Treatment Of Herpes Zoster Research Articles

Randomized clinical trial of famciclovir or acyclovir for the treatment of herpes zoster in adults

BackgroundThis study investigated the safety and efficacy of famciclovir compared to acyclovir in patients with herpes zoster, to determine whether the two regimens are equally effective for the treatment of patients with uncomplicated herpes zoster over a period of 7days. MethodsPatients were randomly assigned to receive either famciclovir 500mg (one tablet) three times daily or acyclovir 800mg (two capsules) five times daily for 7 days. The primary endpoint was defined as the time to full crusting of herpes zoster lesions. Secondary endpoints were the proportion of patients who achieved complete cure and the change in score of signs/symptoms (pain, vesicular lesions, loss of sensitivity, burning pain, and pruritus) according to the patient diary. This study has been registered at ClinicalTrials.gov (NCT01327144). ResultsOne hundred and seventy-four patients were enrolled and randomized; 151 of these patients completed treatment (n=75 famciclovir, n=76 acyclovir). A similar proportion of patients who received acyclovir (94.74%) and famciclovir (94.67%) achieved complete cure. The mean time to full crusting of herpes zoster lesions was 15.033days in the acyclovir group and 14.840days in the famciclovir group (log-rank p-value=0.820). The most common adverse events in the pooled groups were headache, diarrhea, nausea, back pain, cold, and drowsiness, but none of these was deemed to be clinically important. ConclusionsBoth interventions obtained high rates of cure and had a similar time to full crusting of lesions. Analysis of the primary efficacy endpoint proved that famciclovir is non-inferior to acyclovir, as the confidence interval for the difference in efficacy did not violate the non-inferior margin. Therefore, the results are not different enough to be clinically relevant.

Preliminary study on contrast flow analysis of thoracic transforaminal epidural block.

BackgroundThe thoracic transforaminal epidural block (TTFEB) is usually performed to treat herpes zoster or postherpetic neuralgia (PHN). Especially, multiple segmental involvements and approximate contrast medium spread range, according to volume, help to choose the proper drug volume in the transforaminal epidural block. This study investigated the contrast medium spread patterns of 1-ml to 3-ml TTFEBs.MethodsA total of 26 patients with herpes zoster or PHN were enrolled in this study. All participants received 1 ml, 2 ml, or 3 ml of contrast medium. Results were divided into Groups A, B and C based on the volume (1, 2, or 3 ml), with n = 26 for each group. After the injection of contrast medium, the spread levels were estimated in both the lateral and anteroposterior (AP) images using fluoroscopy.ResultsThe cephalad spread of contrast medium in the lateral image as expressed by the median (interquartile range) was 2.00 levels (1.00–2.00) for Group A, 2.50 (2.00–3.00) for Group B, and 3.00 (2.00-4.00) for Group C. The caudal spread level of contrast medium was 1.00 (1.00-2.00) for Group A, 2.00 (2.00–3.00) for Group B, and 2.00 (2.00–3.00) for Group C. There was ventral and dorsal spread of the 3-ml contrast medium injection in 88% (23/26) of cases in the lateral image.ConclusionsInjection of 3 ml of contrast medium through the foramina spread 6 levels in a cephalocaudal direction. Spread patterns revealed a cephalad preference. TTFEB resulted in dorsal and ventral spread in a high percentage of cases. This procedure may be useful for transferring drugs to the dorsal and ventral roots.

Secreting ectopic adrenal adenoma: A rare condition to be aware of

Ectopic adrenal adenoma causing chronic Cushing's syndrome (CS) is a rare phenomenon. Diagnosis is usually made years after disease onset because of the insidious nature of the ectopic adrenal gland and because it overlaps with common symptoms, such as overweight and hypertension, in the general population (Kreitschmann-Andermahr et al., 2015). Here, we report the case of a 46-year-old male with a 15-year history of severe hypertension, facial plethora, and centripetal obesity. During treatment for herpes zoster, the patient presented with severe hypokalemia and flaccid paralysis, characteristic changes associated with CS. The serum cortisol level was elevated and baseline adrenocorticotrophic hormone (ACTH) was suppressed. After administration of the low-dose overnight dexamethasone suppression test, plasma cortisol was 38.9μg/dL. A contrast computed tomography (CT) scan revealed normal adrenal glands and significant tumor adjacent to the right renal hilum measuring ∼3.6×2.3cm. The tumor was removed through retroperitoneoscopy, and pathological examination confirmed adrenocortical adenoma and myelolipoma metaplasia. The serum potassium level gradually became normal after surgical removal of the mass. In the current report, we have reviewed the pertinent literature and highlighted the importance of considering ectopic adrenal adenoma in the differential diagnosis of chronic CS with nonspecific symptoms.

