Shingles: Treatment Options and Recurrence Risks - Dermatology

Dr. Zhang Zhibo reply Dermatology

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Hello: Herpes zoster, commonly known as shingles, is a reactivation of the varicella-zoster virus that occurs in individuals with weakened immune systems.
This virus is one of the few microorganisms that can be effectively treated with antiviral medications.
There are generally two commonly used oral antiviral drugs: Acyclovir (available from both brand-name and generic manufacturers, with the latter being nearly half the price), which is typically prescribed at a dosage of 4000 mg per day divided into five doses, and Valacyclovir, which is prescribed at 3000 mg per day divided into three doses and is currently only available as a brand-name medication.
Due to the high cost of these medications, health insurance regulations are quite strict.

The following antiviral medications are covered under specific conditions: Acyclovir (e.g., Zovirax); Tromantadine (e.g., Virumerz); Famciclovir (e.g., Famvir); Valacyclovir (e.g., Valtrex).
The insured must use these medications for the following indications: (1) Herpes simplex encephalitis.
(2) Herpes zoster or herpes simplex affecting the first division of the trigeminal nerve (V1) that may threaten the cornea.
(3) Herpes zoster or herpes simplex affecting the sacral S2 dermatomes that may impact urinary function.
(4) Infections of herpes zoster or herpes simplex in immunocompromised patients, cancer patients, or organ transplant recipients.
(5) Varicella infections in neonates or immunocompromised patients.
(6) Patients with varicella who present with high fever (oral temperature above 38°C) and pneumonia (confirmed by X-ray) or meningitis, requiring hospitalization.
(7) Keratitis or corneal ulcers caused by herpes zoster or herpes simplex.
(8) Acute retinal necrosis.
(9) Patients with herpes zoster rash within three days and lesions located on the head, neck, or genital area may receive oral or topical medications for up to five days.
(10) Patients post-bone marrow transplant may use acyclovir prophylactically under the following conditions: A.
Limited to those receiving allogeneic bone marrow transplants.
B.
From the day before high-dose chemotherapy or total body irradiation (TBI) until 30 days post-transplant.
2.
The treatment course is generally limited to ten days, but herpes simplex encephalitis may require 14 to 21 days of treatment.
Oral, injectable, or topical formulations may be used, but not in combination.
3.
Other brands with the same active ingredients are treated similarly.

Currently, in practice, outpatient clinics may require patients to pay out-of-pocket for several reasons: 1.
Medications not covered by insurance (including so-called health supplements).
2.
Off-label use of medications (which will definitely be denied by the insurance bureau).
3.
Exceeding the quantity covered by insurance (three-day supply coverage—requesting additional medication).
4.
Patient requests for unrelated or inappropriate additional items (e.g., asking for a topical ointment while visiting for a cold).
5.
Other non-covered items (including cosmetic treatments to prevent herpes outbreaks).
This condition is akin to "the cold of the skin"; it is impossible to never have an outbreak, but if the immune system is strong, the disease will not manifest.
Therefore, herpes zoster can recur even after healing.

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Reply Date: 2009/06/06