Acute herpes zoster (AHZ; shingles) presents as pain usually in V1, distribution the ophthalmic division of the trigeminal nerve. The pain is spontaneous and is described as burning, aching or lancinating. There is associated hyperalgesia. Small cutaneous vesicles are seen during AHZ (acute phase) and scarring may be present during post-herpetic neuralgia (PHN). Post-herpetic neuralgia describes the persistence ofpain after a month, when the vesicles have healed.
The goal is to treat AHZ early with antiviral drugs and analgesics with the hope of decreasing the incidence of PHN. Tricyclic antidepressants, anticonvulsants, NSAIDS, and opioids are also useful for pain control. It is often challenging to treat pain in PHN. Tricyclic antidepressants, lidoderm patch 5%, and anticonvulsants are helpful.
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