Corticosteroids for herpes zoster: what do they accomplish?

Area of Science:

• Infectious Diseases
• Rheumatology
• Neurology

Background:

• Herpes zoster (shingles) can cause acute pain, postherpetic neuralgia, and ocular complications.
• Corticosteroid use for herpes zoster symptoms is debated, with conflicting evidence and recommendations based on clinical experience.

Purpose of the Study:

• To evaluate the efficacy and tolerability of corticosteroids for treating and preventing herpes zoster-related acute pain, postherpetic neuralgia, and ocular complications.

Main Methods:

• Systematic literature search and review of clinical trials investigating corticosteroid use in herpes zoster.
• Analysis of data from trials on oral, topical, injectable, and intrathecal corticosteroid administration.

Main Results:

• Oral corticosteroids show statistically significant improvement in acute herpes zoster pain, though clinical significance is uncertain.
• Larger trials do not support oral corticosteroids' efficacy in preventing postherpetic neuralgia, contradicting smaller studies.
• Topical and parenteral corticosteroids lack proven efficacy.
• Intrathecal corticosteroids may significantly improve intractable postherpetic neuralgia pain but pose serious adverse event risks.

Conclusions:

• Oral corticosteroids may offer a slight benefit for acute herpes zoster symptoms in patients without contraindications.
• Evidence for preventing postherpetic neuralgia with oral corticosteroids is weak.
• Intrathecal corticosteroids are a last-line option for severe postherpetic neuralgia due to safety concerns.