What it is

➝ Herpes zoster (shingles) is caused by reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox.

➝ It typically presents as a painful, blistering rash in a band-like distribution along one or more dermatomes.

➝ Early antiviral treatment combined with a structured pain management plan is critical to reduce acute symptoms, shorten disease course, and lower the risk of postherpetic neuralgia (PHN).

➝ In Korea, herpes zoster is managed through prompt antiviral therapy, aggressive pain control, and supportive dermatologic care.

Why it’s done

→ To reduce viral replication and limit nerve damage when antivirals are started within 72 hours of rash onset.

→ To relieve acute pain, which can be severe and disabling.

→ To prevent or minimize postherpetic neuralgia, a long-lasting nerve pain condition.

→ To speed up rash healing and reduce risk of complications like secondary bacterial infection.

→ In Korea, herpes zoster management is standardized, with early initiation of antivirals considered essential.

Alternatives

→ No antivirals: Risk of longer healing time, more severe pain, and higher PHN risk.

→ Antiviral drugs (mainstay):

• Acyclovir.
• Valacyclovir (preferred due to better absorption).
• Famciclovir.

→ Pain control options:

• NSAIDs or acetaminophen for mild pain.
• Opioids for severe acute pain.
• Neuropathic pain agents (gabapentin, pregabalin, TCAs) if neuralgia develops.

→ Adjunctive care: Cool compresses, topical soothing agents, wound dressings.

→ Vaccination (Shingrix): Preventive measure for older adults to reduce incidence and severity.

Preparation

→ Diagnosis is clinical: painful rash with grouped vesicles on an erythematous base, following dermatomal distribution.

→ Baseline tests are usually not required for immunocompetent patients but may be considered in elderly or immunocompromised patients.

→ Patients are counseled about strict adherence to antiviral dosing and pain management expectations.

→ In Korea, many clinics use digital photography and dermoscopy to document lesion progress.

How it’s Done

→ Antiviral therapy:

• Acyclovir 800 mg five times daily for 7–10 days.
• Valacyclovir 1000 mg three times daily for 7 days (commonly preferred in Korea).
• Famciclovir 500 mg three times daily for 7 days.

→ Pain management:

• Mild pain: NSAIDs or acetaminophen.
• Moderate to severe pain: Add short-course opioids if necessary.
• Neuropathic pain agents (gabapentin, pregabalin, tricyclic antidepressants) if nerve pain persists or PHN risk is high.

→ Supportive measures:

• Cool wet compresses to soothe skin.
• Non-stick dressings to prevent blister rupture and secondary infection.
• Antihistamines for itch control.

→ In Korean clinics, patients often receive combination therapy, with antivirals, structured pain plans, and dermatology-led wound care programs.

Recovery

→ Rash usually crusts over in 7–10 days and heals within 2–4 weeks.

→ Early antiviral therapy reduces the duration and severity of pain.

→ Most patients recover fully, but 10–20% may develop postherpetic neuralgia, especially older adults.

→ With comprehensive early care, patients often experience less nerve damage, fewer scars, and faster return to daily activities.

Complications

→ Postherpetic neuralgia (PHN): Chronic nerve pain lasting weeks to months.

→ Secondary bacterial infection of open blisters.

→ Ophthalmic zoster: When the virus affects the eye, requiring urgent ophthalmology care.

→ Neurological complications (rare): Encephalitis, meningitis, or motor neuropathies.

→ Medication risks: Antivirals are generally well tolerated; rare side effects include headache, nausea, or kidney effects (mostly with acyclovir).

Treatment Options in Korea

→ Korean dermatology and neurology clinics prioritize early antiviral initiation within 72 hours of rash onset.

→ Valacyclovir is commonly prescribed due to convenient dosing and high effectiveness.

→ Clinics integrate multidisciplinary pain management, with neurologists, pain specialists, and dermatologists collaborating.

→ For high-risk patients (elderly, diabetics, immunocompromised), closer monitoring and preventive care are emphasized.

→ Many Korean clinics also provide postherpetic neuralgia prevention protocols, including early use of gabapentin or pregabalin if severe nerve pain is anticipated.

→ Preventive vaccination with Shingrix is increasingly recommended in Korea for adults over 50, reducing future risk.