Shingles: (herpes zoster infection: red patches of skin with white/clear papules, typically very painful, and rash follows a dermatome)

PE: Vesicles on a red base starting in center of chest, on bottom of right breast, wrapped around right side and into mid upper back. Dermatomal distribution.

Tx Plan:

  • Start Valacyclovir 1g tablets – take 1 tablet tid for 7 days
  • Prednisone 20mg PO qd
  • Lortab 5 1 tablet q6hrs PRN for pain.

Plan: For her newly diagnosed shingles today, give 1 week of valtrex and steroids plus 2 weeks of lortab for the pain. Follow up in 2 weeks for the shingles.

  • If rash not resolved, will do another round of anti-virals. (Valtrex)
    • Acyclovir 800 mg PO tid for 1 week (do NOT need topical)
    • Valaciclovir (Valtrex) 1,000mg PO qd for 7 days.
  • If rash resolved and still with pain, will start on Lyrica.
    • Lyrica 50mg PO qd prescribed for neuropathic pain.
    • Gabapentin 300mg capsules: Take 1 capsule on day 1, take 1 capsule twice a day on day 2, and then take 1 capsule three times a day then on as needed for neuropathic pain (shingles).
    • Topical Lidocaine patch (less systemic effects).
  • No more lortab indicated after the acute rash is resolved.
  • Patient will need Shingles vaccine following resolution of rash: Zostavax (not offered in our clinic).

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