Herpes zoster presents with vesicular skin eruption and associated pain requiring prompt antiviral intervention. Early treatment initiation is central to this first-line protocol.
This protocol addresses the first-line management of herpes zoster in patients with active vesicular lesions. The timing of treatment initiation relative to symptom onset is a key clinical consideration.
Management centres on systemic antiviral therapy using orally effective nucleoside analogues, with the specific agent chosen through shared decision making. Treatment should begin as early as possible — timing is critical. The complete regimen, including agent selection and the full duration guidance, is available in the structured protocol below.
Therapy aims to halt the appearance of new vesicular lesions and achieve cessation of zoster-associated pain. Duration is guided by the resolution of active vesiculation.
DOI: 10.1111/ddg.14013
Standard antiviral treatment for herpes zoster currently recommended includes the four orally effective nucleoside analogues acyclovir, valacyclovir, famciclovir, and brivudine as well as acyclovir for IV treatment (Table 14).
In patients without indication for intravenous acyclovir therapy, it is recommended to use shared decision making with respect to the use of oral acyclovir, valacyclovir, famciclovir, or brivudine.
It may be recommended to initiate antiviral therapy as early as possible within 72 hours after the onset of symptoms.
The duration of antiviral therapy should be extended until no more vesicular lesions appear.
If vesicles occur within a period of more than seven days, the diagnosis should be reassessed and viral resistance to the antiviral medication should be considered.
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