Tyring Stephen K
Department of Dermatology, The University of Texas, Houston, Texas, USA.
J Am Acad Dermatol. 2007 Dec;57(6 Suppl):S136-42. doi: 10.1016/j.jaad.2007.09.016.
Patients with herpes zoster experience severe pain and potential lasting complications such as postherpetic neuralgia, ophthalmic disease/damage, and, rarely, skin complications (eg, infection of rash area). Treatment for acute zoster aims to accelerate healing, control pain, and, when possible, reduce the risk of complications. Early intervention with antivirals can accelerate rash healing, reduce rash severity, and reduce the risk of some complications. The addition of corticosteroids to antiviral medication may further alleviate short-term zoster pain, but is associated with an increased risk of serious adverse effects, especially among older adults. If a patient does develop postherpetic neuralgia, gabapentin, pregabalin, opioids, tricyclic antidepressants, lidocaine patch 5%, and capsaicin may all be considered as palliative treatments. For individuals with treatment-refractory postherpetic neuralgia, nonpharmacologic approaches may be considered and a pain-management specialist should be consulted. There is a need for more effective agents to treat herpes zoster and postherpetic neuralgia.
带状疱疹患者会经历严重疼痛以及潜在的长期并发症，如带状疱疹后神经痛、眼部疾病/损伤，以及罕见的皮肤并发症（如皮疹区域感染）。急性带状疱疹的治疗旨在加速愈合、控制疼痛，并在可能的情况下降低并发症风险。早期使用抗病毒药物进行干预可加速皮疹愈合、减轻皮疹严重程度，并降低某些并发症的风险。在抗病毒药物中添加皮质类固醇可能会进一步减轻带状疱疹的短期疼痛，但会增加严重不良反应的风险，尤其是在老年人中。如果患者确实发生了带状疱疹后神经痛，加巴喷丁、普瑞巴林、阿片类药物、三环类抗抑郁药、5%利多卡因贴剂和辣椒素都可被视为姑息治疗药物。对于治疗难治性带状疱疹后神经痛的患者，可考虑非药物治疗方法，并应咨询疼痛管理专家。需要更有效的药物来治疗带状疱疹和带状疱疹后神经痛。
