Oral Corticosteroids for Pain Associated with Herpes Zoster

Abstract

It is apparent from published studies that corticosteroids do not prevent the development of postherpetic neuralgia. Earlier trials that indicated some benefit in both acute neuralgia and the prevention of postherpetic neuralgia are of limited use to clinicians due to problems with uncontrolled study designs, small sample sizes, and the absence of statistical analysis of the results. The lack of a consensus definition of postherpetic neuralgia, the variable agents and dosages used, and the different pain scales reported are of concern when trying to interpret the results of these studies for their clinical significance. In more recent larger and well-designed studies, similar rates of postherpetic neuralgia were observed in the corticosteroid and control groups. As a result of these findings, corticosteroids should not be recommended for the prevention of postherpetic neuralgia. Despite lack of efficacy in preventing postherpetic neuralgia, limited studies suggest corticosteroids such as prednisone (40-60 mg/d tapered over 3 wk) are well tolerated and may confer slightly significant benefits in reducing the duration of acute neuralgia and improving quality-of-life measures. However, the clinical significance and application of these findings remain to be addressed. If corticosteroids are used for acute neuralgia, clinicians are advised to select their patients carefully. The patients treated in these studies were generally healthy and free of comorbid diseases, such as hypertension, diabetes mellitus, and psychiatric disorders, which can be exacerbated in the presence of corticosteroids. Although dissemination of herpes zoster has been reported infrequently, it remains a potential risk with use of corticosteroids. Until the results of these studies are repeated in more diverse patient populations, corticosteroids appear to have a limited role in the management of acute neuralgia associated with herpes zoster.

Chloroquine diphosphate: a risk factor for herpes zoster in patients with dermatomyositis/polymyositis

“…A large prospective study identified four independent predictors of postherpetic neuralgia: older age, severe, acute pain, severe rash and a shorter duration of rash before consultation (41). Although controversial, shortterm use of corticosteroids can reduce the pain severity and improve patient quality of life in the acute phase (42). Note that high prednisone doses at the time of HZ diagnosis were found to decrease the incidence of postherpetic neuralgia in our patients.…”

Update on the dermatologic use of systemic glucocorticosteroids

“…There is considerable controversy over the use of systemic corticosteroids for both the acute neuralgia of herpes zoster and the prevention of postherpetic neuralgia. A review of nine clinical trials investigating the use of GCS in herpes zoster concluded that corticosteroids do not prevent the development of postherpetic neuralgia but may offer slight benefit in limiting the duration of acute neuralgia (50). The optimal dose of prednisone is 40–60 mg daily for 1–3 weeks with or without a rapid taper.…”

Reduction of Postherpetic Neuralgia in Herpes Zoster

“…As a result of these findings, it has been suggested that corticosteroids should not be recommended for the prevention of PHN. 23…”