eMedicine Specialties > Pediatrics: General Medicine > Dermatology

Zoster: Treatment & Medication

Author: Camila K Janniger, MD, Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School
Coauthor(s): Andrea N Driano, MD, Consulting Staff, Department of Emergency Medicine, Children's Hospital and Medical Center, Seattle WA
Contributor Information and Disclosures

Updated: Apr 8, 2009

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

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

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

More on Zoster

Overview: Zoster
Differential Diagnoses & Workup: Zoster
Treatment & Medication: Zoster
Follow-up: Zoster
Multimedia: Zoster
References
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References

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Further Reading

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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

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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.

Medical Editor

Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; 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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-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.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
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.

 
 
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