Herpes Zoster Pregnancy — SCE Dermatology MCQ

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ModerateCutaneous InfectionHerpes Zoster PregnancySCE Dermatology

A 25-year-old woman presents with a unilateral vesicular eruption on her right T4 dermatome. She is 28 weeks pregnant. What is the management of herpes zoster in pregnancy?

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Correct answer: B — Oral Aciclovir is recommended if started within 72 hours of rash onset; Aciclovir is considered safe in pregnancy

Herpes zoster in pregnancy should be treated with oral Aciclovir (800 mg five times daily for 7 days) if started within 72 hours of rash onset. Aciclovir is considered safe in pregnancy (extensive safety data from pregnancy registries show no increased teratogenic risk). Herpes zoster in the immunocompetent pregnant woman does not pose a risk to the fetus (unlike primary varicella which carries the risk of congenital varicella syndrome in the first/second trimester). The main concern is maternal morbidity (pain, PHN) and rare dissemination. Varicella zoster immunoglobulin (VZIG) is NOT indicated for zoster — it is for post-exposure prophylaxis of primary varicella in susceptible pregnant women.

Reference: BAD/RCOG Varicella Guidelines; BNF