Effectiveness of continuous epidural analgesia on acute herpes zoster and postherpetic neuralgia: A retrospective study.

Despite early treatment of herpes zoster (HZ), postherpetic neuralgia (PHN) can persist. This study was designed to compare the therapeutic and pain relief effects of continuous epidural analgesia (CEA) on the chronic phase as well as the acute phase of HZ with standard medical treatment.Medical records of 227 patients with moderate to severe zoster-associated pain that had not responded to standard medications were retrospectively reviewed. Patients received standard treatment alone (medical group) or standard treatment plus concurrent CEA (epidural group). The acute and chronic groups were classified according to a 4-week cut-off with regard to time between the onset of the rash and the first treatment. Four groups were studied: Group A (acute/medical group); Group B (acute/epidural group); Group C (chronic/medical group); and Group D (chronic/epidural group). Pain was assessed using the visual analog scale (VAS) and measured every 2 weeks for 6 months. We compared the pain rating at 6 months after the first treatment with the initial pain rating. Response to treatment was defined as a ≥50% reduction in pain severity since the initial visit. Remission was considered complete for patients whose VAS pain score was ≤2 for >3 successive visits and who no longer needed medical support.Patients who received a combination of standard treatment plus CEA (Groups B and D) had significantly higher response to treatment (P = .001) than patients receiving standard treatment alone (Groups A and C). The adjusted odds ratio (OR) for response to treatment in the epidural group versus the medical group was 5.17 (95% confidence interval [CI]: 1.75–15.23) in the acute group and 5.37 (95% CI: 1.62–17.79) in the chronic groups. The adjusted OR for complete remission in the epidural group versus the medical group was 3.05 (95% CI: 1.20–7.73) in the acute group and 4.46 (95% CI: 1.20–16.54) in the chronic group.CEA can effectively relieve pain caused by PHN and acute HZ and increase remission rates. Combining CEA with standard medical treatment may offer a clinical advantage in the management of pain caused by PHN as well as acute HZ.

Antiviral Drugs Against Alphaherpesvirus.

The discovery of acyclovir and penciclovir has led to the development of a successful systemic therapy for treating herpes simplex virus infection and varicella-zoster virus infection, and the orally available prodrugs, valacyclovir and famciclovir, have improved antiviral treatment compliance. Acyclovir and penciclovir are phosphorylated by viral thymidine kinase and are incorporated into the DNA chain by viral DNA polymerase, resulting in chain termination. Helicase-primase plays an initial step in DNA synthesis to separate the double strand into two single strands (replication fork) and is a new target of antiviral therapy. The helicase-primase inhibitors (HPIs) pritelivir and amenamevir have novel mechanisms of action, drug resistance properties, pharmacokinetic characteristics, and clinical efficacy for treating genital herpes. The clinical study of amenamevir in herpes zoster has been completed, and amenamevir has been submitted for approval for treating herpes zoster in Japan. The clinical use of HPIs will be the beginning of a new era of anti-herpes therapy.

The Influence of Hepatic and Renal Impairment on the Pharmacokinetics of a Treatment for Herpes Zoster, Amenamevir (ASP2151): Phase 1, Open-Label, Single-Dose, Parallel-Group Studies

IntroductionAmenamevir (ASP2151) is a nonnucleoside human herpesvirus helicase-primase inhibitor that was approved in Japan for the treatment of herpes zoster (shingles) in 2017. This article reports the results of two clinical trials that investigated the effects of renal and hepatic impairment on the pharmacokinetics of amenamevir.MethodsThese studies were phase 1, open-label, single-dose (oral 400 mg), parallel-group studies evaluating the pharmacokinetics, safety, and tolerability of amenamevir in healthy participants and participants with moderate hepatic impairment and mild, moderate, and severe renal impairment.ResultsIn the hepatic impairment study, the pharmacokinetic profile of amenamevir in participants with moderate hepatic impairment was generally similar to that of participants with normal hepatic function. In the renal impairment study, the area under the amenamevir concentration versus time curve from the time of dosing up to the time of the last sample with extrapolation to infinity of the terminal phase was increased by 78.1% in participants with severe renal impairment. There was a positive relationship between creatinine clearance and oral and renal clearance for amenamevir in the renal impairment study. In both studies, amenamevir was safe and well tolerated.ConclusionThe findings of the hepatic impairment study indicate that no dosing adjustment is required in patients with moderate hepatic impairment. In the renal impairment study, systemic amenamevir exposure was increased by renal impairment. However, it is unlikely that renal impairment will have a significant effect on the safety of amenamevir given that in previous pharmacokinetic and safety studies in healthy individuals amenamevir was safe and well tolerated after a single dose (5–2400 mg, fasted condition) and repeated doses for 7 days (300 or 600 mg, fed condition), and the amount of amenamevir exposure in the renal impairment study was covered by those studies. These findings suggest that amenamevir does not require dosage reduction in accordance with the creatinine clearanceFundingAstellas Pharma.

