Pediatric Herpes Zoster Treatment & Management

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

Approach Considerations

Unlike herpes zoster in adults, in most children, herpes zoster (shingles) runs a benign, mild course lasting 1-3 weeks. Careful follow-up with attention to the eyelids and eyelid eversion is recommended in patients with herpes zoster, to detect early ocular involvement.

Go to Herpes Zoster, Herpes Zoster Ophthalmicus, and Herpes Zoster Oticus for complete information on these topics.

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Pain Control

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).

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Antiviral Therapy

Antiviral therapy for herpes zoster (shingles) 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.

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Prevention of Herpes Zoster

Zostavax (zoster vaccine) is a 1-dose, high-potency, live, attenuated varicella zoster virus (VZV) vaccine. It is generally well tolerated in older adults.[15] A zoster vaccine immunization program in older adults may be cost effective and has the potential to decrease the incidence of herpes zoster or reduce its severity.[16, 17]

In March 2011, the Food and Drug Administration (FDA) lowered the approved age for use of Zostavax to 50-59 years. Zostavax was already approved for use in individuals aged 60 years or older. Annually, in the United States, shingles affects approximately 200,000 healthy people aged 50-59 years. Approval was based on a multicenter study, the Zostavax Efficacy and Safety Trial (ZEST).[18] The trial was conducted in the United States and 4 other countries in 22,439 people aged 50-59 years. Participants were randomized in a 1:1 ratio to receive either Zostavax or placebo. Participants were monitored for at least 1 year to see if shingles developed. Compared with placebo, Zostavax significantly reduced the risk of developing zoster by approximately 70%.

Since the routine use of the live, attenuated varicella vaccine began in 1994, preliminary observations have revealed that zoster frequency is significantly higher in children who had natural exposure to VZV (chickenpox) than in children who were vaccinated. However, Zostavax is currently only FDA approved for the prevention of herpes zoster in persons aged 50 years and older.

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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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  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].

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

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