CURRENT AND FUTURE MANAGEMENT OF HERPES-ZOSTER

Herpes zoster (shingles) is a common disease affecting approximately t hree in 1000 of the population per year and up to 10 in 1000 per year in the elderly populations. This incidence is likely to increase as th e proportion of elderly people in the general population increases and various forms of immunosuppression become more common, e.g. following organ transplantation. Management of both the acute and chronic pain is probably the most important part of caring for shingles patients. A ntiviral therapy, anti-inflammatory steroids and sympathetic nerve blo cks are the main measures used during the acute phase to prevent the d evelopment of post-herpetic neuralgia (PHN). Antiviral agents given ea rly in the acute phase of herpes zoster are generally the therapy of c hoice and there is also growing evidence for benefit with tricyclic an tidepressants. Pain relief once PHN has developed is generally much le ss effective. Many classes of drug have been investigated for the mana gement of PHN and some have been found to be helpful in some patients. There is as yet no generally effective agent, however, preventive ant iviral therapy early in the course of herpes zoster is recommended for all elderly patients since they have a high risk of developing severe PHN.