From the Research
Shingles affecting the hand should be treated immediately with oral antiviral medications, such as valacyclovir 1.5 g twice daily for 7 days, to reduce the severity and complications associated with herpes zoster and post-herpetic neuralgia. The C6, C7, or C8 dermatomes are typically involved, which innervate different parts of the hand, including the thumb, index finger, middle finger, ring finger, and little finger. When shingles (herpes zoster) occurs in these dermatomes, patients experience a painful, blistering rash that follows the specific nerve distribution, not crossing the midline of the body.
The treatment approach should prioritize reducing the duration and intensity of zoster-associated pain (ZAP) and preventing post-herpetic neuralgia (PHN) 1. Pain management is also crucial, often requiring analgesics ranging from acetaminophen or NSAIDs to stronger medications like gabapentin (starting at 300 mg daily and titrating up) for neuropathic pain. Cool compresses and calamine lotion can provide topical relief. Patients should keep the rash clean and covered to prevent spreading the virus to others who haven't had chickenpox.
Some key points to consider in the management of shingles affecting the hand include:
- Initiating treatment with oral antiviral medications within 72 hours of rash onset to reduce severity and complications 2, 3
- Using valacyclovir 1.5 g twice daily for 7 days, which has been shown to be safe and effective in treating uncomplicated herpes zoster in immunocompetent patients over 18 years of age 2
- Managing pain with analgesics and considering stronger medications like gabapentin for neuropathic pain
- Keeping the rash clean and covered to prevent spreading the virus to others who haven't had chickenpox.
It's essential to note that the varicella-zoster virus remains dormant in sensory nerve ganglia since a previous chickenpox infection, and the specific dermatome affected determines which fingers and hand areas develop the characteristic painful rash. Routine vaccination for individuals over 60 years has shown considerable effect in terms of reducing the incidence of herpes zoster and post-herpetic neuralgia 1.