Unifying Concepts

Indications for Antiviral Treatment in Patients with Herpes Zoster

Primary infection with varicella–zoster virus (VZV) results in chickenpox, characterized by viremia with a diffuse rash and seeding of multiple sensory ganglia, where the virus establishes lifelong latency. Herpes zoster is caused by reactivation of latent VZV in cranial-nerve or dorsal-root ganglia, with spread of the virus along the sensory nerve to the dermatome.

Indications for Antiviral Treatment in Patients with Herpes Zoster

  • Age >/=50 yr
  • Moderate or severe pain
  • Severe rash
  • Involvement of the face or eye
  • Other complications of herpes zoster
  • Immunocompromised state

Although antiviral agents may benefit other patients with herpes zoster, they are primarily recommended by experts for patients with these indications who either have complications or are at increased risk for complications from herpes zoster.



  1. Cohen JI. Clinical practice: Herpes zoster. N Engl J Med. 2013 Jul 18;369(3):255-63. [Medline]
  2. O’Connor KM, Paauw DS. Herpes zoster. Med Clin North Am. 2013 Jul;97(4):503-22 [Medline]


Created Aug 21, 2013.

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