What is the recommended method for dressing herpes zoster lesions?

Bandaging Shingles Lesions

For shingles (herpes zoster) lesions, the recommended approach is to keep lesions clean and covered with a dry, non-adherent dressing until all lesions have formed well-adherent scabs and no new vesicles are present. 1, 2

Proper Dressing Technique for Shingles

Initial Assessment

• Determine if lesions are still active (vesicular, moist) or healing (crusting, scabbing)
• Check for signs of secondary bacterial infection (increased redness, swelling, purulence)

Dressing Selection and Application

1. Primary dressing option:

   • Dry, non-adherent dressing is the preferred option 1
   • Hydrocolloid dressings may help with pain control in severe cases 3

2. Application technique:

   • Clean the affected area gently with mild soap and water
   • Pat dry (do not rub) with a clean towel
   • Apply dressing loosely over lesions to avoid adhesion to vesicles
   • Secure with hypoallergenic tape or wrap, avoiding excessive pressure

3. Dressing changes:

   • Change dressings daily or when soiled
   • Dispose of used dressings properly in sealed bags to prevent virus transmission

Antiviral Therapy and Pain Management

While dressing the lesions is important, optimal management includes:

• Antiviral therapy (ideally started within 72 hours of rash onset):

  • Acyclovir 800 mg orally 5 times daily for 7-10 days, OR
  • Valacyclovir 1000 mg three times daily for 7 days, OR
  • Famciclovir 500 mg three times daily for 7 days 2, 4

• Pain management:

  • Mild pain: Acetaminophen or NSAIDs
  • Moderate to severe pain: Consider gabapentin, pregabalin, or tricyclic antidepressants 2
  • Topical options: Lidocaine patches for localized pain 2

Special Considerations

Immunocompromised Patients

• May require longer duration of antiviral therapy
• More vigilant monitoring for disseminated disease
• Consider intravenous acyclovir for severe cases 2

Infection Control Measures

• Wash hands thoroughly before and after dressing changes
• Avoid direct contact with lesions to prevent autoinoculation
• Patients should avoid contact with susceptible individuals (pregnant women, newborns, immunocompromised persons) until lesions are fully crusted 2

When to Seek Advanced Care

• Signs of bacterial superinfection
• Involvement of the eye (requires urgent ophthalmologic evaluation)
• Disseminated disease (lesions appearing in >3 dermatomes)
• Severe pain unresponsive to initial management 1, 2

Common Pitfalls to Avoid

• Do not use wet dressings - there is insufficient evidence to support their use over dry dressings 1
• Do not cover active lesions during participation in contact sports - patients should be excluded until lesions are completely healed with well-adherent scabs 1
• Do not use occlusive dressings that trap moisture and may delay healing
• Do not apply topical antibiotics unless secondary bacterial infection is present

Following these guidelines will help promote healing, reduce pain, and minimize the risk of complications and transmission of the varicella zoster virus.