Zoster of the 2nd and 3rd trigeminal branch
Last Updated: 2019-08-26
ICD11: -
Last Updated: 2019-08-26
Author(s): Anzengruber F., Navarini A.
ICD11: -
Herpes Zoster-Infektion im Innervationsgebiet des 2. und 3. Trigeminusasts.
Image of herpes zoster in the area of the cheeks as well as the oral mucosa and tongue. Enorally, the efflorescences can also appear aphthoid or erosive.
Gingivitis
Contact with pregnant women or small children should be avoided if possible.
In young patients, the exclusion of immunosuppression (especially HIV) makes sense.
Pain treatment
Always adequate pain therapy to reduce risk of post-zoster neuralgia.
Therapy of postzosteric neuralgia (stage scheme).
1st stage NSAID (e.g. ibuprofen, max. 2.4g/d) or paracetamol max. 4d/d.
2nd stage additionally weak opioid analgesics (e.g. Tramadol 200-400mg/d).
3rd stage (in addition to stage 1) highly effective opioid analgesics (e.g. oxycodone).
4th stage (in addition to stage 1 or 2) anticonvulsants (e.g. gabapentin max. 3.6g/d), pregabalin max. 600mg/d or antidepressants (e.g. amitriptyline max. 150mg/d); presentation in the pain consultation.
Systemic Therapy
Absolute indications for systemic treatment, ideally within the first 72 hours after infection
Immunosuppression.
Acyclovir (Zovirax®)
Application: at 3x 5mg/kg bw/d intravenously or 5x 800mg/d p.o., with immunosuppression 10mg/kg bw/d intravenously
Contraindication: hypersensitivity, breastfeeding (because of transfer to breast milk)
Side effects (very common): headache, nausea
In older patients there is an increased risk of reversible neurological disorders.
Adjustment of dosage for reduced kidney function.
Valaciclovir (Valtrex®)
Application: 1 g 3x/d for 7d
Contraindication: Hypersensitivity, lactation.
Side effects (frequent): headache, nausea.
Adjustment of dosage for reduced kidney function.
Brivudine (Brivex®- Tbl.)
Daily dosage: 125 mg 1x/d for 7 days
Drug interaction: 5-fluorouracil preparations (at least 4 weeks apart).
Side effects (frequent): Nausea.
Famciclovir (Famvir®)
In patients >50, 500mg should be given 3x/d to prevent zoster neuralgia.
Independent of meals.
Contraindication: Pregnancy, lactation, hypersensitivity to famciclovir or penciclovir.
Patients at risk of dehydration, especially older patients, should pay attention to adequate hydration.
Foscarnet (Foscavir®)
for immunosuppression and acyclovir resistance
Side effects (very common): granulocytopenia, anorexia, hypokalemia, hypomagnesemia, hypocalcaemia, paresthesia, headache, dizziness, nausea, vomiting, diarrhea, rash, increased serum creatinine, fever, fatigue, chills, asthenia.
Adjustment of dosage for reduced kidney function.
Topical Therapy
Different local therapies depending on the clinic.
According to current guidelines, therapy with topical local anaesthetics and capsaicin is not recommended.
Tannosynt®-Lsg. several times a day
Werner RN, Nikkels AF, Marinovic B, Schafer M, Czarnecka-Operacz M, Agius AM, Bata-Csorgo Z, Breuer J, Girolomoni G, Gross GE, Langan S, Lapid-Gortzak R, Lesser TH, Pleyer U, Sellner J, Verjans GM, Wutzler P, Dressler C, Erdmann R, Rosumeck S, Nast A: European consensus-based (s2k) guideline on the management of herpes zoster - guided by the european dermatology forum (edf) in cooperation with the european academy of dermatology and venereology (eadv), part 1: Diagnosis. J Eur Acad Dermatol Venereol 2017;31:9-19.
Werner RN, Nikkels AF, Marinovic B, Schafer M, Czarnecka-Operacz M, Agius AM, Bata-Csorgo Z, Breuer J, Girolomoni G, Gross GE, Langan S, Lapid-Gortzak R, Lesser TH, Pleyer U, Sellner J, Verjans GM, Wutzler P, Dressler C, Erdmann R, Rosumeck S, Nast A: European consensus-based (s2k) guideline on the management of herpes zoster - guided by the european dermatology forum (edf) in cooperation with the european academy of dermatology and venereology (eadv), part 2: Treatment. J Eur Acad Dermatol Venereol 2017;31:20-29.
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