Section Review: Anti-infectives: The value of steroids in the treatment of herpes zoster

Since 1951 short courses of systemic corticosteroids have been used widely in the treatment of acute herpes zoster with the predominant aims of decreasing the severity of the acute illness and preventing or shortening the duration of post-herpetic neuralgia. This practice has not been based upon well designed studies of adequate size. A large well-controlled study of corticosteroid use has recently been reported and, in conjunction with previous smaller controlled trials, enables a critical evaluation of this therapy. We conclude that there is no evidence that systemic corticosteroids given early in acute herpes zoster are beneficial in preventing or shortening the period of post-herpetic neuralgia but that there is a short-lived reduction in the severity of acute pain when steroids and acyclovir are given in combination. However, owing to the risk of side effects, we believe this small gain is insufficient to justify the routine use of steroids in this illness.