[Acyclovir-corticosteroid therapy in herpes zoster].

Thirty patients between 60 and 86 years of age (average 73.6 years) [8, 9, 11] with high risk of having the disease for an extraordinarily long time or of developing neuritis were treated for 5 days with 4-5 mg acyclovir per kilogram body weight. They were not immunocompromised and received the drug intravenously at 8-h intervals. Of this group, 20 patients received daily 40-80 mg methylprednisolone simultaneously. All patients were hospitalized because of extensive, hemorrhagic lesions, which in 8 cases were necrotizing. The primary site of the disease was the head in 13 patients (43.3%), the neck or trunk in 15 (50%) and the extremities in 2 (6.7%). In addition, 8 (26.7%) showed generalized lesions. The duration of the disease could be reduced by one-third by acyclovir treatment, as compared with reference groups, and the methylprednisolone group had even better results. Individual pain was more promptly resolved by the combined treatment than by acyclovir alone. No persistent neuritis was observed in the methylprednisolone-acyclovir group, but occurred in two out of ten patients who had received acyclovir alone. No side effects were reported. The antiviral effect of acyclovir obviously reduces the risk of possible generalization during corticosteroid treatment to negligible amounts. Because of the possible selection of resistant strains, acyclovir should usually only be given to high-risk zoster patients beyond the age of 60. Administration must be initiated in the early phase of the disease, since no effect can be expected after viral shedding has been terminated.