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Q. My mother is diagnosed with herpes zoster infection. Can this infection progress to PHN?

Answered by
Dr. Pathave Hari Shivaram
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 02, 2020

Hi doctor,

this consultation is for my mother. She has been having skin rashes for around 20 days now. Her rash first started on her back, then spread to stomach. Her physician diagnosed that it is herpes zoster. We also did an Antibody blood test for Varicella Zoster Virus and it came out positive. She has high blood pressure (since 5 years), for which she takes one Ozotel AM tablet daily. She also did a blood test recently, and the main concerning results are high cholesterol, high TSH, and low protein.

Her current prescription is as follows: - Valacyclovir (1000mg) 3 times a day [Stopped now] - Pregabid CR 82.5 MG twice a day - Dolomed T 2 times a day - Methylcobalamin (500 mcg) 2 times a day (Methycobal Tablet). Besides this, she takes multivitamins, Becosules, Vitamin-C (500 mg) and Vitamin-D3 (1000 IU) tablets daily. The rashes have now got crust and scabs. However, her pain is quite severe, the painkillers help but only for a short duration. She also has had to increase the dose of Pregabid 82.5 MG from once to twice a day, in order to relieve pain.

I'm a little worried if this could be Postherpetic neuralgia (PHN). What can she do to relieve pain and minimize the risk of getting PHN? Would Continuous epidural infusion help in her case? I've read that it is a possible treatment that helps in prevention of PHN. Thank you in advance Please find attached here the test results of Varicella antibody: Please find attached below all her blood test reports Here is a recent picture of the rash on her waist Please find below pictures showing her rash 9 days ago.

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Hii...

Welcome to ICliniq...

Thank you for providing information. It is Herpes Zoster; reports showing IgG increased but IgM negative indicates active infection is subsided but the nerve damaged is still there so pain is persisting. This pain is called Zoster associated pain; sometime it goes to PHN. Continue Valacyclovir for 5 days. Dolomed T as per requirement, Pregabid CR for atleast 20 days. Along with it take treatment of hyperlipidemia, hypoproteinemia and hypertension. If pain is not controlled; then there is choice of epidural injection. If possible consult nearby Pain care physician. They will help you in better way for pain relief because now herpes zoster is not active and lesions will heal. If any query you can ask. Thank you.

Thanks for response doctor,

- Could you let me know the dosage of Valacyclovir, and Pregabid CR

- Regarding treatment of hyperlipidemia, hypoproteinemia, could you tell me which specialist to reach out?

- Is Carbamazepine better than Pregabid for PHN?

- Is there anything else she can do for pain relief, and prevention of PHN?

Also doctor, is antiviral treatment needed still? She has already taken antiviral treatment for around 6-7 days

#

Hii,

1) Tab. Valacyclovir (1000mg) one tab three times a day, Pregabid OD (100mg ) one tab 2 or 3 times can be given.

2) for hyperlipidemia and hypoproteinemia consult to medicine doctor.

3) for time being Pregabid is ok.

4) for pain relief she can apply ice cube 2-3 times a day. She can also apply Lidocaine jelly on pain area. If antiviral treatment taken early then PHN severity and possibilities can be decreased.

5) Antiviral treatment of 5 days is sufficient; no need extra treatment. Thank you.

Thanks doctor, For lidocaine jelly: is this a good option --

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Apply plain Lidocaine gelly... already she is on oral Gabapentin. Topical gabapentin is not that much helpful. Nerve involvement is more in deeper parts including superficial also. So, i will say apply only plain lidocaine gelly.

Okay doctor, could you prescribe a good jelly? Also, my mother's physician had prescribed the Kapsi Gel 2 days ago. Should she keep using the Kapsi gel also, or stop it?

#

Kapsi gel can be applied but for time being stop applying Kapsi gel. Gesicain or Lidoderm gel can be used


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