Managing herpes zoster during pregnancy requires careful clinical judgement when the disease takes a complicated course or when recognised risk factors are present. In these specific circumstances, the treatment approach differs from routine zoster management, and the benefit-risk balance must be assessed in relation to both maternal and fetal outcomes.
This protocol applies to pregnant patients presenting with herpes zoster who have a complicated disease course or who have risk factors for one. Systemic treatment is not indicated for uncomplicated zoster in pregnancy; it is reserved for this higher-risk subgroup, where the maternal condition warrants a more active intervention.
Systemic antiviral therapy is the treatment modality considered in this setting — recommended when the potential therapeutic benefits for the mother outweigh the potential risk for the fetus.
DOI: 10.1111/ddg.14013
During pregnancy, systemic antiviral therapy is only recommended for complicated disease courses. In such cases, acyclovir is recommended.
Use of acyclovir may therefore be recommended in pregnant women with risk factors for a complicated disease course, if the potential therapeutic benefits for the mother outweigh the potential risk for the fetus (Table 23).
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