Management of Active Shingles in Patients on Rinvoq

Primary Management Approach

The American Academy of Dermatology recommends initiating oral valacyclovir 1 gram three times daily for 7-10 days until all lesions have completely scabbed in patients with active shingles on Rinvoq 1
Treatment should begin immediately, ideally within 48-72 hours of rash onset, though benefit exists even beyond this window 1
Consider temporary reduction or holding Rinvoq during active shingles infection, particularly if disseminated disease develops, as recommended by the Journal of the American Academy of Dermatology 2

The American Academy of Dermatology suggests that short-course oral prednisone may be used only in highly selected cases of severe, widespread shingles with significant inflammation, where benefits outweigh substantial risks 1
If steroids are used, dosing should be prednisone 0.5-1 mg/kg/day for 7-14 days maximum, then taper, as recommended by the Journal of the American Academy of Dermatology and the Annals of the Rheumatic Diseases 2, 3
Steroids should only be given in combination with adequate antiviral coverage, such as valacyclovir or acyclovir at full therapeutic doses, as recommended by the American Academy of Dermatology 1

The American Academy of Dermatology recommends avoiding steroids in patients with active shingles on Rinvoq who have an immunocompromised state, as it increases dissemination risk 1
Steroids are also contraindicated in patients with poorly controlled diabetes, as they worsen glycemic control, according to the American Academy of Otolaryngology-Head and Neck Surgery 4

The Journal of Clinical Oncology recommends gabapentin or pregabalin for neuropathic pain management during active shingles infection 6
Oral antihistamines may also be used for pruritus, as suggested by the Journal of Clinical Oncology 6

The American Academy of Dermatology recommends monitoring for signs of dissemination, such as new dermatomal involvement, fever, or visceral symptoms, if steroids are used despite risks 1
Blood glucose should be checked in diabetic patients, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 4
The American Academy of Dermatology strongly recommends recombinant zoster vaccine (Shingrix) after resolution of acute infection, ideally before continuing Rinvoq, to reduce recurrence risk 1