Treatment Plan

Self-management for mild cases Pain management:

• Paracetamol
• Codeine if needed
• Neuropathic pain pathway
• Lidocaine patches
• Oral prednisolone if severe pain (immunocompetent only) Antiviral therapy:
• If ≤72 hours from onset Admission criteria:
• Widespread dissemination
• Systemically unwell
• Ophthalmic involvement with Hutchinson sign
• Immunocompromised

Referral needed:

• Pregnant/breastfeeding requiring antivirals
• New vesicles after 7 days of antivirals
• Recurrent shingles
• Uncontrolled pain Prevention:
• Avoid contact with: non-chickenpox immune, pregnant women, immunocompromised
• Cover weeping lesions
• Avoid school/work if rash weeping/uncovered
• Vaccination: age ≥50 if immunocompromised, age 60-80 for others Prognosis

Complications:

• Post-herpetic neuralgia (>90 days): burning pain, allodynia, hyperalgesia, itching
• Secondary infections
• Scarring
• Ocular complications
• Disseminated disease
• Herpes zoster ophthalmicus (linked with Hutchinson’s sign)
• Ramsay Hunt syndrome