From the Guidelines
The clinical workup for shingles should primarily involve a thorough physical examination and prompt initiation of oral antiviral medications, such as acyclovir or famciclovir, within 72 hours of rash onset to reduce the severity of acute pain and accelerate cutaneous healing. The diagnosis of shingles is typically clinical, based on the characteristic unilateral, painful vesicular rash that follows a dermatomal distribution [ 1 ].
Key Components of Clinical Workup
- Physical examination focusing on the rash
- Laboratory testing (if necessary) with viral PCR or direct fluorescent antibody testing of vesicular fluid
- Prompt treatment with oral antiviral medications, such as acyclovir 800mg five times daily or famciclovir 500mg three times daily, for 7 days [ 1 ]
- Pain management with acetaminophen, NSAIDs, or in more severe cases, gabapentin or pregabalin
Importance of Early Treatment
Early treatment (within 72 hours of rash onset) is crucial to reduce the duration and severity of symptoms and lower the risk of postherpetic neuralgia [ 1 ].
Monitoring for Complications
Complications to monitor include bacterial superinfection of skin lesions, ocular involvement (especially if the ophthalmic branch of the trigeminal nerve is affected), and postherpetic neuralgia. Shingles results from reactivation of latent varicella-zoster virus in sensory ganglia, typically triggered by declining cell-mediated immunity due to age, stress, or immunosuppression.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Clinical Workup for Shingles
- The clinical workup for shingles typically involves a physical examination and a review of the patient's medical history to determine the presence of a rash and other symptoms such as malaise, headache, and low-grade fever 2.
- Laboratory tests may not be necessary for diagnosis, but they can be used to confirm the presence of varicella zoster virus in some cases.
- The diagnosis of shingles is usually based on the characteristic appearance of the rash, which is typically unilateral and confined to a single dermatome 2.
Treatment Options
- Antiviral medications such as acyclovir, valacyclovir, and famciclovir are commonly used to treat shingles, and are most effective when started within 72 hours of the onset of the rash 3, 2, 4.
- These medications can help reduce the severity and duration of the rash, as well as the risk of complications such as postherpetic neuralgia 3, 2, 4.
- Pain management is also an important part of the treatment plan, and may include the use of analgesics, topical lidocaine or capsaicin, and oral gabapentin, pregabalin, or tricyclic antidepressants 2.
Prevention
- The varicella zoster virus vaccine is available and can help prevent shingles in adults 50 years and older 2, 5.
- The vaccine is recommended for adults 60 years and older, except for certain immunosuppressed patients 2.
- The vaccine can also help reduce the risk of postherpetic neuralgia, which is a common complication of shingles 2, 5.