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Dermatology · Viral infections: herpes zoster
Sample itemA 68-year-old man has severe burning pain followed by grouped vesicles on an erythematous base confined to the right T5 dermatome, appearing 36 hours ago. What is the best treatment?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Oral valaciclovir or acyclovir started within 72 hours, with analgesia
Herpes zoster results from reactivation of varicella-zoster virus in a dorsal root ganglion. Oral antivirals (valaciclovir, famciclovir or acyclovir) started within 72 hours of the rash reduce the duration and severity and may lower the risk of postherpetic neuralgia. Older patients benefit especially. The recombinant zoster vaccine prevents disease.
Option by option
A. Topical acyclovir only
Topical antivirals are ineffective for zoster.
B. No treatment because it is self-limiting in all patients
Treatment is recommended in older adults, because of the risk of postherpetic neuralgia.
C. Oral valaciclovir or acyclovir started within 72 hours, with analgesia (correct)
Correct. Early oral antiviral therapy shortens the illness and reduces complications.
D. Oral prednisolone alone
Steroids alone do not treat the virus and may only be added to an antiviral in selected cases.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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