Herpes zoster has been known since ancient times. It is a ubiquitous disease, occurring sporadically without any seasonal preference and is caused by the varicella-zoster virus. It may be defined as an endogenous relapse of the primary
infection varicella.
Herpes zoster is characterised by typical efflorescences in the innervation region of a cranial or spinal nerve and starts and ends with
pain of varying intensity. Currently, several
antiviral drugs are approved and many studies have shown that
antiviral therapy, started early in the course of disease, can significantly reduce the risk and the duration of
postherpetic neuralgia in elderly patients. The effects of all
antivirals discussed in this article, given either orally or intravenously, are comparable with regards to the resolution of virus replication, prevention of dissemination of skin lesions and reduction of acute
herpes zoster pain.
Valaciclovir (
valacyclovir),
famciclovir and
brivudine (
brivudin) are comparably effective in the reduction of the incidence and/or prevention of
zoster-associated
pain and
postherpetic neuralgia.
Brivudine 125mg once daily is as effective as
famciclovir 250mg three times daily in reducing the prevalence and the duration of
zoster-associated
pain and
postherpetic neuralgia, especially if
therapy is combined with a structured-
pain therapy. The intensity of the
therapy for
pain should depend on the intensity of the
pain that it is treating.
Famciclovir and
brivudine offer an advantage over other
antivirals because they are administered less frequently; this is particularly relevant for elderly patients who may already be taking a number of medications for other diseases. Therefore,
antiviral therapy in combination with adequate
pain management should be given to all elderly patients as soon as
herpes zoster is diagnosed.