Herpes zoster treatment and postherpetic neuralgia prevention
DOI:
https://doi.org/10.32385/rpmgf.v37i5.12960Keywords:
Herpes zoster, Shingles, Postherpetic neuralgiaAbstract
Objectives: Postherpetic neuralgia (PHN) is the main complication of herpes zoster (HZ), with a significant impact on patients’ quality of life and health costs. The purpose of this review was to evaluate the efficacy of different therapies used in the acute treatment of shingles in the prevention of this complication.
Data sources: MEDLINE/PubMed, National Guide Clearinghouse, Canadian Medical Association Practice Guidelines, Bandolier, Evidence-Based Medicine Online, DARE, TRIP database, and The Cochrane Library.
Methods: Research of guidelines, meta-analyses, systematic reviews, and randomized and controlled clinical trials published between April 2010 and March 2020, written in English, Portuguese or Spanish, using the MeSH terms ‘herpes zoster’ and ‘neuralgia, postherpetic’.
Results: From the 333 results obtained in the initial research, seven articles were selected to be included in this review, namely two meta-analyses, one systematic review, and four randomized and controlled clinical trials. Data found regarding the use of antivirals, glucocorticoids, or gabapentinoids in the treatment of HZ showed no benefit in the prevention of PHN. Only the option of amitriptyline or intravenous vitamin C revealed positive results, although with limited evidence.
Conclusion: This review concludes that none of the treatments commonly used in the acute treatment of HZ prevents PHN occurrence. Despite the positive results of amitriptyline and vitamin C, there is still insufficient evidence to recommend the disseminated use of these drugs in the acute phase of HZ in order to prevent this complication. Further studies are needed in this context considering the morbidity and health costs associated with PHN.
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References
Cohen JI. Herpes zoster. N Engl J Med. 2013;369(18):1766-7.
Wareham DW, Breuer J. Herpes zoster. BMJ. 2007;334(7605):1211-5.
Werner RN, Nikkels AF, Marinovic B, Schäfer M, Czarnecka-Operacz M, Agius AM, et al. European consensus-based (S2k) Guideline on the Management of Herpes Zoster: guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 1: diagnosis. J Eur Acad Dermatol Venereol. 2017;31(1):9-19.
Gershon AA, Gershon MD, Breuer J, Levin MJ, Oaklander AL, Griffiths PD. Advances in the understanding of the pathogenesis and epidemiology of herpes zoster. J Clin Virol. 2010;48 Suppl 1:S2-7.
Pinchinat S, Cebrián-Cuenca AM, Bricout H, Johnson RW. Similar herpes zoster incidence across Europe: results from a systematic literature review. BMC Infect Dis. 2013;13:170.
Schmader K. Herpes zoster in older adults. Clin Infect Dis. 2001;32(10):1481-6.
Marra F, Parhar K, Huang B, Vadlamudi N. Risk factors for herpes zoster infection: a meta-analysis. Open Forum Infect Dis. 2020;7(1):ofaa005.
Johnson RW, Rice AS. Postherpetic neuralgia. N Engl J Med. 2014;371(16):1526-33.
Kawai K, Gebremeskel BG, Acosta CJ. Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open. 2014;4(6):e004833.
Wei S, Li X, Wang H, Liu Q, Shao L. Analysis of the risk factors for postherpetic neuralgia. Dermatology. 2019;235(5):426-33.
Gan EY, Tian EA, Tey HL. Management of herpes zoster and post-herpetic neuralgia. Am J Clin Dermatol. 2013;14(2):77-85.
García-González AI, Rosas-Carrasco O. Herpes zoster and post-herpetic neuralgia in the elderly: particularities in prevention, diagnosis, and treatment. Gac Med Mex. 2017;153(1):92-101.
van Wijck AJ, Aerssens YR. Pain, itch, quality of life, and costs after herpes zoster. Pain Pract. 2017;17(6):738-46.
Schmidt-Ott R, Schutter U, Simon J, Nautrup BP, von Krempelhuber A, Gopala K, et al. Incidence and costs of herpes zoster and postherpetic neuralgia in German adults aged ≥50 years: a prospective study. J Infect. 2018;76(5):475-82.
Matthews S, De Maria A, Passamonti M, Ristori G, Loiacono I, Puggina A, et al. The economic burden and impact on quality of life of herpes zoster and postherpetic neuralgia in individuals aged 50 years or older in Italy. Open Forum Infect Dis. 2019;6(2):ofz007.
Nilsson J, Cassel T, Lindquist L. Burden of herpes zoster and post-herpetic neuralgia in Sweden. BMC Infect Dis. 2015;15:215.
Schmader KE. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Clin J Pain. 2002;18(6):350-4.
Saguil A, Kane S, Mercado M, Lauters R. Herpes zoster and postherpetic neuralgia: prevention and management. Am Fam Physician. 2017;96(10):656-63.
Chen N, Li Q, Zhang Y, Zhou M, Zhou D, He L. Vaccination for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2011;(3):CD007795.
Donato H, Donato M. Etapas na condução de uma revisão sistemática [Stages for undertaking a systematic review]. Acta Med Port. 2019;32(3):227-35. Portuguese
Schmader K. Herpes zoster. Clin Geriatr Med. 2016;32(3):539-53.
Chen N, Li Q, Yang J, Zhou M, Zhou D, He L. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2014;(2):CD006866.
Han Y, Zhang J, Chen N, He L, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2013;(3):CD005582.
Bulilete O, Leiva A, Rullán M, Roca A, Llobera J. Efficacy of gabapentin for the prevention of postherpetic neuralgia in patients with acute herpes zoster: a double blind, randomized controlled trial. PLoS One. 2019;14(6):e0217335.
Lee EG, Lee HJ, Hyun DJ, Min K, Kim DH, Yoon MS. Efficacy of low dose gabapentin in acute herpes zoster for preventing postherpetic neuralgia: a prospective controlled study. Dermatol Ther. 2016;29(3):184-90.
Skvarc NK, Kamenik M. Effects of pregabalin on acute herpetic pain and postherpetic neuralgia incidence. Wien Klin Wochenschr. 2010;122 Suppl 2:49-53.
Watson PN. Postherpetic neuralgia. BMJ Clin Evid. 2010;2010:0905.
Hemilä H. Vitamin C and infections. Nutrients. 2017;9(4):339.
Carr AC, McCall C. The role of vitamin C in the treatment of pain: new insights. J Transl Med. 2017;15(1):77.
Kim MS, Kim DJ, Na CH, Shin BS. A study of intravenous administration of vitamin C in the treatment of acute herpetic pain and postherpetic neuralgia. Ann Dermatol. 2016;28(6):677-83.
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