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Year : 1991  |  Volume : 57  |  Issue : 3  |  Page : 152-153

Oral acyclovir versus placebo in acute herpes zoster

Correspondence Address:
S D Mehta

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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Mehta S D, Kumar B, Malhotra S, Bagga R. Oral acyclovir versus placebo in acute herpes zoster. Indian J Dermatol Venereol Leprol 1991;57:152-3

How to cite this URL:
Mehta S D, Kumar B, Malhotra S, Bagga R. Oral acyclovir versus placebo in acute herpes zoster. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2020 Nov 28];57:152-3. Available from:

Herpes zoster is a common disease caused by reactivation of varicella-zoster virus from its site of latency in the sensory ganglion[1]. It can occur at any age, but in the elderly and in immunocompromised patients, it has a long lasting and more intensely pain­ful, extensive and more destructive rash with higher incidence of post-herpetic neuralgias and other complications[2].

Acyclovir (9-(C2-hydroxy-ethoxy) methyl­guanine an acyclic analogue of the natural neucleoside 2' deoxyguanosine, selectively inhibits replication of members of the herpes group of DNA viruses with low host cell tox­icity[3]. In various studies dosages ranging from 400-600 mg five times a day have been used. The effect ranged from fewer days of new lesion formation to reduction in viral shedding, pain and eye complications[4].

We used acyclovir in 15 patients with herpes zoster to assess its effect on healing time, new lesion formation and reduction in symptoms compared to a placebo.

  Material and Methods Top

Thirty patients, both of study and control group were roughly matched for age and sex, local symptoms, site of involvement and associated diseases. They were recruited within 72 hours of the disease onset. A dose of 800 mg of acyclovir or a placebo was administered orally three times a day before meals for 7 days (children. and pregnant women were not included).

Occasionally a tablet of diazepam or an analgesic was administered to the placebo group if the patient was very uncomfortable. No other supportive therapy of any kind was given to patients in either group.

Patients were examined on day 1, 3, 7, 14 and at 1 and 6 months. Viral cultures were attempted on egg yolk on day 1 and day 7. Post herpetic neuralgia was labeled in a pa­tients if the pain persisted for more than 6 weeks. Statistical analysis was done by using student 't' test.

  Results Top

There were 10 men and 5 women in the acyclovir treated group and 9 men and6 women in the placebo group. The mean age in the treated group was 50.0 years (range 40-72 years) and in the placebo group 49.5 years (range 38-70 years).

All patients tolerated acyclovir very well except one patient who developed erythema multiforme like lesions on 5th day but the therapy was completed.

On day 3, 7 (47%) patients in the pla­cebo group developed new lesions as com­pared to only 1 (6.6%) in the acyclovir group. Similarly, at day 7, 2 (13.3%) patients in the placebo group had new lesions as compared to none in the treated group.

In 11 (73.3%) treated patients scab for­mation started as early as second day (range 2-4 days) and was completed by7the day. In the placebo group scabs did not from before 6th day (range 6-10 days)and were complete only by 14th day. The differences for appearance of new lesions and crusting were statistically significant (p <0.01).

The intensity of pain was much less in the treated group after 3rd day and by 4 weeks no patient except one had pain, in whom it lasted for nearly 6 weeks. In the placebo group pain of moderate to severe in­tensity persisted for more than 6 weeks in 5 (33.3%) patients.

None of the patients in treated group has positive cultures on 7th day while 5 (35.7%) still had positive cultures in the placebo group.

  Comments Top

The study was designed to evaluate the efficacy of oral acyclovir in elderly, immunocompromised patients and where the disease was rather widespread or could be­come extensive.

This study has shown that acyclovir re­duces duration of viral shedding, minimizes appearance of new lesions and promotes healing. Symptomatic relief due to reduction in degree of pain is early and marked. In a previous study acyclovir in same does had shown similar results[5].

The role of acyclovir in prevention of post-herpetic neuralgia is controversial and in some studies it failed to prevent post-herpetic neuralgia[6]. However, recent studies have shown that if given within 48 hours of hours of onset, acyclovir can significantly reduce incidence of post-herpetic neuralgia[5]. In our study group only one patient developed post­herpetic neuralgia. However, the number is small to permit a confident comment in this aspect.

  References Top

1.Loeser JD : Herpes Zoster and post-herpetic neuralgia, Pain, 1986; 25 : 149-164.  Back to cited text no. 1    
2.Cohen PR and Grossman ME : Clinical features of human deficiency virus associated disseminated herpes zoster virus infection, CL Expt Dermatol,1989; 14 : 273-276.  Back to cited text no. 2    
3.Brien JJ and Richards CMD : Acyclovir an update. Review of its antiviral activity, Drugs, 1989; 37 233-309.  Back to cited text no. 3    
4.Mckendrick MW, Case C, Burke C et al : Oral acyclovir in herpes zoster, J Antimicrob Chemother, 1984; 14 : 661-665.  Back to cited text no. 4    
5.Huff JC, Bean N, Balfour Laskin OL et al : Therapy of herpes zoster with acyclovir, Amer J Med, 1988; 85 : 84-89.  Back to cited text no. 5    
6.Wood MJ, Ogan PH, Mckendrick MW et al : Effi­cacy of oral acyclovir in treatment of acute herpes zoster, Amer J Med 1988; 85 : 79-83.  Back to cited text no. 6    


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