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Post-Herpetic Neuralgia-Current Management and Prevention

 林鳳玲(Feng-Ling Lin)
Herpes zoster (HZ) or shingles is a clinical condition caused by activation of the varicella-zoster virus (VZV) that remained latent in the sensory ganglia and dorsal nerve roots after infection. The reactivation of VZV occurs when VZV specific cellmediated immunity declines below a critical threshold, particularly in aging, human immunodeficiency virus (HIV) infection, lymphoproliferative malignancies and immunosuppressive therapies. Though herpes zoster is a self-limited disease. The sequela post-herpetic neuralgia (PHN) may persist for months and cause chronic, debilitating pain. This article reviewed the current practical management and prevention of PHN. In the early onset of herpes zoster, within 3 days, antivirals can be considered to reduce severity and duration of eruptive phase. For patients with severe PHN, systemic agents such as anticonvulsants, tricyclic antidepressants, opioid analgesics can be used. If patients can't tolerate systemic treatment, clinical physicians can consider topical local anesthesia or topical Capsaicin. The clinical physicians should evaluate the patient closely and choose the optimal management according to the benefit and side effect of drugs.