Antiviral Therapy and Local Treatment for Herpes Zoster

In the twenty-first century, there is great interest in prevention of zoster, both in healthy and immunocompromised patients. Successful prevention of clinical reactivation of varicella zoster virus (VZV) is obviously preferable to treatment after VZV has reactivated and caused disease. Despite the development of effective zoster vaccines [1, 2], however, there will continue to be a need for antiviral therapy for zoster in patients who have not received immunization or in whom a vaccine has not been entirely effective. Today, most individuals who develop zoster, particularly if they are immunocompromised or over 50 years old, are recommended to receive specific therapy mainly to decrease morbidity from VZV infection; death from zoster is uncommon or rare [3]. Therapy of zoster, even if given early after onset, unfortunately, probably does not prevent development of postherpetic neuralgia (PHN), as discussed below. On the other hand, relief of pain and promotion of healing of the rash of zoster are obviously greatly welcomed by patients, and antiviral therapy is given to most zoster patients.