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Safety and Efficacy of Different Systemic Treatment Modalities for Acute Pain of Herpes Zoster: A Pilot Study

BACKGROUND: Herpes zoster is a viral infection of skin caused by Varicella Zoster virus. The most important symptom for which the patient seeks medical advice is pain, which is perceived before the development of rash and lasts even after its resolution. The pain during the first 30 days after onset...

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Autores principales: Choudhary, Sanjiv, Dhande, Shivani, Kharat, Sachin, Singh, A. L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885613/
https://www.ncbi.nlm.nih.gov/pubmed/29644194
http://dx.doi.org/10.4103/idoj.IDOJ_377_16
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author Choudhary, Sanjiv
Dhande, Shivani
Kharat, Sachin
Singh, A. L.
author_facet Choudhary, Sanjiv
Dhande, Shivani
Kharat, Sachin
Singh, A. L.
author_sort Choudhary, Sanjiv
collection PubMed
description BACKGROUND: Herpes zoster is a viral infection of skin caused by Varicella Zoster virus. The most important symptom for which the patient seeks medical advice is pain, which is perceived before the development of rash and lasts even after its resolution. The pain during the first 30 days after onset of herpes zoster is known as acute herpetic neuralgia. The aim of this study was to compare the efficacy and side-effects of different systemic treatment modalities for acute herpes zoster neuralgia. MATERIALS AND METHODS: This was a randomized, single-blind, parallel control study. Forty-five patients of herpes zoster within 72 hours of onset were enrolled after considering various inclusion and exclusion criteria over a duration of 1 year. Pain severity was assessed after sequential distribution and allotment of patients in three groups using verbal rating scale (VRS). Patients in Group A (control group), were treated with Tab.valacyclovir (1 g tds × 7 days), Group B–Tab.valacyclovir (1 g tds × 7 days) + Cap. Pregabalin (75 mg bd × 1 month), and Group C –Tab.valacyclovir (1 g tds × 7 days) +Cap. Pregabalin (75 mg bd × 1 month) + Tab.methylprednisolone (0.64 mg/kg body weight in two divided doses × 7 days). Patients were followed up at 1, 4, 6 weeks. Complete resolution of acute pain and side-effects were noted. RESULTS: At the end of 4 weeks, reduction in acute pain was statistically significant (P < 0.05) in all the three groups individually compared to the baseline value. At the end of 6 weeks, percentage of patients with persistence of pain was more in Group A and B compared to Group C, which was statistically significant (P = 0.0001). In group A, postherpetic neuralgia was observed in more patients compared to group B and C. No significant side-effects were observed in any group except vomiting, somnolence, and dizziness. LIMITATIONS: Sample size of this study was limited. Further studies with large sample size are required to further validate the findings of the present study. CONCLUSIONS: Combination therapy with valacyclovir, methylprednisolone, and pregabalin has better efficacy compared to valacyclovir and pregabalin and valacyclovir alone in the management of acute herpes zoster neuralgia. No significant side-effects were observed
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spelling pubmed-58856132018-04-11 Safety and Efficacy of Different Systemic Treatment Modalities for Acute Pain of Herpes Zoster: A Pilot Study Choudhary, Sanjiv Dhande, Shivani Kharat, Sachin Singh, A. L. Indian Dermatol Online J Original Article BACKGROUND: Herpes zoster is a viral infection of skin caused by Varicella Zoster virus. The most important symptom for which the patient seeks medical advice is pain, which is perceived before the development of rash and lasts even after its resolution. The pain during the first 30 days after onset of herpes zoster is known as acute herpetic neuralgia. The aim of this study was to compare the efficacy and side-effects of different systemic treatment modalities for acute herpes zoster neuralgia. MATERIALS AND METHODS: This was a randomized, single-blind, parallel control study. Forty-five patients of herpes zoster within 72 hours of onset were enrolled after considering various inclusion and exclusion criteria over a duration of 1 year. Pain severity was assessed after sequential distribution and allotment of patients in three groups using verbal rating scale (VRS). Patients in Group A (control group), were treated with Tab.valacyclovir (1 g tds × 7 days), Group B–Tab.valacyclovir (1 g tds × 7 days) + Cap. Pregabalin (75 mg bd × 1 month), and Group C –Tab.valacyclovir (1 g tds × 7 days) +Cap. Pregabalin (75 mg bd × 1 month) + Tab.methylprednisolone (0.64 mg/kg body weight in two divided doses × 7 days). Patients were followed up at 1, 4, 6 weeks. Complete resolution of acute pain and side-effects were noted. RESULTS: At the end of 4 weeks, reduction in acute pain was statistically significant (P < 0.05) in all the three groups individually compared to the baseline value. At the end of 6 weeks, percentage of patients with persistence of pain was more in Group A and B compared to Group C, which was statistically significant (P = 0.0001). In group A, postherpetic neuralgia was observed in more patients compared to group B and C. No significant side-effects were observed in any group except vomiting, somnolence, and dizziness. LIMITATIONS: Sample size of this study was limited. Further studies with large sample size are required to further validate the findings of the present study. CONCLUSIONS: Combination therapy with valacyclovir, methylprednisolone, and pregabalin has better efficacy compared to valacyclovir and pregabalin and valacyclovir alone in the management of acute herpes zoster neuralgia. No significant side-effects were observed Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC5885613/ /pubmed/29644194 http://dx.doi.org/10.4103/idoj.IDOJ_377_16 Text en Copyright: © 2018 Indian Dermatology Online Journal http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Choudhary, Sanjiv
Dhande, Shivani
Kharat, Sachin
Singh, A. L.
Safety and Efficacy of Different Systemic Treatment Modalities for Acute Pain of Herpes Zoster: A Pilot Study
title Safety and Efficacy of Different Systemic Treatment Modalities for Acute Pain of Herpes Zoster: A Pilot Study
title_full Safety and Efficacy of Different Systemic Treatment Modalities for Acute Pain of Herpes Zoster: A Pilot Study
title_fullStr Safety and Efficacy of Different Systemic Treatment Modalities for Acute Pain of Herpes Zoster: A Pilot Study
title_full_unstemmed Safety and Efficacy of Different Systemic Treatment Modalities for Acute Pain of Herpes Zoster: A Pilot Study
title_short Safety and Efficacy of Different Systemic Treatment Modalities for Acute Pain of Herpes Zoster: A Pilot Study
title_sort safety and efficacy of different systemic treatment modalities for acute pain of herpes zoster: a pilot study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885613/
https://www.ncbi.nlm.nih.gov/pubmed/29644194
http://dx.doi.org/10.4103/idoj.IDOJ_377_16
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