Older age at onset

■ More psychosocial interference in role, social, and physical functioning; personality disorders

■ Compromised immune functions (Katz et al., 2005)

To minimize the possibility of PHN, patients with HZ should take antiviral treatment at the onset of the eruption. With no antiviral treatment, 40% of the patients with HZ will develop PHN, although the incidence drops to 20% in those patients who take the antiviral medications (Hampton, 2005). After many years in development, a new HZ vaccine has been released for patients who are older and at greater risk for HZ and PHN. This new development will hopefully decrease the cases of HZ and subsequently decrease the cases of PHN.

The 5% lidocaine patch (Lidoderm) was developed for use in this condition. It is a prescription strength topical local anesthetic application in patch form that penetrates deeper into the dermis to provide a local anesthetic effect in the area of PHN. The newest medication that is considered for this condition is the Quetensa 8% capsaicin patch. It is a patch with high concentrations of capsaicin cream that requires a health care provider to place it for a 60-minute treatment. Prior to the treatment, the area needs to be treated with a topical anesthetic agent, such as a eutectic mixture of local anesthetic, so the patient will be able to tolerate the treatment. There is emerging evidence for the use of combination treatments for PHN. Interventional options, such as epidural steroid injections, trigger point injections, or acupuncture, have limited evidence for use but have anecdotal reports of efficacy.

Clinical Pearl

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