Pharmacokinetic Evaluation of the Interactions of Amenamevir (ASP2151) with Ketoconazole, Rifampicin, Midazolam, and Warfarin in Healthy Adults.

IntroductionAmenamevir is a nonnucleoside antiherpes virus compound available for treating herpes zoster infections. Four studies aimed to determine any potential interactions between amenamevir and ketoconazole, rifampicin, midazolam, or warfarin in healthy male participants.MethodsTwo studies were open-label studies that evaluated the effects of multiple doses of ketoconazole (400 mg) and rifampicin (600 mg) on the pharmacokinetics of a single oral dose of amenamevir. The other two studies were randomized, double-blind, parallel-group studies that evaluated the effects of multiple doses of amenamevir on the pharmacokinetics of a single dose of midazolam (7.5 mg) and warfarin (25 mg). A drug interaction was considered to occur if the 90% confidence interval (CI) of the least squares geometric mean ratio (GMR) of amenamevir to the comparator was outside the prespecified interval of 0.80–1.25.ResultsInteractions were observed between amenamevir and ketoconazole, rifampicin, and midazolam, but not between amenamevir and warfarin. After a single 400-mg dose of amenamevir, the GMRs of amenamevir plus ketoconazole or rifampicin versus amenamevir alone for C max and the area under the plasma concentration–time curve from time zero to infinity (AUCinf) were 1.30 (90% CI 1.17–1.45) and 2.58 (90% CI 2.32–2.87), respectively, for ketoconazole and 0.42 (90% CI 0.37–0.49) and 0.17 (90% CI 0.15–0.19), respectively, for rifampicin. Following multiple doses of amenamevir (400 mg), the GMRs of midazolam plus amenamevir versus midazolam alone for AUCinf and C max were 0.53 (90% CI 0.47–0.61) and 0.63 (90% CI 0.50–0.80), respectively. After a single dose of warfarin, the (S)-warfarin and (R)-warfarin mean C max increased and mean AUCinf decreased in the presence of amenamevir; however, the 90% CIs of the GMRs for these parameters remained within the predefined limits.ConclusionThese findings confirm that amenamevir (as a cytochrome P450 3A4 substrate) can interact with ketoconazole or rifampicin, and (as a cytochrome P450 3A4 inducer) can interact with midazolam; however, no interaction between amenamevir and (S)-warfarin was observed, indicating that amenamevir is not an inducer of cytochrome P450 2C9.FundingAstellas Pharma.Trial registrationEudraCT2007-002227-33 (study 15L-CL-008), EudraCT2007-002228-14 (study 15L-CL-009), EudraCT2007-002761-13 (study 15L-CL-010), and EudraCT2007-002779-14 (study 15L-CL-018).

Clinical effect of acyclovir combined with prednisone in treatment of herpes zoster

Objective To observe the clinical efficacy of acyclovir combined with prednisone in the treatment of herpes zoster. Methods 128 patients with herpes zoster were selected as study objects, and they were divided into the treatment group and the control group by using the method of complete random distribution, 64 cases in each group.The patients in the treatment group were treated with oral acyclovir and prednisone, while those in the control group received oral acyclovir alone.The clinical efficacy of the two groups was observed. Results The blistering, crusting and healing time had no significant differences between the two groups(t=1.76, 1.79, 1.41, all P>0.05). The analgesic time of the treatment group was (3.2±1.2)d, which was significantly shorter than (7.4±2.6)d of the control group (t=11.73, P<0.01). The total effective rate of the treatment group was 95.3%, which was significantly higher than 73.4% of the control group, the difference was significant(χ2=16.13, P<0.01). In the treatment group, there were 2 cases of postherpetic neuralgia.In the control group, 8 cases had postherpetic neuralgia.The incidence rate of adverse events in the treatment group was significantly lower than that in the control group(χ2=6.01, P<0.05). Conclusion Acyclovir combined with prednisone in the treatment of herpes zoster has significant clinical efficacy, it can shorten the analgesic time, and is worthy of clinical application. Key words: Herpes zoster; Acyclovir; Prednisone

Toxicity study of Warbugia ugandensis used by traditional healers to treat Herpes zoster in HIV patients using Drosophila melanogaster as a model

