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Herpes Zoster — SCE Dermatology MCQ

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ModerateCutaneous InfectionHerpes ZosterSCE Dermatology

A 72-year-old woman on Prednisolone 40 mg daily for bullous pemphigoid develops a painful left thoracic dermatomal vesicular eruption. She is immunosuppressed. What is the most appropriate treatment?

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Correct answer: B — Intravenous Aciclovir 10 mg/kg three times daily

In immunosuppressed patients, herpes zoster carries a higher risk of dissemination, complications (post-herpetic neuralgia, visceral involvement), and prolonged course. BAD/BHIVA guidelines recommend intravenous Aciclovir (10 mg/kg TDS adjusted for renal function) for immunocompromised patients with herpes zoster, especially those on significant immunosuppression. IV therapy ensures adequate drug levels and should be continued until no new lesions form and existing lesions begin to crust. Oral antivirals may be insufficient in immunosuppressed individuals.

Reference: BAD/BHIVA 2022 VZV Guidelines; BNF