HOW I MANAGE
|Year : 2001 | Volume
| Issue : 1 | Page : 30
Post herpetic neuralgia (PHN)
Dept. of Dermatology, St. John's Medical College Hospital, Bangalore-560 034, India
Dept. of Dermatology, St. John«SQ»s Medical College Hospital, Bangalore-560 034
|How to cite this article:|
Abraham A. Post herpetic neuralgia (PHN).Indian J Dermatol Venereol Leprol 2001;67:30-30
|How to cite this URL:|
Abraham A. Post herpetic neuralgia (PHN). Indian J Dermatol Venereol Leprol [serial online] 2001 [cited 2019 Nov 12 ];67:30-30
Available from: http://www.ijdvl.com/text.asp?2001/67/1/30/8129
Dermatologists have to manage post herpetic neuralgia (PHN) because their patients expect them to deal with the pain after zoster and not only to treat the vesicular rash. It is ideal to manage the case if possible, without always referring to a neurologist.
I observe carefully any pain persisting after herpes zoster has healed and use the term post herpetic neuralgia when pain persists for more than 3 months after the rash heals.
There are 3 classical of PHN: constant burning pain (Amitryptiline group are the drugs of choice) intermittent stabbing pain (carbamazepine group are drugs of choice), and the combination/Allodynia type.
The risk factors for developing neuralgia are older age (infrequent 1. Antidepressants (tricyclic)
Though amitryptiline is the most widely used it has the side effects of sedation, anticholinergic action and postural hypotension which make it unsuitable for elderly patients. Nortryptiline is better tolerated (Sensival 25mg) and is a better choice. I start with 25mg at bedtime and build up by 25mg weekly to a maximum of 150mg/day or pain relief whichever is earlier.
Carbamazepine or phenytoin is traditionally used, but adverse effects once again make patients noncompliant. Gabapentin is a better drug with excellent tolerability, improvement in pain ratings, sleep, mood and quality of life. It should be considered the first line treatment in those without depression. It is available as Gabantin, and is started at 100300mg 3 times daily and built up at 300mg increments to a maximum of 3600mg/day or pain relief whichever is earlier.