In the ED, diagnosis of herpes zoster is based primarily on clinical findings. Patients with herpes zoster usually experience severe pain. In many cases, narcotic analgesia is necessary. Acyclovir antivirals may decrease incidence of postherpetic neuralgia. Indicated for patients presenting within 48 h of onset of rash.
Treated patients experience less pain and faster resolution of cutaneous lesions.
More expensive but more convenient dosing regimen than acyclovir. Analgesics ensure patient comfort, promote pulmonary toilet, and enable physical therapy regimens. Most analgesics have sedating properties that are beneficial for patients who have skin lesions. Reduces fever by direct action on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating. Inhibits inflammatory reactions and pain, probably by decreasing activity of enzyme cyclooxygenase, in turn inhibiting prostaglandin synthesis.