Objectives: To carryout toxicity study of Warbugia ugandensis, also to participate in the compilation of ethnopharmacological knowledge of Rukararwe and makes it available for future research, and also to avail the healers with the information on scientific literature. Methods: Different concentrations of aqueous and ethanol extracts of Warbugia ugandensis with or without food were fed on Drosophila melanogaster and acute toxicity, locomotion assay, longevity study of the flies was done in 3 replicates, together with preliminary phytochemical screening of different extracts. Results: Traditional healers mostly used oral formulation (80%), herbs for treating herpes zoster (40%); Steroids, Terpenoids and Glycosides were present in all extracts of W. ugandensis. Extracts of W. ugandensis were not toxic at acute exposure, ethanol extract of W. ugandensis decreased negative geotaxis (P&lt;0.01) and aqueous extract also (P&lt;0.05). Finally longevity study has shown toxicity of ethanolic extract of W. ugandensis at concentration of 1% and 2%. Conclusion: The herb appears to be non toxic at acute exposure and toxic (ethanolic extract) at higher dose on chronic exposure.

АНАЛІЗ ЕФЕКТИВНОСТІ АЛОКІНУ-АЛЬФА У СКЛАДІ КОМПЛЕКСНОЇ ТЕРАПІЇ РЕЦИДИВНОГО ОПЕРІЗУВАЛЬНОГО ГЕРПЕСУ

Мета роботи – вивчення терапевтичної ефективності нового імунотропного препарату «Алокін-альфа», діючою речовиною якого є цитокіноподібний пептид алоферон, у складі комплексної терапії рецидивного оперізувального герпесу у ВІЛ-інфікованих та хворих без імунодефіциту.Матеріали та методи. Загальне число обстежених і пролікованих хворих на рецидивний оперізувальний герпес склало 56 людей, із них 16 ВІЛ-інфікованих та 40 хворих без імунодефіциту. Для репрезентативної вибірки хворі були поділені на чотири групи. До першої основної групи було включено 19 імунокомпетентних хворих на оперізувальний герпес, до другої основної – 8 ВІЛ-інфікованих хворих з оперізувальним герпесом. Цим особам на фоні базисної терапії (щоденний прийом етіотропного засобу з міжнародною непатентованою назвою (МНН) валацикловір – 1,0 г всередину 2 рази на день впродовж 10-14 діб, з переходом на супресивну терапію по 0,5 г 2 рази на день впродовж 1 місяця) додатково призначали 3 підшкірні ін’єкції імунотропного препапату алокін-альфа, діючою речовиною якого є алоферон, в дозі 1 мг через один день. Першу і другу групу контролю склали 21 і 8 пацієнтів відповідно, яким призначали тільки зазначену базисну терапію.Оцінку протокольного та запропонованого нами лікування хворих здійснювали з врахуванням стадії ВІЛ-інфекції. Для цього дослідження пацієнти відбиралися методом довільної вибірки. Період спостереження за хворими складався з часу лікування і наступного амбулаторного спостереження протягом 3 міс. У дослідження включали пацієнтів з клінічною картиною оперізувального герпесу в період загострення, не більше ніж через 48 год від моменту появи висипань. Найближчі результати лікування оцінювали за зміною тривалості рецидиву оперізувального герпесу. Тривалість рецидиву (час досягнення повної реепітелізації) оцінювали в добах. Віддалені результати лікування визначали за перебігом захворювання протягом 3 місяців амбулаторного спостереження: кількість наступних рецидивів за спостережуваний період; тривалість ремісій у добах.Результати. На підставі дослідження клінічних показників встановили, що тільки базисна терапія шляхом щоденного прийому етіотропного засобу валацикловіру по 1,0 г всередину 2 рази на день впродовж 10-14 діб не забезпечує вагомого клінічного ефекту. Доповнення базисного лікування 3 підшкірними ін’єкціями алокіну-альфа в дозі 1 мг через один день забезпечує статистично достовірне скорочення тривалості клінічних проявів оперізувального герпесу в хворих без імунодефіциту порівняно з терапією тільки валацикловіром (Р&lt;0,05).Найближчі висліди лікування хворих на рецидивний оперізувальний герпес у імунокомпетентних хворих також переконливо демонструють перевагу доповнення базисної терапії алокіном-альфа: не тільки зменшувалася частота рецидивів, але й вкорочувалася тривалість першого рецидиву після зазначеного лікування.При оцінці тривалості клінічних проявів оперізувального герпесу на фоні ВІЛ-інфекції незалежно від клінічної стадії виявили статистично достовірне її скорочення на фоні доповнення базисної терапії алокіном-альфа порівняно з лікуванням тільки валацикловіром. Тримісячне амбулаторне спостереження за пацієнтами у I-II клінічній стадії ВІЛ-інфекції, які отримали тільки валацикловір, вказувало на відсутність будь-якої зміни частоти наступних рецидивів. Водночас доповнення базисної терапії алокіном-альфа забезпечувало збільшення тривалості ремісії і достовірне зменшення частоти наступних рецидивів оперізувального герпесу (Р&lt;0,05).Поряд зі зменшенням частоти рецидивів після застосування апробованого цитокіноподібного препарату статистично вагомо скорочувалась й тривалість першого рецидиву ВІЛ-асоційованого оперізувального герпесу після лікування, вона становила (7,0±0,6) доби. У пацієнтів, лікованих лише валацикловіром, цей показник становив (11,3±0,5) доби (Р&lt;0,05).Відповідне амбулаторне спостереження за пацієнтами у III-IV клінічній стадії ВІЛ-інфекції, які отримали тільки базисну терапію оперізувального герпесу, також не виявило якого-небудь впливу на частоту рецидивів (Р&gt;0,05). Доповнення ж базисної терапії апробованим цитокіноподібним препаратом забезпечувало збільшення тривалості ремісії і достовірне зменшення частоти рецидивів оперізувального герпесу – від (1,60±0,24) до (0,60±0,24) разу на 3 міс. (Р&lt;0,05).Також поряд зі зменшенням частоти рецидивів ВІЛ-асоційованого оперізувального герпесу у пацієнтів з III-IV клінічною стадією після застосування апробованого цитокіноподібного препарату вагомо скорочувалась й тривалість першого рецидиву після лікування – (9,8±0,4) і (16,3±0,6) доби відповідно (Р&lt;0,05). Висновки. Доповнення базисного етіотропного лікування оперізувального герпесу імунотропним препаратом алокін-альфа забезпечує скорочення тривалості клінічних проявів під час лікування, скорочення тривалості першого рецидиву після лікування, а також зменшення частоти рецидивів як у ВІЛ-інфікованих хворих, так і у хворих без імунодефіциту.

Clinical Study: Lotion Containing Propolis Special Extract GH 2002 0.5% vs. Placebo as On-Top Treatment of Herpes Zoster

Background: The aim of the clinical trial was to establish the contribution of propolis special extract GH 2002 as constituent of a lotion for the supportive treatment of Herpes zoster. Methods: 60 patients with diagnosed Herpes zoster were either treated with a propolis containing (n = 33) or an identical, but propolis-free lotion (n = 27) for 28 days, as an add-on therapy to oral antiviral treatment with aciclovir. Study parameters were the assessment of pain on a visual analogue scale, the assessment of the formation of new vesicles, and the safety of application of the preparation. Results: Improvement of pain was significantly better and quicker in the propolis lotion group (p < 0.001 at all visits). On day 3/4, the reduction of pain versus baseline was 54% versus 20% reduction in favour of propolis lotion. On day 14 the results were 80% versus 42% pain reduction. Healing of lesions was significantly quicker with the propolis-containing lotion: at visit 3 on day 7, 21% versus none of the patients showed a closed skin with or without crusting. After 14 days, the comparison showed 57.6% versus 25.9%. At least 50% of propolis-treated patients were lesion-free on day 14, versus day 28 in the control group (p = 0.013). The formation of new vesicles was also significantly suppressed. On day 3/4 the number of newly formed vesicles was 15 versus 25, on day seven the number of new vesicles was 4 versus 14 (p < 0.001). The advantage of propolis lotion was confirmed through the global assessment of efficacy by the physician, with 75.8 versus 33.3% “good” to “excellent” ratings already on day 3/4, 90.9 vs. 44.4% on day 7, and 100 vs. 74.1% on day 28 (p < 0.001). Skin tolerability was excellent, no allergic reactions, skin irritations or other adverse events were observed. Conclusion: The observations clinically confirm antiviral and anti-inflammatory effects of propolis special extract GH 2002 and at the same time demonstrate the benefits of the topical add-on to the systemic antiviral therapy of Herpes zoster.

Helicase-primase inhibitor amenamevir for herpesvirus infection: Towards practical application for treating herpes zoster.

Valacyclovir and famciclovir enabled successful systemic therapy for treating herpes simplex virus (HSV) and varicella zoster virus (VZV) infection by their phosphorylation with viral thymidine kinase. Helicase-primase inhibitors (HPIs) inhibit the progression of the replication fork, an initial step in DNA synthesis to separate the double strand into two single strands. The HPIs amenamevir and pritelivir have a novel mechanism of action, once-daily administration with nonrenal excretory characteristics, and clinical efficacy for genital herpes. Amenamevir exhibits anti-VZV and anti-HSV activity while pritelivir only has anti-HSV activity. A clinical trial of amenamevir for herpes zoster has been completed, and amenamevir has been licensed and successfully used in 20,000 patients with herpes zoster so far in Japan. We have characterized the features of the antiviral action of amenamevir and, unlike acyclovir, the drug's antiviral activity is not influenced by the viral replication cycle. Amenamevir is opening a new era of antiherpes therapy.

