Corticosteroid therapy of zoster-associated pain

Abstract

Lack of exact clinical studies on effects of corticosteroids in therapy and prevention of herpes zoster-related pain, elicited many controversies in the past. The aim of our study was to estimate effects of prednisone on frequency, intensity and duration of postherpetic neuralgia. 68 immunocompetent herpes zoster patients, 8-90 years of age (37 females and 31 males, mean age 55.7 years) were enrolled for study; 30 patients were treated with acyclovir (5 x 800 mg daily for a 7-day period) and prednisone (initial daily dose 60 mg, tapering over 14 days), and the control group of 38 patients with acyclovir only. Patients were clinically followed up for 3 months after complete resolution of skin lesions. Chi-square test was used in statistical data analysis. The difference regarding incidence of postherpetic neuralgia in acyclovir/prednisone group and acyclovir group (although slightly less in the former one) was not significant. Duration of postherpetic neuralgia over 3 months was similar in both groups. Mild postherpetic pain was more common in the acyclovir/prednisone group (44.4%) than in the acyclovir group (28.6%); however, statistical validation requires more patients to be studied. Results of our study didn't confirm efficiency of prednisone regarding occurrence and characteristics of postherpetic neuralgia. Failure of prednisone therapy may be partly contributed to advanced age of patients and delayed onset of therapy. Use of corticosteroids in zoster patients gives neither reliable protection from appearance of postherpetic neuralgia, nor shortens its duration. Further investigations are necessary to estimate their effects on postherpetic pain.