Multiple drugs
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Lack of efficacy: case report A 30-year-old man exhibited lack of efficacy during treatment with aciclovir for herpes zoster, and during treatment with capsaicin, gabapentin, morphine, nortriptyline, prednisone and tramadol for post herpetic neuralgia [not all dosages and routes stated]. The man developed a macropapulovesicular rash on his left trunk (fourth or fifth thoracic segment). Due to the suspicion of herpes zoster, he visited to the dermatology clinic. He had a history of chickenpox during his childhood. Further examination revealed erythematous maculopapular and vesicular eruptions on the left trunk. After 10 days, he developed crust and cystic lesions in the affected field. The diagnosis of herpes zoster was confirmed. Initially, he was prescribed oral tablet of aciclovir [acyclovir] 800mg five times daily for 7 days without improvement. Five days later, he developed post herpetic neuralgia and received treatment for pain. He received oral tablet of nortriptyline 10mg every night at bedtime, and after 5 days the dose was increased to 20mg every night at bedtime. Topical capsaicin 0.025% was applied to the affected areas 3–5 times daily, without any signs of improvement. Other medications included oral gabapentin 100mg at bedtime along with oral prednisone 30mg twice a day (on days 1 through 7), then 15mg twice a day (on days 8 through 14), then 7.5mg twice a day (on days 15 through 21), oral tramadol 50mg every 4–6 hours as needed and morphine; however, none of these medications showed improvement in his pain. After covering the painful area with bandages and wearing comfortable clothes, the irritation reduced. His recalcitrant cystic lesions were removed by surgery and aspiration with reduction in his symptoms. Rahmatpour Rokni G, et al. Postherpetic neuralgia and recalcitrant cystic lesions following herpes zoster: A case report and review of treatment options. Dermatologic Therapy 33: No. 4, Jul-Aug 2020. Available from: URL: http://doi.org/10.1111/dth.13793 803507062
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Reactions 17 Oct 2020 No. 1826
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