Dermatology
Shingles (Herpes Zoster)
شنگلز
Burning, itching, appearance of papules and malaise or fever, with involvement of a dermatome and papules like grapes. Treated with oral acyclovir, topical antiviral and anaesthetic, pregabalin, B12 and an NSAID.
- ICD-10
- —
- Source
- OPD handbook pp.146–148
- Status
- Draft
Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.
Symptoms
- Burning
- Itching
- Appearance of papules
- Malaise / fever
Diagnosis
- Involvement of a dermatome
- Papules like grapes (clusters)
Treatment
Step 1 of 6
1. Oral antiviral
- Acyclovir is the drug of choice (brand Acylex; dose 400–800 mg every 4 hours)
- Indications: immunocompromised patients (diabetic, CKD); age below 12 years (as read; verify); if the patient presents within 72 hours of symptoms
- Sample: Tab Acylex 400 mg five times daily at 8 am, 12 noon, 4 pm, 8 pm and 12 midnight for 7 days
Prescription
AcyclovirAntiviral
Dose400–800 mg every 4 hours (sample: 5 times a day)
Brand Tab Acylex 400 mg
7 days
Also sold as Acylex, Aylex (as written in theory page)
Step 2 of 6
2. Topical antiviral and local anaesthetic
- Xyloaid ointment (xylocaine) + Acylex cream (acyclovir) + Fusil cream, applied on the affected site morning, noon and evening; Urdu note: if burning is more, apply up to 5 times
Prescription
Lidocaine (xylocaine) ointmentTopical local anaesthetic
DoseApply on the affected site morning, noon and evening
Brand Xyloaid ointment
AcyclovirAntiviral
DoseApply with the above
Brand Acylex cream
Also sold as Acylex, Aylex (as written in theory page)
Fasil cream (generic not written in the book)Topical antibacterial (impetigo)
DoseApply with the above
Brand Fusil cream
Also sold as Fasil, Fusil
Step 3 of 6
3. Pregabalin
- Nerve-origin pain
Prescription
Step 4 of 6
4. B12
Prescription
Methylcobalamin (vitamin B12)Nervine tonic / B12
Dose1 daily
Brand Tab Neuromet 500 mcg
7 days
Also sold as Neuromet, Mexamine, Cobalamin, Mexamin, Methycobal
Step 5 of 6
5. Oral NSAIDs and painkillers
- Tab Neoprox 500 mg BD, OR Tab Tonoflex P 1+1 (morning and evening)
Prescription
Step 6 of 6
6. Counselling (Urdu notes)
- Keep away from other people (the line is only partly legible)
- Drink plenty of water; use more vegetables and fruits
Sample prescription from the book (patient details removed)
- Male, 20 y, burning of chest and fever for 2 days, lesions appeared in the morning; papules over the trunk; T 100 °F, pulse 102: Tab Acylex 400 mg at 8, 12, 4, 8 and 12 for 7 days; Xyloaid ointment + Fusil cream + Acylex cream applied on the affected site; Tab Gabica 50 mg at night; Tab Neuromet 500 mcg daily; Tab Tonoflex P 1+1.