eMedicine Specialties > Pediatrics: General Medicine > Dermatology
Zoster: Treatment & Medication
Updated: Apr 8, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
Unlike herpes zoster in adults, in most children, herpes zoster (shingles) runs a benign mild course lasting 1-3 weeks. Although pain may occur, postherpetic neuralgia is quite rare in the pediatric population. Conservative therapy includes nonsteroidal anti-inflammatory drugs (NSAIDs), wet dressings with 5% aluminum acetate (Burrow solution) applied 30-60 minutes 4-6 times daily, and lotions such as calamine. Antiviral therapy for herpes zoster (shingles) may decrease time of new vesicle formation, number of days to attain complete crusting, and 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.
Consultations
Immediately refer children with zoster that involves the first branch of the trigeminal nerve to an ophthalmologist.
Medication
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.11
Antiviral agents
Nucleoside analogs are initially 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.
Acyclovir (Zovirax)
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 PO acyclovir if initiated within 72 h of eruption.
Adult
250-600 mg/m2 per dose PO 4-5 times per d for 7-10 d
10 mg/kg per dose IV or 500 mg/m2 per dose IV q8h
Pediatric
Administer as in adults
CNS toxicity of acyclovir is increased by concomitant use of probenecid or zidovudine
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Carefully monitor renal function of patients with renal failure or concurrent therapy with nephrotoxic medications
Analgesics
Pain control is fundamental to care of patients with herpes zoster (shingles).
Acetaminophen (Tylenol)
Indicated in patients with mild pain or fever. DOC for patients with aspirin sensitivity, GI disease, or anticoagulation.
Adult
650 mg PO q4h; not to exceed 4 g/d
Pediatric
<12 years: 15 mg/kg per dose PO q4h prn; not to exceed 2.6 g/d
>12 years: Administer as in adults
Therapeutic effects may be diminished and hepatotoxicity may be increased when coadministered with barbiturates, carbamazepine, hydantoins, isoniazid, rifampin, or sulfinpyrazone
Documented hypersensitivity; G-6-PD deficiency
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Carefully monitor hepatic function of patients with hepatic failure; acetaminophen is contained in many OTC products, and combined use with these products may result in cumulative doses exceeding recommended maximum dose
Ibuprofen (Advil, Motrin)
Indicated in patients with mild-to-moderate pain.
Adult
200-400 mg PO q6h
Pediatric
<12 years: 5-10 mg/kg per dose PO q6h; not to exceed 2.4 g/d
>12 years: Administer as in adults
Loop diuretics may be less effective when coadministered with ibuprofen; probenecid can increase serum concentration
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Category D in third trimester of pregnancy; caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in coagulation abnormalities or during anticoagulant therapy; acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with renal disease or compromised renal perfusion are at increased risk of acute renal failure
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References
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Further Reading
Keywords
zoster, herpes zoster, shingles, varicella-zoster virus, VZV, chickenpox, vesicular rash, human immunodeficiency virus, HIV, cardiac transplant, renal transplant, appendicitis, renal calculi, biliary colic, myeloma, colon cancer, lymphadenopathy, treatment, diagnosis
Treatment & Medication: Zoster