Not all herpes zoster presentations carry the same risk. When the disease affects high-risk patient groups or extends beyond a simple dermatomal pattern, a more intensive evidence-based approach is required. This protocol addresses those complicated scenarios.
This protocol applies when any of the following are present:
In these complicated presentations, intravenous antiviral therapy is recommended — oral antiviral therapy alone is not sufficient. The complete structured regimen and duration guidance are available in the full protocol.
DOI: 10.1111/ddg.14013
In patients with herpes zoster and a complicated disease course or those at risk of a complicated disease course, intravenous antiviral therapy is recommended. This includes the following patient groups: Herpes zoster of the head and neck region, especially in elderly patients; herpes zoster with hemorrhagic/necrotic lesions, multisegmental involvement, aberrant vesicles/satellite lesions, mucosal involvement, or generalized herpes zoster; herpes zoster in immunosuppressed patients; herpes zoster with signs of visceral or CNS involvement (including vasculitis).
Based on consensus, intravenous administration of acyclovir is recommended in patients presenting with complicated herpes zoster or at risk of a complicated disease course (recommendation #22, Table 16).
The duration of antiviral therapy should be extended until no more vesicular lesions appear.