Why should I be concerned about Shingles in my IBD patient?

1. There is an increase in the incidence, duration, and complications in IBD patients

2. There are rare complications of systemic dissemination (i.e., lung, liver, CNS, peripheral/ cranial nerves, ocular manifestations) or local dissemination (i.e., involving more than 3 dermatomes) in IBD patients

3. There is an increase in the incidence of post-herpetic neuralgia in IBD patients

 

What should I prescribe as treatment?

• Valacyclovir (Valtrex) 1gram TID for 7-10 days OR Famcyclovir 500mg TID for 7-10 days

 

What if the patient has any symptoms of disseminated VZV?

• They should immediately contact the family physician or go to the emergency department for an assessment

• Admission for IV Acyclovir at 10mg/kg q8h may be required

 

What do I do with the biologics?

• Hold the biologics or immunosuppressive medication until the vesicles resolve (i.e., crust over) and after completing a 7-10day course of Valacyclovir (Valtrex)/ Famcyclovir

 

Reference for additional reading: 

1. Kim BS, Maverakis E, Alexanian C, Wang JZ, Raychaudhuri SP. Incidence, Clinical Features, Management, and Prevention of Herpes Zoster in Patients Receiving Antitumor Necrosis Factor Therapy: A Clinical Review. J Cutan Med Surg. 2020 May/Jun;24(3):278-284. DOI: 10.1177/1203475420914622. PMID: 32238066.