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Can it not be famciclovir?
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why try and be fancy
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Epidermis Benign
User
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Axillary Stasis
QuestionComment
me getting it wrong because I wrote 1 week duration instead of 7 days...
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NewJeans
Concept
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# Summary 

Shingles is a reactivation of the varicella zoster virus which can lie dormant in nerve ganglia following primary infection (chickenpox). It commonly occurs in the elderly and shingles in young adults should prompt investigation for an underlying immune condition. Management normally includes oral antivirals, but intravenous antiviral medications can be used if severe or if the patient is immunocompromised.

# Signs & Symptoms

Shingles can manifest first as a tingling feeling in a dermatomal distribution. Progresses to erythematous papules occurring along one or more dermatomes within a few days, which develop into fluid-filled vesicles which then crust over and heal. May be associated with viral symptoms e.g. fever, headache, malaise.

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**Herpes zoster ophthalmicus (HZO)** presents with symptoms including a painful red eye, fever, malaise, and headache, followed by an erythematous vesicular rash over the trigeminal division of the ophthalmic nerve. A lesion on the nose, known as **Hutchinson's sign,** may suggest ocular involvement.



# Management

- Oral antiviral (e.g. valaciclovir 1g three times per day for 7 days) within 72h of rash onset if immunocompromised (and infection is not severe) or moderate/severe rash or moderate/severe pain, or non-truncal involvement.
- Admit to hospital for IV antivirals if severe disease or immunocompromise, ophthalmic symptoms or suspicion of meningitis/encaphalitis/myelitis
- Advise avoiding contact with pregnant women, babies and those who are immunocompromised until the lesions are fully crusted over, as transmission can occur via skin contact
- Pain can be managed with NSAIDs (e.g. ibuprofen). If unsuccessful, consider offering amitriptyline (off-label use), duloxetine (off-label use), gabapentin, or pregabalin

# Shingles vaccine

There is a one-off vaccine available for shingles that is typically advised for those in their 70s.

# Complications

- Secondary bacterial infection of skin lesions
- Corneal ulcers, scarring and blindness if eye involved
- Post-herpetic neuralgia
  - Pain occurring at site of healed shingles infection
  - Can cause neuropathic type pain (burning, pins and needles)
  - Can cause allodynia (perception of pain from a normally non-painful stimulus e.g. light touch)

# NICE Guidelines

[NICE Clinical Knowledge Summary (CKS): Shingles](https://cks.nice.org.uk/topics/shingles/)

[NICE Treatment Summary: Varicella-zoster vaccine](https://bnf.nice.org.uk/treatment-summary/varicella-zoster-vaccine-2.html)
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Another example of the appearance of a shingles rash, this time situated on the chest
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An example of the typical appearance of a shingles rash
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# Drug choice feedback

This patient is suffering from shingles, the appropriate treatment of which is aciclovir, an anti-viral effective against the Herpes simplex family.

# Dose/Route/Frequency/Duration feedback

The optimal dose is 800mg, and should be given five times a day for 7 days, as licensed. Although the intravenous route exists, this is not required as the patient is generally well and is in the community setting.
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800 mg
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aciclovir 800 mg tablets
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1 week
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five times daily
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oral (PO)
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800 mg
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aciclovir 800 mg tablets
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7 days
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five times daily
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oral (PO)
Case Presentation: A 51-year-old gentleman sees his GP with a 12-hour history of a painful rash that appeared overnight which was preceded by a mild flu-like illness and itch in the same area. She mentions she has been facing increased stress at work recently.


## PH

Type 2 Diabetes Mellitus

## DH

Metformin 500mg BD PO (NKDA)

## On examination

Appears well, oriented to time and place. Vesicular rash seen along dermatome T5 on the torso. Otherwise normal.

Temperature 36.1°C, HR 72, RR 13, BP 130/80, O2 96% RA, GCS 15, Weight 82kg

## Prescribing Request

Write a prescription for one drug that is most appropriate for treating her rash.