Valacyclovir versus acyclovir for the treatment of herpes zoster ophthalmicus in immunocompetent patients.

Herpes zoster ophthalmicus affects the eye and vision, and is caused by the reactivation of the varicella zoster virus in the distribution of the first division of the trigeminal nerve. An aggressive management of acute herpes zoster ophthalmicus with systemic antiviral medication is generally recommended as the standard first-line treatment for herpes zoster ophthalmicus infections. Both acyclovir and its prodrug valacyclovir are medications that are approved for the systemic treatment of herpes zoster. Although it is known that valacyclovir has an improved bioavailability and steadier plasma concentration, it is currently unclear as to whether this leads to better treatment results and less ocular complications. To assess the effects of valacyclovir versus acyclovir for the systemic antiviral treatment of herpes zoster ophthalmicus in immunocompetent patients. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2016, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2016), Embase (January 1980 to June 2016), Web of Science Conference Proceedings Citation Index-Science (CPCI-S; January 1990 to June 2016), BIOSIS Previews (January 1969 to June 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP; www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 June 2016. We considered all randomised controlled trials (RCTs) in which systemic valacyclovir was compared to systemic acyclovir medication for treatment of herpes zoster ophthalmicus. There were no language restrictions. Two review authors independently selected trials, evaluated the risk of bias in included trials, and extracted and analysed data. We did not conduct a meta-analysis, as only one study was included. We assessed the certainty of the evidence for the selected outcomes using the GRADE approach. One study fulfilled the inclusion criteria. In this multicentre, randomised double-masked study carried out in France, 110 immunocompetent people with herpes zoster ophthalmicus, diagnosed within 72 hours of skin eruption, were treated, with 56 participants allocated to the valacyclovir group and 54 to the acyclovir group. The study was poorly reported and we judged it to be unclear risk of bias for most domains.Persistent ocular lesions after 6 months were observed in 2/56 people in the valacyclovir group compared with 1/54 people in the acyclovir group (risk ratio (RR) 1.93 (95% CI 0.18 to 20.65); very low certainty evidence. Dendritic ulcer appeared in 3/56 patients treated with valacyclovir, while 1/54 suffered in the acyclovir group (RR 2.89; 95% confidence interval (CI) 0.31 to 26.96); very low certainty evidence), uveitis in 7/56 people in the valacyclovir group compared with 9/54 in the acyclovir group (RR 0.96; 95% CI 0.36 to 2.57); very low certainty evidence). Similarly, there was uncertainty as to the comparative effects of these two treatments on post-herpetic pain, and side effects (vomiting, eyelid or facial edema, disseminated zoster). Due to concerns about imprecision (small number of events and large confidence intervals) and study limitations, the certainty of evidence using the GRADE approach was rated as low to very low for the use of valacyclovir compared to acyclovir. This review included data from only one study, which had methodological limitations. As such, our results indicated uncertainty of the relative benefits and harms of valacyclovir over acyclovir in herpes zoster ophthalmicus, despite its widespread use for this condition. Further well-designed and adequately powered trials are needed. These trials should include outcomes important to patients, including compliance.

Effect of corticosteroid therapy in acute pain edema caused by Herpes Zoster

Purpose: To evaluate the curative effect of corticosteroids in the treatment of acute pain, local edema, and skin lesions caused by herpes zoster, and to develop some pertinent therapeutic guidelines. Methods: A total of 48 cases of patients diagnosed with herpes zoster from 2010 to 2011 in the dermatology clinic of Shan Dong Traffic Hospital were selected and all received the same therapy of antiviral, pain-relieving and nerve nutrition. They were divided into a corticosteroid application group, with 24 patients treated with corticosteroids, and a control group of 24 patients without corticosteroids. Local swelling subsided in the corticosteroid group. The differences observed in pain relief and days needed for blisters to dry and scab between the two patient groups were analyzed to determine significance and, thus, assess the curative effect of corticosteroids in treatment of herpes zoster. Results: Patients in the glucocorticosteroid application group relieved pain faster than patients in the control group (2.38 ± 1.41 days vs 5.50 ± 3.19 days), and the difference was significant (p < 0.05). Skin lesions of patients in the glucocorticosteroid application group healed quicker than that of patients in control group (2.83 ± 0.87 days vs 3.54 ± 1.02 days), and the difference was remarkable (p < 0.05). Local swelling of patients in the glucocorticosteroid application group recovered rapidly after treatment. . Conclusion: Treatment of herpes zoster with appropriate corticosteroid isodose application can effectively relieve acute pain and local swelling, and speed up scabbing and healing of skin lesions. Keywords: Herpes zoster, Corticosteroids, Local edema, Scab, Skin lesions, Acute pain, Blisters, Therapeutic guidelines

Therapeutic observation of thin-cotton moxibustion plus surround needling for herpes zoster

Objective To compare the clinical efficacies between thin-cotton moxibustion plus surround needling and Western medication in treating herpes zoster (HZ).

