Post-Herpetic Neuralgia — SCE Infectious Diseases MCQ

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EasyCNS InfectionPost-Herpetic NeuralgiaSCE Infectious Diseases

A 32-year-old woman with HIV on ART (CD4 480, VL <50) develops shingles in the L1 dermatome. She is treated with oral Valaciclovir. Two months later she develops a burning neuropathic pain in the same dermatome despite healed skin. What is this complication and its management?

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Correct answer: C — Post-herpetic neuralgia (PHN); treatment with Amitriptyline, Gabapentin, Pregabalin, or topical Capsaicin/Lidocaine patches

Post-herpetic neuralgia (PHN) is defined as neuropathic pain persisting >90 days after zoster rash onset. It is the most common complication of herpes zoster and occurs more frequently in older and immunocompromised patients. Management follows NICE neuropathic pain guidelines: first-line agents include Amitriptyline (10–75 mg nocte), Gabapentin (300–3600 mg/day), Pregabalin (150–600 mg/day), or Duloxetine. Topical treatments (Capsaicin 8% patch, Lidocaine 5% patch) are useful adjuncts. Shingrix vaccination reduces future zoster (and therefore PHN) risk.

Reference: NICE CG173 2013 – Neuropathic pain; NICE CKS 2024 – PHN