Is treatment necessary?
Most children with uncomplicated HZ do not require treatment. Antiviral medications, ideally given within the first 72 hours, are indicated for patients with moderate to severe pain, an extensive rash, or a rash involving the face, and for patients ages 50 years or older6 (strength of recommendation [SOR]: A). Acyclovir is the treatment of choice for children.2
Antivirals have been shown to lessen the acute pain of HZ, reduce the number of lesions, speed healing, and limit the duration of viral shedding.6 Most studies also show a decreased incidence of the persistent severe pain syndrome known as postherpetic neuralgia, which is more common in older individuals.6
Our young patient gets better, but Dad starts to itch
Our 6-year-old patient was treated symptomatically with calamine lotion and acetaminophen-codeine at night. He returned to school once his lesions crusted over. As the boy’s rash resolved, his father developed a fever and pruritic vesicular rash (FIGURE 2). The father’s varicella lesions also contained the Oka-type VZV. He, too, recovered without complications.
FIGURE 2
Father developed chickenpox as the son’s herpes zoster rash resolved
Acknowledgement
The authors thank Edward J. Mayeaux Jr, MD, DABFP, FAAFP, for his guidance in the preparation of this article.
CORRESPONDENCE
Jan Hood, MD, DABFP, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130; jhood@lsuhsc.edu