Treatment for Disseminated Zoster

Introduction to Disseminated Zoster

The American College of Physicians and the Infectious Diseases Society of America recommend that disseminated zoster is characterized by multi-dermatomal involvement, visceral organ involvement, and cutaneous lesions that begin on face/trunk and evolve peripherally 2, 3
Disseminated zoster has a risk of 10-20% for dissemination in immunocompromised patients without prompt antiviral therapy, according to the Centers for Disease Control and Prevention 2, 3

The Infectious Diseases Society of America recommends intravenous acyclovir 5-10 mg/kg every 8 hours as the definitive treatment for disseminated herpes zoster, continued until clinical resolution is attained 1, 4
Higher doses (10 mg/kg) are preferred for severely immunocompromised patients, as suggested by the National Institutes of Health 4
Treatment should be continued for a minimum of 7-10 days and until clinical resolution is attained, according to the American College of Physicians 1

The American College of Physicians recommends temporary reduction or discontinuation of immunosuppressive therapy in severe cases of disseminated VZV infection 1, 4
Immunosuppression may be restarted after the patient has commenced anti-VZV therapy and skin vesicles have resolved, as suggested by the Infectious Diseases Society of America 1

The Infectious Diseases Society of America recommends continuing IV acyclovir until all lesions have completely scabbed, no new lesions are forming, and clinical resolution of visceral complications if present 1, 4
The American College of Physicians suggests that the endpoint is clinical resolution, not an arbitrary calendar duration—treatment may need to extend beyond 7-10 days if lesions remain active 4

The Centers for Disease Control and Prevention recommend that all immunocompromised patients with disseminated zoster require IV acyclovir, and close monitoring for visceral complications is essential 1, 4
The National Institutes of Health suggest considering longer treatment duration if healing is delayed in immunocompromised patients 1
The Infectious Diseases Society of America recommends monitoring for acyclovir resistance if lesions persist in HIV-positive patients 4