Herpes zoster
Reactivation of latent varicella-zoster virus (VZV) in spinal or cranial nerve ganglia after primary chickenpox. Presentation: unilateral vesicular eruption within a dermatome with pain, burning, dysesthesia. AAD 2024 and IDSA 2007 base therapy on antivirals (aciclovir, valacyclovir, famciclovir) for 7 days, started within 72 hours of rash onset. Early start reduces postherpetic neuralgia risk. Recombinant zoster vaccine (Shingrix, two-dose) is recommended for all adults over 50 and for immunocompromised adults over 18.
ICD-10 B023 drugs
Also known as: Shingles
Drugs used for this condition
- AAciclovirFirst line · Antiviral – nucleoside analogueFirst-line for herpes zoster per AAD 2024 and IDSA 2007. Dose 800 mg five times daily for 7 days. Starting within 72 hours of rash onset reduces pain intensity, skin lesion duration, and postherpetic neuralgia risk. Valacyclovir and famciclovir have more convenient three-times-daily dosing with equivalent efficacy and are often preferred.
- AFamciclovirFirst line · Antiviral nucleoside analogue for herpes infections (HSV-1, HSV-2, VZV)Famciclovir is first-line for herpes zoster in adults. AEDV 2021 and NICE recommend starting therapy within 72 hours of rash onset: 500 mg three times daily for 7 days. Early treatment shortens rash duration, reduces postherpetic neuralgia risk and acute pain. Treatment is mandatory in ophthalmic zoster, second trigeminal branch involvement and immunocompromised patients.
- AValacyclovirFirst line · Antiviral – aciclovir prodrugFirst-line for herpes zoster per AAD 2024 and IDSA 2007. Dose 1000 mg three times daily for 7 days. Starting within 72 hours of rash reduces pain intensity, skin lesion duration, and postherpetic neuralgia risk. Convenient dosing improves adherence over aciclovir (five times daily).
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit