The goals of shingles or herpes zoster management are to relieve the pain and to reduce or avoid complications. Pain is controlled with analgesics, because adequate pain control during the acute phase helps prevent persistent pain patterns. Systemic corticosteroids may be prescribed for patients older than age 50 years to reduce the incidence and duration of postherpetic neuralgia (persistent pain of the affected nerve after healing). Healing usually occurs sooner in those who have been treated with corticosteroids. Triamcinolone (Aristocort, Kenacort, Kenalog) injected subcutaneously under painful areas is effective as an anti-inflammatory agent.

    There is evidence that infection is arrested if oral antiviral agents such as Acyclovir (Zovirax), Valacyclovir (Valtrex), or Famiclovir (Famvir) are administered within 24 hours of the initial eruption. Intravenous Acyclovir, if started early, is effective in significantly reducing the pain and halting the progression of the disease. In older patients, the pain from herpes zoster may persist as postherpertic neuralgia for months after the skin lesions disappear.

    Opthalmic herpes zoster occurs when eye is involved. This is considered an ophthalmic emergency, and the patient should be reffered to an opthalmologist immediately to prevent the possible sequelae of keratitis, uveitis, ulceration, and blindness.

    People who have been exposed to varicella by primary infection or by vaccination are not at risk for infection after exposure to patients with herpes zoster.

    A nurse assesses the patient’s discomfort and responses to medication and collaborates with the physician to make necessary adjustments to treatment regimen. The patient is taught how to apply wet dressings or medication to the lesions and to follow proper hand hygiene techniques to avoid spreading the virus.

    Diversionary activities and relaxation techniques are encouraged to ensure restful sleep and to alleviate discomfort. A care giver may be required to assist with dressings, particularly if the patient is elderly and unable to apply them.