National Skin Centre, 1 Mandalay Road, Singapore 308205, Singapore.
Am J Clin Dermatol. 2013 Apr;14(2):77-85. doi: 10.1007/s40257-013-0011-2.
Herpes zoster and its sequela post-herpetic neuralgia (PHN) are conditions with significant morbidity. PHN is a chronic, debilitating neuropathic pain that can persist long beyond resolution of visible cutaneous manifestations. This paper provides practical guidelines for management of herpes zoster and PHN. For herpes zoster, antivirals should be started, preferably within 72 h of onset, to reduce the severity and duration of the eruptive phase and to reduce the intensity of acute pain. PHN can be treated with either topical or systemic agents. Topical lidocaine and capsaicin are effective. For patients with more severe pain, the following systemic agents can be considered (in decreasing order of recommendation): the anticonvulsants gabapentin and pregabalin, the tricyclic antidepressants amitriptyline, nortriptyline, and desipramine, and, lastly, the opioid analgesics tramadol, morphine, oxycodone, and methadone. For patients at high risk of developing PHN, early initiation of gabapentin or amitriptyline after the onset of herpes zoster is suggested. The new zoster vaccine has been shown to be effective in reducing the incidence of herpes zoster and PHN.
带状疱疹及其后遗症——带状疱疹后神经痛（PHN），是具有显著发病率的疾病。PHN 是一种慢性、使人虚弱的神经性疼痛，在可见的皮肤症状消退后还可能持续很长时间。本文为带状疱疹和 PHN 的管理提供了实用指南。对于带状疱疹，建议在发病后 72 小时内尽早开始使用抗病毒药物，以减轻出疹期的严重程度和持续时间，并减轻急性疼痛的强度。PHN 可以用局部或全身药物治疗。局部利多卡因和辣椒素有效。对于疼痛更严重的患者，可以考虑以下全身药物（按推荐顺序递减）：抗惊厥药加巴喷丁和普瑞巴林、三环类抗抑郁药阿米替林、去甲替林和丙咪嗪，最后是阿片类镇痛药曲马多、吗啡、羟考酮和美沙酮。对于有发生 PHN 高风险的患者，建议在带状疱疹发病后尽早开始加巴喷丁或阿米替林治疗。新型带状疱疹疫苗已被证明可有效降低带状疱疹和 PHN 的发病率。