The changing landscape of antiviral treatment of herpes zoster: a 17-year population-based cohort study.

BackgroundHerpes zoster (HZ) is a common viral disease that produces a painful vesicular rash. Early use of antiviral medications is recommended, as it reduces pain and speeds healing. A population-based observational study was conducted to evaluate the changing burden of HZ in the province of Manitoba (Canada) over a period of 17 years.MethodsAdministrative health care data including medical and hospital records were examined, and International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, Tenth Revision, Clinical Modification codes were used to identify episodes of HZ between April 1, 1997 and March 31, 2014 in persons aged 20 or over. Annual age-adjusted incidence and hospitalization rates were calculated. Prescription records of HZ-diagnosed persons for acyclovir, valacyclovir, and famciclovir were used to calculate the rates and costs of antiviral treatment.ResultsThere were 73,893 identified cases of HZ and 1,245 HZ-related hospitalizations between 1997 and 2013. Of these episodes, 42,270 (57.2%) were treated with antiviral medications at a total cost of $4,708,065 (CAD). The age-adjusted incidence of HZ rose from 4.67/1,000 person years in 1997/1998 to 5.67/1,000 person years in 2013/2014, a 21.9% increase. Antiviral treatment rates increased from 41.7% to 66.2% of all diagnosed episodes. Mean treatment costs per episode dropped from $127.29 in 1997/1998 to $56.06 in 2013/2014, primarily due to the introduction of generic antiviral medications. The total cost of antiviral treatment peaked in 2005/2006 at $329,935 and dropped steadily thereafter to $223,973 in 2013/2014. HZ-related hospitalization rates decreased from 3.1% to 0.9%.ConclusionWhile both the incidence of HZ and the rates of antiviral treatment have risen substantially, the economic burden from antiviral treatment has been decreasing since a peak in 2005/2006 and was only 3.2% higher in 2013/2014 than in 1997/1998. This drop in cost is attributed to the introduction of generic antiviral drugs.

Thin cotton moxibustion combined with plum-blossom needle in treatment of herpes zoster: a controlled trial

ObjectiveTo compare the difference of clinical efficacy of thin cotton moxibustion combined with plum-blossom needle and western medication in treatment of herpes zoster. MethodEighty patients with herpes zoster were divided into thin cotton moxibustion group (group A, n=40) and western medication group (group B, n=40) according to the sequence of admission. Patients in group A received thin cotton moxibustion that the colton was used as thin as a cicada's wings, combined with plum-blossom needle, and patients in group B received intravenous infusion with 0.25 g of acyclovir once a day, and acyclovir ointment application on affected part for 3–5 times per day. Five days were considered as a course of treatment. Analgesic effect and the incidence of postherpetic neuralgia were observed after two consecutive courses. ResultThe total effective rate was 97.5% (39/40) in group A, and 80.0% (32/40) in group B (P<0.05); it was shown from the comparison of course between two groups that the cure rate after one in group A was markedly higher than that in group B (P<0.01, P<0.05); the differences in effectual time and analgesic time between group A and group B were statistically significant (P<0.05); after treatment, the incidence of postherpetic neuralgia in group A was markedly lower than that in group B (P<0.05). ConclusionThin cotton moxibustion combined with plum-blossom needle in treatment of herpes zoster can obviously shorten the time of therapy, effectively control pain, and reduce the incidence of postherpetic neuralgia.

한의학 학술지에 게재된 대상포진 임상논문에서 사용된 약침에 관한 고찰

Objective : This study was carried out to analyze the trends of pharmacopuncture used to treat Herpes Zoster related articles that have been published in the Korean medicine journal.Method : We studied 14 research papers treated with pharmacopuncture for Herpes Zoster in Korean medicine journal. We analyzed for type of pharmacopuncture used, treatment point and clinical type.Results : 1. The number of searched journal is 14 papers. 2. The most common clinical type is herpes zoster generalisatus. Others types are postherpetic neuralgia, ramsay hunt syndrome, herpes zoster ophthalmicus, postherpetic paralysis 3. Pharmacopunctures used to treat herpes zoster are BV, Hwangreonhaedok-tang pharmacopuncture, Ginseng Pharmacopuncture, CF, JsD, Immuno-yakchim, etc. The most frequently used type of harmacopuncture is BV. 4. The most used part as a treatment point is a-shi point.Conclusions : It is needed to improve the cure rate through a comprehensive analysis of the Herpes zoster treatments. It is necessary to comprehensively analyze the treatments to increase the cure rate of about Herpes zoster.

