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Herpes Zoster
 What is the best way to provide symptomatic relief to a patient with herpes zoster who is suffering with itching and pain?
 Symptomatic treatment for pruritis includes both topical and systemic agents. Colloidal oatmeal baths, given two to three times each day, may provide some temporary relief. Hydrocortisone cream (1%) can be applied to intact skin to decrease itching. Oral antihistamines, diphenhydramine or hydroxyzine, decrease itching as well. Keeping the skin clean and fingernails trimmed decrease the chance for secondary bacterial infection. Wearing soft cotton gloves at night, or placing socks on the hands if gloves are not available, will help protect the skin from excoriation due to scratching while asleep. Pain can be controlled with oral pain medications such as acetaminophen. In some cases a mild narcotic is needed to control the burning pain associated with herpes zoster. If this occurs, acetaminophen with codeine or acetaminophen with hydrocodone is often useful. Any measures to increase comfort, such as bathing and avoiding temperature extremes, may also be useful in decreasing itching and discomfort.
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