Does Treatment of Acute Herpes Zoster Prevent or Shorten Postherpetic Neuralgia? A Systematic Review of the Literature

Recommendations for clinical practice

When acute herpes zoster occurs, providers should restrict their attention regarding PHN prevention to patients older than 50 years. According to the available evidence, antiviral therapy (famciclovir or valacyclovir for 7 days) started within 72 hours of rash onset and/or low-dose amitriptyline (for 90 days) may be offered in an effort to reduce PHN incidence or duration. Patients should be informed of the natural history of zoster and PHN, expected benefits for medications, potential for adverse effects, and expected costs. Other treatments, such as steroids or analgesics, may be offered to alter the acute course of zoster but would have no effect on preventing PHN.

Acknowledgments

The authors wish to thank Dehorah Lovett, Karen J. Alper, and Stacey Raulzhan for their assistance.