Polish consensus guidelines on the use of acyclovir in the treatment and prevention of VZV and HSV infections.

A physician has to perform a benefit-risk assessment each time acyclovir is prescribed "off label" for children. A group of Polish infectious disease experts was created to develop evidence-based guidelines on the use of acyclovir in the treatment and prevention of varicella zoster and herpes simplex infections. In primary varicella zoster virus infections, oral acyclovir treatment is recommended in children over 12 years of age and should be considered in younger children who fall into one of the groups at risk of severe varicella. Intravenous acyclovir therapy in varicella is recommended in patients with immune deficiencies, newborns and in complicated cases. When there is a justified need for prevention of varicella, oral acyclovir prophylaxis may be considered if immunoglobulin cannot be administered, and if it is too late for vaccination. Oral acyclovir treatment of herpes zoster may be beneficial to otherwise healthy patients with a rash in places other than the trunk and in patients over 50 years of age. In immunocompetent patients with herpes simplex infections, indications for treatment with oral acyclovir include primary (genital herpes, skin herpes in children with atopic dermatitis, ocular herpes simplex, severe gingivostomatitis, paronychia and pharyngitis) and recurrent infections. Intravenous acyclovir should be administered for herpes infections in neonates, immunocompromised patients and patients who develop complications including neurological.

English

OBJECTIVES: 1. To find out the incidence of zoster in patients attending the dermatology and venereology clinic. 2. To determine the distribution of herpes zoster in relation to age, sex, religion, season, socio-economic status and rural urban background. 3. To study the various clinical features like site of occurrence, initial presentation and course of the disease. MATERIALS AND METHODS: A total of 100 patients of herpes zoster attending outpatient Department of Dermatology and Venereology were included in the study. Detailed history, thorough physical examination and relevant investigations were done. RESULTS: No seasonal variation was found. Out of the 100 patients of herpes zoster majority of the patients belonged to the age group 21-40 years (42%). The male to female ratio was 1.8:1. Most of the patients were from low socio-economic group. 65 patients were literate and 35 patients were illiterate. Prodromal symptoms occurred in 61% of patients. Post-herpetic neuralgia was common in elderly and immunosuppressed patients. Commonest segment involved was the thoracic segment (46%). Majority of patients had single dermatomal involvement (87%). Multidermatomal involvement was seen in 13 patients (13%), out of which majority had immunosuppression like HIV and Diabetes Mellitus. INTRODUCTION: `Herpes zoster' is a localized disease characterized by unilateral radicular pain and a vesicular eruption that is generally limited to the dermatome innervated by a single spinal or cranial sensory ganglion.1 the words are derived from Greek Herpes - Meaning to creep or to spread and 'Zoster' meaning 'Girdle' or 'Zone'. 2 Zoster is characterized by a prodromal stage characterized by fever, headache, burning pain, followed by an acute stage, with appearance of crops of vesicles on an erythematous base in a dermatomal pattern and an intractable neuropathic pain in chronic stage. Zoster is a common infection among the elderly. Chicken pox and herpes zoster (Shingles) are usually benign but are associated with morbidity and mortality especially in immuno compromised hosts. The distinction between the natural history and manifestation of these clinical syndromes caused by VZV is essential for understanding the potential value of antiviral therapy. zoster usually involves one or more dermatomes and occurs at one particular site. 3 many complications like cutaneous, visceral, ocular and neurologic can occur. Post herpetic neuralgia (PHN) is the most feared and debilitating complication of zoster. The risk for PHN is increased in patients over 60 years of age. Recurrent herpes zoster is listed as one of the AIDS defining illness. In HIV infected there are many atypical manifestations like ulceration, necrosis, ecthymatic lesions, hyperkeratotic papules and many neurological, cutaneous, ophthalmic complications. The thoracic dermatomes are the most commonly affected (56%) followed by cervical (17%), lumbar (10%), sacral (5%) and the trigeminal nerve was infected in 12%.4 the management of PHN remains a challenge, with various modalities of treatment having a modest success. Laboratory studies for herpes zoster includes, serological tests, PCR, Tzanck smear, biopsy and viral tissue culture. The drugs used for the treatment of herpes zoster are Acyclovir, Valacyclovir and Famcyclovir, Desiclovir, Penciclovir and Foscarnet.