What is the treatment for viral exanthem (viral rash) in adults?

From the Guidelines

To treat viral exanthem in adults, antiviral medications such as acyclovir or famciclovir should be administered within 72 hours of rash onset to accelerate cutaneous healing and reduce the severity of acute pain, as evidenced by studies 1. When managing viral rashes, it's essential to prioritize symptom relief and supportive care.

• Take over-the-counter antihistamines like diphenhydramine (Benadryl) 25-50mg every 6 hours or cetirizine (Zyrtec) 10mg daily to reduce itching.
• Apply calamine lotion or hydrocortisone cream (0.5-1%) to affected areas 2-3 times daily for itch relief.
• Acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil) 400mg every 6 hours can help with fever and discomfort.
• Stay hydrated and rest to support your immune system.
• Take cool baths with colloidal oatmeal or baking soda to soothe skin.
• Wear loose-fitting cotton clothing to prevent irritation.
• Avoid scratching to prevent secondary infections. It's crucial to note that while these measures can help alleviate symptoms, antiviral medications like acyclovir and famciclovir, as mentioned in the study 1, are specifically approved for treating certain viral rashes, such as herpes zoster (HZ), and should be considered for treatment within the recommended timeframe. If the rash worsens, spreads rapidly, develops blisters, is accompanied by severe symptoms like difficulty breathing, high fever, or if you're immunocompromised, seek medical attention immediately as prescription antivirals or other treatments may be necessary.

From the FDA Drug Label

The only relevant information for viral exanthem (viral rash) in adults is for herpes zoster (shingles) and chickenpox. In a double-blind, placebo-controlled study of immunocompetent patients with localized cutaneous zoster infection, acyclovir (800 mg 5 times daily for 10 days) shortened the times to lesion scabbing, healing, and complete cessation of pain, and reduced the duration of viral shedding and the duration of new lesion formation 2. VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults. The efficacy of VALTREX when initiated more than 72 hours after the onset of rash and the efficacy and safety of VALTREX for treatment of disseminated herpes zoster have not been established 3. Two randomized, double-blind clinical trials in immunocompetent adults with localized herpes zoster were conducted. VALTREX was compared with placebo in subjects aged less than 50 years and with oral acyclovir in subjects aged greater than 50 years. All subjects were treated within 72 hours of appearance of zoster rash 3.

The treatment for viral exanthem (viral rash) in adults, specifically for herpes zoster (shingles), is:

• Acyclovir: 800 mg 5 times daily for 10 days
• Valacyclovir: dosage not specified in the provided text for herpes zoster, but it is indicated for the treatment of herpes zoster in immunocompetent adults. For chickenpox, there is no specific treatment recommended in the provided text for adults.

From the Research

Treatment Options for Viral Exanthem in Adults

• Antiviral medications such as acyclovir, valacyclovir, and famciclovir are effective in treating viral exanthem, including herpes zoster and varicella 4, 5, 6, 7
• Intravenous acyclovir is recommended for immunocompromised patients and those with severe cases of varicella or herpes zoster 4, 7
• Oral acyclovir, valacyclovir, and famciclovir can be used to treat mild to moderate cases of viral exanthem, ideally within 72 hours of the development of the rash 5, 6, 7
• Topical treatments such as lidocaine or capsaicin can be used to manage pain associated with postherpetic neuralgia, a common complication of herpes zoster 5, 6

Dosage and Administration

• Intravenous acyclovir: 500 mg/m2 or 10 mg/kg every 8 hours, with adequate hydration and urine flow, and monitoring of mental status and renal function 4
• Oral acyclovir: 800 mg five times a day, with adequate hydration and monitoring of renal function 4
• Valacyclovir and famciclovir: dosing schedules vary, but are generally more convenient than acyclovir 5, 8, 6

Prevention

• The varicella zoster virus vaccine is recommended for adults 50 years and older to prevent herpes zoster and postherpetic neuralgia 5