhibit herpes simplex virus polymerase with 30-50 times the potency of human alpha-DNA polymerase.

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Acyclovir (Zovirax)

 

Treatment with acyclovir is indicated in patients with involvement of the first branch of the trigeminal nerve, those who are immunocompromised, or those with increased risk for major complications from a varicella infection (ie, patients >13 y, those receiving long-term corticosteroid or aspirin therapy, those with chronic cutaneous or pulmonary diseases). Zoster in adolescents may be treated with oral acyclovir if initiated within 72 hours of eruption.

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Analgesics

Class Summary

Pain control is fundamental to the care of patients with herpes zoster (shingles).

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Acetaminophen (Tylenol)

 

This medication is indicated for use in patients with mild pain or fever. It is the drug of choice for patients with aspirin sensitivity, upper GI disease, or for patients who are taking oral anticoagulants.

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Ibuprofen (Advil, Motrin)

 

Ibuprofen is a nonsteroidal anti-inflammatory that is indicated for use in patients with mild to moderate pain. It works by inhibiting inflammatory reactions and pain by decreasing prostaglandin synthesis.

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Contributor Information and Disclosures
Author

Camila K Janniger, MD  Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School

Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Andrea N Driano, MD  Consulting Staff, Department of Emergency Medicine, Children's Hospital and Medical Center, Seattle WA

Disclosure: Nothing to disclose.

Specialty Editor Board

Kevin P Connelly, DO  Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  2. Najjar DM, Youssef OH, Flanagan JC. Palpebral subconjunctival hemorrhages in herpes zoster ophthalmicus. Ophthal Plast Reconstr Surg. Mar-Apr 2008;24(2):162-4. [Medline].

  3. Ogita S, Terada K, Niizuma T, Kosaka Y, Kataoka N. Characteristics of facial nerve palsy during childhood in Japan: frequency of varicella-zoster virus association. Pediatr Int. Jun 2006;48(3):245-9. [Medline].

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  8. Nouri K, Ricotti CA Jr, Bouzari N, Chen H, Ahn E, Bach A. The incidence of recurrent herpes simplex and herpes zoster infection during treatment with arsenic trioxide. J Drugs Dermatol. Feb 2006;5(2):182-5. [Medline].

  9. Korber A, Franckson T, Grabbe S, Dissemond J. Ambilateral reactivation of herpes zoster V2 following cataract operation of both eyes. J Eur Acad Dermatol Venereol. May 2007;21(5):712-3. [Medline].

  10. Fernandes NF, Malliah R, Stitik TP, Rozdeba P, Lambert WC, Schwartz RA. Herpes zoster following intra-articular corticosteroid injection. Acta Dermatovenerol Alp Panonica Adriat. Mar 2009;18(1):28-30. [Medline].

  11. Koh MJ, Seah PP, Teo RY. Zosteriform herpes simplex. Singapore Med J. Feb 2008;49(2):e59-60. [Medline].

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  13. Kalpoe JS, Kroes AC, Verkerk S, et al. Clinical relevance of quantitative varicella-zoster virus (VZV) DNA detection in plasma after stem cell transplantation. Bone Marrow Transplant. Jul 2006;38(1):41-6. [Medline].

  14. Boer A, Herder N, Blodorn-Schlicht N, Falk T. Herpes incognito most commonly is herpes zoster and its histopathologic pattern is distinctive!. Am J Dermatopathol. Apr 2006;28(2):181-6. [Medline].

  15. Sanford M, Keating GM. Zoster vaccine (Zostavax): a review of its use in preventing herpes zoster and postherpetic neuralgia in older adults. Drugs Aging. 2010;27(2):159-76. [Medline].

  16. Caple J. Varicella-zoster virus vaccine: a review of its use in the prevention of herpes zoster in older adults. Drugs Today (Barc). Apr 2006;42(4):249-54. [Medline].

  17. van Hoek AJ, Gay N, Melegaro A, Opstelten W, Edmunds WJ. Estimating the cost-effectiveness of vaccination against herpes zoster in England and Wales. Vaccine. Feb 25 2009;27(9):1454-67. [Medline].

  18. Schmader K, Levin M, Gnann J, McNeil S, Vesikari T, et al. Efficacy, immunogenicity, safety, and tolerability of zoster vaccine (ZV) in subjects 50 to 59 years of age (Poster/Abstract). Infectious Diseases Society of America. The 48th Annual Meeting of the Infectious Diseases Society of America. 10-21-2010;Vancouver, British Columbia, Canada:Ref Type: Abstract: 3363.

  19. Khaliq W, Alam S, Puri N. Topical lidocaine for the treatment of postherpetic neuralgia. Cochrane Database Syst Rev. 2007;(2):CD004846. [Medline].

  20. Paster Z, Morris CM. Treatment of the localized pain of postherpetic neuralgia. Postgrad Med. Jan 2010;122(1):91-107. [Medline].

  21. Quan D, Hammack BN, Kittelson J, Gilden DH. Improvement of postherpetic neuralgia after treatment with intravenous acyclovir followed by oral valacyclovir. Arch Neurol. Jul 2006;63(7):940-2. [Medline].

 
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Herpes zoster, unilateral, trunk.
 
 
 
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