Akut schmerzhaft, chronisch belastend – Herpes zoster stellt hohe Anforderungen an
eine differenzierte Schmerzbehandlung. Frühzeitige antivirale Therapie, gezielte Analgesie
und Prävention durch Impfung sind entscheidend, um Komplikationen wie die Post-Zoster-Neuralgie
zu vermeiden.
Abstract
Herpes zoster (HZ), caused by reactivation of the varicella-zoster virus, primarily
affects older or immunocompromised individuals and can lead to painful skin rashes
and long-term complications such as postherpetic neuralgia (PHN). In Europe, approximately
1.7 million people are affected annually, with a lifetime risk of 20–30% that increases
with age. PHN develops in 10–20% of cases and in up to 50% of individuals over 85.
The disease progresses through three stages: a prodromal phase with localized pain,
an acute phase with a vesicular rash, and a chronic phase often marked by persistent
neuropathic pain. PHN is defined as pain lasting three months or more after the rash
has resolved. Diagnosis is usually clinical, with PCR testing used in atypical presentations.
Vaccination with the recombinant adjuvanted vaccine (Shingrix) is recommended for
adults aged 60 and older and has proven effective in preventing both HZ and PHN. Antiviral
therapy, such as aciclovir, should be
initiated within 72 hours of symptom onset. Pain management depends on the severity
and type of pain and may involve NSAIDs, opioids, anticonvulsants like pregabalin,
antidepressants, as well as topical or interventional approaches in difficult cases.
HZ represents a significant health burden, particularly in older adults, and prevention
through vaccination along with early treatment is essential to reduce complications
and improve patient outcomes.
Schlüsselwörter
Gürtelrose - Varicella zoster - Zosterneuralgie - postherpetische Neuralgie
Keywords
varicella zoster - shingles - postherpetic neuralgia
