13.4.1 Herpes Simplex
It is an acute viral infection caused by Herpes simplex virus hominis (types HSV1, HSV2 acquired by close contact with an infected individual
Diagnostic Criteria
- Preceding tingling sensation, discomfort and itching,
- Grouped vesicles forming on the skin, and mucous membranes, particularly the buccal area, gentalia, conjunctivae, and cornea,
Non-Pharmacological Treatment
Avoid scratching which often leads to secondary infection
Pharmacological Treatment
B: Acyclovir cream applied 4 hourly for 7–10 days
OR (especially if severe or recurrent)
B: Acyclovir (PO) 400mg 8 hourly for 7–10 days
Note: Benefit of systemic acyclovir is optimum when given within the first 48 hours of onset of sympoms
13.4.2 Chickenpox
It is a highly infectious disease caused by Varicella zoster virus (VZV)
Diagnostic Criteria
- Red macular rash with a central vesicle (blister) on the trunk, oral mucosa and scalp
- Pustules and crusting
- Intense pruritus
- Occasional regional lymphadenopathy
Pharmacological Treatment
B: Acyclovir 800mg 5 times a day for 7 days
AND
A: Paracetamol 1g 8 hourly for 4–5 days
AND
A: Calamine lotion with 1% phenol, apply over the whole body for 24 hours for 4–5 days.
13.4.3 Herpes Zoster (Shingles)
It is due to resurgence or reactivation of the Varicella zoster virus infection which also causes chickenpox.
Diagnostic Criteria
- Severe burning pain
- Grouped vesicles overlying erythematous skin following a dermatomal distribution; typically lesions do not cross the midline
Pharmacological Treatment
B: Acyclovir (PO) 800 mg 5 times a day for 7–10 days
Wound care
A: Potassium Permanganate soaks (1:4000) 12hrly for 3–4 days
For Secondary infection (bacterial) apply
B: Gentamicin 1% ointment
OR
C: Mupirocin 2% cream 12 hourly
13.4.4 Post-herpetic Neuralgia
A complication of shingles (herpes zoster) whereby nerve fibers and the skin is affected
Diagnostic Criteria
Intense pain described as burning, stabbing, or gnawing.
Pharmacological Treatment
A: Amitriptyline (PO) 25 mg at night, may be increased to 150 mg at night
OR
D: Gabapentin 300–900 mg once or divided doses a day for two weeks
Referral
- Refer if there is no improvement of severe neuralgia.
- Refer immediately in case of herpes zoster ophthalmicus for atropinization
