Current experience with antiviral therapy for acute herpes zoster

Inhibition of varicella-zoster virus replication during acute herpes zoster would, theoretically, accelerate cutaneous healing and reduce the pain, both acute and chronic, associated with shingles. Early antiviral drugs were of limited efficacy, excessively toxic, or needed to be given parenterally, and were unsuitable for use in immunocompetent individuals. Acyclovir was a significant advance and remains the antiviral drug of choice for herpes zoster. There is ample evidence for its efficacy in acute illness, but its ability to influence post-herpetic neuralgia is controversial. This review also discusses the role of adjunctive therapy with steroids in acute shingles.