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    How can postherpetic neuralgia be treated?

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Posted on Tue, 29 Aug 2017 in Skin Hair and Nails
Question: Hi, I am 46, and dealing with my second bout of Shingles. I came down with this episode on May 3, while I was inpatient in the hospital. So I just passed my 3 month mark, and the rash doesn't appear to be clearing up as it should. I've been prescribed a few meds for this episode, such as Neurontin, and I just completed a 15 day treatment with Prednisone, and am currently on a Pharmacy-compounded Diclofenac/Lidocaine (3/5%). I am also on Lyrica, but for FMS. Together, the Lyrica and Neurontin help keep the neuropathy under somewhat control.

The rash (what's left of it, which is still significant after all this time) reopened tonight and bled. That's new. It itches when it's close to changing the non-stick patches. I experience moderate nerve pain after roughly 5-6 hours with the new patch and compound medicine.

How long do I need to endure this? I'm concerned my PCP will refer me to a dermatologist the next time I see him if this isn't cleared up. He's been very supportive and tries to be helpful, especially when I call his office to request a new drug to help clear the rash and the pain. He's done his research, which is why he approved my request for the Prednisone and the Neurontin. That's why I'm concerned. I want to get well, but I'm so tired of doctors (no offense, please).

Thank you in advance,
XXXX
YYYY@YYYY


I don't remember choosing any specialist, so please don't be mad that oncology popped up. I have pictures of my rash, but the pics were taken while the rash was in its early stages.

Please advise me of any questions you might have. I feel like I haven't given a thorough explanation or a clear question. Thank you.
doctor
Answered by Dr. Kakkar S. 14 hours later
Brief Answer:
Regarding post herpetic neuralgia

Detailed Answer:
Helo XXXXXXX Thank you for writing to us.

I am Dr. Kakkar (Dermatologist).
I have gone through your query and I have noted your concern.
Post herpetic Neuralgia (PHN) can last for months or even more than an year after resolution of herpes zoster/ shingles. While treatment for PHN is effective but it is largely symptomatic. I suggest you continue with Lyrica 75mg (which is pregabalin), twice daily. There is really no need to continue Neurontin(gabapentin) along with Lyrica as both of these are similar acting. I would rather suggest adding either Nortriptyline or Carbmazepine along with lyrica. Probably the topical coumpound mix is causing allergic dermatitis. That may be causing itching. You may discontinue it. Kindly upload recent images of the area in "Reports Section" so that I am able to guide you better.

Regards
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Kakkar S. 2 hours later
Thank you, Doctor. I took a recent (today) pic of the rash. I realize Lyrica and Neurontin are similar-acting meds, and my PCP prescribed both. He did that bc he knew my insurance won't pay for a larger dose of the Lyrica (I'm on 300mg 2/day), and I understand the Neurontin is a temporary medicine for me, at least until the PHN gets under control.

I will ask my PCP Monday about the two meds you mention. I am currently on Lexapro, so I'll see if he wants to change that to Nortriptyline. I'm unsure Carbmazepine is something he'd put me on, however, as the side effects are worse than the benefit of taking it. But I will ask, and whatever he says, I'll do.
I didn't know the compounded topical could cause allergic dermatitis. I am directed to change my patch and put the compound on each change every 8 hours, but am changing it roughly once a day. I didn't want too much NSAID in my system from it.

Please advise.

Thank you,
XXXX
doctor
Answered by Dr. Kakkar S. 13 hours later
Brief Answer:
A hypertrophic scar

Detailed Answer:
Thank you. I have viewed the Image.

It seems like a linear, raised, hypertrophied scar to me with wounds within its span.
A raised hypertrophied scar can be itchy and probably you scratched it and that may have led to formation of this wound.
Does this feels firm/ hard when you pinch it? A hypertrophied scar feels firm as compared to surrounding skin.
I suggest you to use a topical antibiotic for the wound e.g 2% mupirocin or 2% fusidic acid ointment, twice daily over the wound.
After the wound heals I would suggest you to use a silicone gel sheet dressing for the scar. That would gradually flatten, soften and make it less itchy.

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Answered by
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Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 8961 Questions

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