For more on herpes zoster, see the CDC website:

Treatment action Topical/behavioral Oral meds IV meds Testing/Notes
Comfort measures, general care Cool sitz baths or cool gel packs or compresses may help to decrease swelling. Use gentle cleansing, topical petrolatum; Avoid irritants, daily panty liners, tight clothing, douching, or feminine hygiene products. Avoid having sex when having prodromal symptoms or blisters. Diagnosis is usually based on morphology, remembering that although herpes zoster resembles herpes simplex, the lesions are unilateral and follow dermatomes. Direct fluorescent antibody testing (DFA) on scrapings from active vesicular skin lesions that have not yet crusted can distinguish between herpes simplex and herpes zoster. (LINK to Herpes Zoster in Atlas)
Reduction of itching or pain Topical xylocaine 5%, applied as needed, usually up to 4-6 times a day (no more than 15 grams a day) Warn the patient that xylocaine stings when first applied.


Topical Lidocaine 2.5%/Prilocaine 2.5% (EMLA) cream in a thick layer topped off with a piece of saran wrap for 20 min.

For severe pain with urination, have pt dilute urine with a peri-bottle or by sitting in water when voiding.

Catheterization and sedation may be necessary.

Herpes zoster of the vulva and the dermatomes S1 through S4 can be incapacitating and depressing. Early institution of gabapentin or Pregabalin may reduce the zoster-associated pain complex. Usually the lesions settle in three to four weeks with some degree of scarring and, in the elderly, post-herpetic neuralgia may result. The use of prednisone to prevent the neuralgia is controversial
Anti-viral action
for early or mild outbreak
Acyclovir (Zovirax) 800 mg orally at 7:00 AM, 11:00 AM, 3:00 PM, 7:00 PM, and 11:00 PM x 7 days.


Famciclovir (Famvir) 500 mg orally 3 times a day x 7 days


Valacyclovir (Valtrex) 1g orally 3 times a day x 7 days if renal function is normal

Anti-viral action for severe skin outbreak Acyclovir (Zovirax) 10 mg/kg IV q8h x 7 days
Anti-viral action for immunocompromised patients if intolerant of acyclovir Foscarnet (Foscavir) 40 mg/kg IV q8h x 7 to 10 days
For severe pain management Acetaminophen and codeine 15 to 30 mg orally q3- 4h


Gabapentin 300 mg at bedtime. Increase by 300 mg every two days to 1000 mg


Pregabalin 50 mg at bedtime. Increase by 50 mg every three days to 150-300 mg if needed.

Prevention Prescribe the herpes zoster vaccine for prevention.