Zoster ophthalmicus steroids

Wayne E Anderson, DO, FAHS, FAAN  Assistant Professor of Internal Medicine/Neurology, College of Osteopathic Medicine of the Pacific Western University of Health Sciences; Clinical Faculty in Family Medicine, Touro University College of Osteopathic Medicine; Clinical Instructor, Departments of Neurology and Pain Management, California Pacific Medical Center

Wayne E Anderson, DO, FAHS, FAAN is a member of the following medical societies: California Medical Association , American Headache Society , San Francisco Medical Society , San Francisco Medical Society , International Headache Society , California Neurology Society , San Francisco Neurological Society , American Academy of Neurology , California Medical Association

Disclosure: Received honoraria from Teva for speaking and teaching; Received grant/research funds from Allergan for other; Received honoraria from Insys for speaking and teaching; Received honoraria from DepoMed for speaking and teaching.

Treating the pain associated with herpes zoster, particularly in the acute stage, is considered an integral component of management and may have benefits in reducing the severity and incidence of postherpetic neuralgia. This should follow a stepwise approach based on current Australian guidelines. 11 These have been summarised in Table 1 . Of note, one double-blind randomised controlled trial showed a reduction in incidence of postherpetic neuralgia at six months by about half with early (within 48 hours of rash onset) commencement of low-dose amitriptyline 25 mg at night (for 90 days) although caution must be used when treating the elderly. 12 Pharmacological management of postherpetic neuralgia follows a similar stepwise approach and may additionally involve the use of gabapentin or pregabalin and topical capsaicin. Transcutaneous electrical nerve stimulation (TENS) may also be useful. 13

Unless the immune system is compromised, it suppresses reactivation of the virus and prevents shingles outbreaks. Why this suppression sometimes fails is poorly understood, [35] but shingles is more likely to occur in people whose immune systems are impaired due to aging, immunosuppressive therapy , psychological stress , or other factors. [36] [37] Upon reactivation, the virus replicates in neuronal cell bodies, and virions are shed from the cells and carried down the axons to the area of skin innervated by that ganglion. In the skin, the virus causes local inflammation and blistering. The short- and long-term pain caused by shingles outbreaks originates from inflammation of affected nerves due to the widespread growth of the virus in those areas. [38]

Zostavax vaccination is available (unsubsidised) for protection against shingles. A 2012 meta-analysis showed that older adults who had received the zoster vaccine had a 50% reduced incidence of shingles compared with those who had a placebo vaccination. 16 The vaccine was most effective in people aged 60 – 69 years (64% reduced incidence of shingles). 16 A related meta-analysis was inconclusive as to whether zoster vaccination prevents post-herpetic neuralgia in patients who get shingles despite vaccination. 17

Zoster ophthalmicus steroids

zoster ophthalmicus steroids

Zostavax vaccination is available (unsubsidised) for protection against shingles. A 2012 meta-analysis showed that older adults who had received the zoster vaccine had a 50% reduced incidence of shingles compared with those who had a placebo vaccination. 16 The vaccine was most effective in people aged 60 – 69 years (64% reduced incidence of shingles). 16 A related meta-analysis was inconclusive as to whether zoster vaccination prevents post-herpetic neuralgia in patients who get shingles despite vaccination. 17

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