Is prednisone suitable for a 75-year-old male with herpes zoster (shingles) on the face?

Management of Shingles on the Face in a 75-Year-Old Male

Prednisone should not be used in this 75-year-old male with facial shingles due to increased risks in elderly patients that outweigh potential benefits. 1

First-Line Treatment Recommendations

• Initiate oral antiviral therapy immediately as the primary treatment for herpes zoster:

  • Acyclovir 800 mg orally 5 times daily for 7-10 days, OR
  • Valacyclovir or famciclovir (better bioavailability and less frequent dosing) 1

• Antivirals should be started as soon as possible to reduce viral replication, decrease symptom severity, and potentially reduce the risk of complications 1

• Topical antiviral therapy is not recommended as it is substantially less effective than systemic therapy 1

Corticosteroid Considerations in Elderly Patients

• While corticosteroids may provide some short-term pain relief during the acute phase of herpes zoster, they do not prevent postherpetic neuralgia 2, 3

• The Mayo Clinic specifically notes that prednisone carries significant risks in elderly patients who are most susceptible to shingles 1

• Studies show that adding prednisolone to acyclovir therapy confers only slight benefits over standard antiviral treatment alone 2

• The 75-year-old age of this patient increases risk of adverse events from corticosteroid therapy 1

Special Considerations for Facial Involvement

• Facial zoster requires particular attention due to risk of complications:

  • Potential involvement of cranial nerves
  • Risk of ocular complications if ophthalmic division of trigeminal nerve is affected 4

• Close monitoring for ophthalmic involvement is essential; refer to ophthalmology if eye symptoms develop 4

Supportive Care

• Elevation of the affected area to promote drainage of edema and inflammatory substances 5

• Pain management with appropriate analgesics based on pain severity 1

• Keep the skin well hydrated with emollients to avoid dryness and cracking 5

Prevention of Recurrence

• After recovery, consider recombinant zoster vaccine (Shingrix) to prevent future episodes, as recommended for adults aged 50 years and older 1

• The vaccine has been shown to significantly reduce the incidence of both herpes zoster and postherpetic neuralgia 4

Monitoring

• Follow up to ensure complete healing of lesions 1

• Monitor for development of postherpetic neuralgia, which is more common in elderly patients 4

• Watch for potential complications, particularly with facial involvement 4