Shingles (Herpes Zoster)

Description

General Measures

Medicine Treatment

Referral

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ICD-10 codes: B02.0-3/B02.7-9

DESCRIPTION

Dermatomal eruption of vesicles on an erythematous base due to varicella zoster virus (lies dormant in nerve ganglia following chickenpox).

GENERAL MEASURES

• Isolate patient from immunocompromised or pregnant non-immune individuals (who may develop severe chickenpox).

• Offer HIV test, especially to patients.

MEDICINE TREATMENT

Antiviral therapy, indicated for herpes zoster:

• In immunocompetent individuals - only of benefit within 72 hours of onset, and
• In immunocompromised patients - beyond 72 hours, provided that there are active lesions.

Adults:

• Antiviral, (active against herpes zoster) e.g.: 
  • Aciclovir, oral, 800 mg five times daily for 7 days (4 hourly missing the middle of the night dose)

LoE:Ia⁸

For pain: 

Pain is often very severe and requires active control. A combination of different classes of analgesics is often necessary.

• Paracetamol, oral, 1g 4–6 hourly when required.
  • Maximum dose: 15mg/kg/dose.
  • Maximum dose: 4g in 24 hours.

LoE:IVb⁹

AND/OR 

During acute presentation if pain is severe and not adequately controlled: 

• Tramadol, oral 50mg 6 hourly (Doctor prescribed).
  • If response not adequate, increase dose to 100mg 6 hourly.

LoE:IVb¹⁰

To treat post-herpetic neuralgia:

Initiate treatment with adjuvant therapy early. 

• Amitriptyline, oral, 25mg at night (Doctor prescribed).
  • Titrate as necessary to a maximum of 75mg.

LoE:IVb¹¹

REFFERAL

• Herpes zoster with secondary dissemination or neurological involvement.
• Ocular involvement (if the tip of the nose is involved then ocular involvement is more likely).
• Uncontrolled pain.
• All children. 

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.1_20 January 2025

Chapter 10: Infections and Related Conditions_10.13 Shingles (Herpes Zoster)