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Post-Herpetic Neuralgia — SCE Dermatology MCQ

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EasyCutaneous InfectionPost-Herpetic NeuralgiaSCE Dermatology

A 60-year-old woman develops shingles (herpes zoster) in the T3 dermatome. She is immunocompetent. She develops persistent pain at the site 4 months after the rash has healed. What is this complication and what is the first-line treatment?

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Correct answer: E — Post-herpetic neuralgia; first-line treatment is Amitriptyline, Gabapentin, or Pregabalin

Post-herpetic neuralgia (PHN) is defined as pain persisting ≥90 days after the onset of the herpes zoster rash. It is the most common complication of HZ, occurring in approximately 10-20% of patients (risk increases with age). First-line pharmacological treatments per NICE neuropathic pain guidelines include: Amitriptyline (10-75 mg nocte), Gabapentin, Pregabalin, or Duloxetine. Topical Capsaicin 8% patch and Lidocaine 5% patch are also options. Opioids are reserved for refractory cases. Prevention of PHN is the rationale for the national shingles vaccination programme (Shingrix — recombinant adjuvanted vaccine for adults ≥50 years).

Reference: NICE CG173 Neuropathic Pain; BAD/BHIVA HZ Guidelines