Herpes zoster and postherpetic neuralgia: the need for early intervention in the elderly

Herpes zoster is an acute nervous system infection that commonly affects the elderly. Because the causative agent is a virus, herpes zoster is often treated symptomatically in the primary care setting. While this approach is acceptable for immunocompetent patients less than 50 years of age, it can leave older patients at greater risk of developing painful and debilitating complications such as postherpetic neuralgia. There is evidence that appropriate treatment initiated within 48 to 72 hours after the onset of the zoster eruption can decrease healing time, reduce acute pain, decrease ocular complications and may prevent the development of postherpetic neuralgia in this age group. The health care practitioner in a primary care setting is ideally placed to identify elderly clients with herpes zoster in the early stages; to consult with physicians about therapies such as steroids, antiviral agents and sympathetic nerve blocks; to monitor treatment effects; and to provide supportive therapy to those who develop postherpetic neuralgia.