From the Guidelines
Left-sided facial shingles treatment should begin immediately with oral antiviral medications such as acyclovir, valacyclovir, or famciclovir for 7-10 days, as these medications are most effective when started within 72 hours of rash onset, according to the 2014 update by the Infectious Diseases Society of America 1.
Key Considerations
- The treatment should be initiated promptly to reduce the severity and duration of the outbreak, as well as the risk of developing postherpetic neuralgia, a painful condition that can persist for months after the rash heals.
- Oral antiviral medications such as acyclovir (800 mg five times daily), valacyclovir (1000 mg three times daily), or famciclovir (500 mg three times daily) are the preferred treatment options for left-sided facial shingles in otherwise healthy hosts 1.
- For immunocompromised patients, high-dose IV acyclovir remains the treatment of choice for VZV infections, while oral therapy should be reserved for mild cases or as treatment to complete therapy once the patient has shown a clinical response to IV acyclovir 1.
Pain Management and Wound Care
- For pain management, use acetaminophen or NSAIDs initially, with prescription pain medications like gabapentin (starting at 300 mg daily and increasing as needed) for more severe pain.
- Keep the rash clean and dry, and avoid touching or scratching it to prevent bacterial infection.
- Apply cool compresses for comfort and consider calamine lotion to reduce itching.
Important Complications to Watch For
- Since facial shingles can potentially affect the eye, seek immediate medical attention if you experience any eye symptoms like redness, pain, or vision changes.
- Facial shingles near the eye requires urgent evaluation by an ophthalmologist to prevent vision complications.
From the FDA Drug Label
The recommended dosage of VALTREX for treatment of herpes zoster is 1 gram 3 times daily for 7 days. Therapy should be initiated at the earliest sign or symptom of herpes zoster and is most effective when started within 48 hours of the onset of rash.
The treatment for left-sided facial shingles is 1 gram of valacyclovir three times daily for 7 days 2. It is essential to initiate therapy at the earliest sign or symptom of herpes zoster for maximum effectiveness.
- Key points:
- Dosage: 1 gram three times daily
- Duration: 7 days
- Initiation: At the earliest sign or symptom of herpes zoster
- Efficacy: Most effective when started within 48 hours of rash onset
From the Research
Left Sided Facial Shingles Treatment
- The treatment for left sided facial shingles typically involves antiviral medications, such as acyclovir, famciclovir, and valacyclovir 3.
- These medications are most effective when started within 72 hours after the onset of the rash 3.
- Valacyclovir has been shown to be effective in reducing the duration of zoster-associated pain and is administered in a more convenient oral dosage regimen compared to acyclovir 4, 5, 6, 7.
- In addition to antiviral medications, the use of orally administered corticosteroids can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia 3.
- Patients with postherpetic neuralgia may require narcotics for adequate pain control, and tricyclic antidepressants or anticonvulsants may help to control neuropathic pain 3.
- Capsaicin, lidocaine patches, and nerve blocks can also be used in selected patients to manage pain associated with left sided facial shingles 3.
Treatment Options
- Acyclovir: 800mg 5 times daily for 7 days 3, 4, 6, 7
- Valacyclovir: 1000mg 3 times daily for 7 or 14 days 4, 5, 6, 7
- Famciclovir: dosage not specified in the provided studies
Important Considerations
- Ocular involvement in herpes zoster can lead to rare but serious complications and generally merits referral to an ophthalmologist 3.
- Patients with left sided facial shingles should be closely monitored for the development of postherpetic neuralgia, a complication of herpes zoster that can be highly debilitating 3.