Therapy with intravenous acyclovir (10 mg/kg or 500 mg/m2 every 8 hours for 7–10 days) should be initiated at the first sign of infection. A switch to oral antiviral therapy (acyclovir, valacyclovir, or famciclovir) can be considered when the patient is afebrile and new lesion formation has ceased. When feasible, the dosage of immunosuppressive medications should be temporarily reduced in immunosuppressed patients with varicella.
Despite the lack of data from large-scale controlled trials, the safety and efficacy of intravenous acyclovir have led to its acceptance as the drug of choice for varicella in severely immunocompromised patients.
Oral antiviral therapy may be efficacious in modestly immunocompromised patients (e.g., those with solid tumor malignancies or a low-dose corticosteroids), but prospectively acquired data are limited.
Tropical
There are a variety of topical treatments, including topical acyclovir 5% cream, lidocaine, and capsaicin. Capsaicin applied at least 5 times a day, depletes neurotransmitters at involved nerve endings. Topical lidocaine also can be used.
For acute HZO, a good approach is wet-to-dry dressings with sterile saline solution or Burow solution (5% aluminum acetate dissolved in water), which should be applied to the affected skin for 30-60 minutes 4-6 times daily. The acyclovir cream often is applied 5 times a day for 4 days. Calamine lotion {zinc oxide with 0.5% iron (III) oxide}, may be used as an antipruritic agent. Calamine also is used as a mild antiseptic to prevent infections that can be caused by scratching the affected area, as well as an astringent for weeping or oozing blisters. There is, however, no proof that calamine lotion has any real therapeutic effect on rashes and itching. Topical ozone therapy may be beneficial in diminishing pain and shortening the course, but of course with many adverse effects.
Antiviral agents
For the treatment of herpes zoster in immunocompetent individuals, oral antiviral agents are the cornerstone of therapy. Recommended particularly for patients aged 50 years and older, those with moderate to severe pain or rash, and individuals with non-truncal involvement, these medications are crucial in managing the viral infection effectively. Patients younger than 50 years with mild symptoms and truncal involvement also should consider oral antivirals to prevent the development of postherpetic neuralgia (PHN). Among the preferred antivirals, Brivudine, famciclovir, and valacyclovir are better than acyclovir. It is essential to initiate antiviral therapy within 72 hours of the onset of the rash to maximize its effectiveness, although treatment still may be beneficial for those presenting later if they experience severe symptoms or complications. Famciclovir or valacyclovir should be administered for 7-10 days
Many studies have found acyclovir and its derivatives (valacyclovir, famciclovir, penciclovir, and desciclovir), are banned in many countries for their sever and lifelong side effects.
Corticosteroids
For immunocompetent individuals experiencing moderate to severe pain from herpes zoster that does not adequately respond to initial therapies, corticosteroids such as prednisone may be added to the treatment regimen. These steroids are particularly considered when patients exhibit severe inflammatory symptoms or when other allopathic pain management strategies fail to provide relief. Corticosteroid can be used alone or in combination with other treatments such as gabapentin, pregabalin, or tricyclic antidepressants. However, their use should be carefully managed due to potential side effects, and treatment should be tailored to the individual’s specific health profile and response to other treatments.
Agents for pain control
Effective pain management is critical in the treatment of varicella and herpes zoster. For mild to moderate pain, acetaminophen or an NSAIDs may be sufficient, and these can be used alone or in combination with weaker opioids such as codeine or tramadol
In cases of moderate to severe pain, stronger opioids like oxycodone or morphine are recommended. If pain persists despite opioid treatment, additional medications such as gabapentin or pregabalin, tricyclic antidepressants (especially nortriptyline), or corticosteroids may be considered.
Homeopathic Vaccination and Treatment for varicella Zoster
All natural vaccines are Homeopathic medicine not allopathic, said Dr. Qaisar Ahmed MD, DHMS. 
Vaccine, suspension of weakened, killed, or fragmented microorganisms or toxins or other biological preparation, such as those consisting of antibodies, lymphocytes, or messenger RNA (mRNA), that is administered primarily to prevent disease.
The very first vaccine (According to the world first Materia medica “Pen-Ts’ao” written in 2700BC by orders of king “Shen-Nung”.) experiment did by chines doctors (herbalists/Ayur-Vedas) There are dozens of Homeopathic medicines for smallpox and antivirals beneficial for smallpox, chickenpox, varicella zoster, shingles etc. These Homeopathic antiviral medicines can cure not only chickenpox but will completely remove the varicella virous from body forever without any side effects. These medicines not only slow down the viral activity which will allow one’s body’s immune system to destroy the virus and heal faster itself, but they act as antivirals too.
Homeopathic Vaccines & Treatments
Homeopathic Vaccine for Varicella family like: Chickenpox, Morbilli/Measles, varicella zoster, Herpes Zoster and some Homeopathic anti-viral medicines:
Morbillinium
A good antiviral Homeopathic medicine. As a prophylactic (vaccine) given to those who are, or may be, exposed to infection, I prescribe a dose of the 200th twice or thrice daily (Dr Qaisar Ahmed MDM, DHMS). For an attack of a viral disease, I find nothing better than Morbillinium. 200, eight or ten globules in six ounces of water, a tablespoon every two hours. The effect of this is heightened by giving alternately Belladona in the same way. These two medicines will be sufficient to carry through any uncomplicated case, and in my experience do even better than Pulsatilla. As the viral poison has a great affinity for the mucous passages, the eyes, the ears and the respiratory mucous membranes.
Variolinum
Variolinum 1M/10M or CM for prophylactic and for vaccination purpose – single dose is enough. In 2023 a study published in International Journal of research studies proves efficacy of Variolonum in smallpox, chickenpox, Varicella zoster virus (VZV) and shingles.
Other symptoms are – exanthema of sharp, pointed pimples, usually small, seldom large and suppurating, dry, resting on small red areolae, frequently interspersed with spots of red color, sometimes severe itching. Petechial eruptions. Var. 1m in water every two hours, given on third day of eruption of a confluent case cut short the attack. Shingles.
Fever very severe, commencing with chills running down back like streams of cold water, causing shivering and chattering of teeth. Hot fever with no thirst. Very profuse and bad-smelling sweat.
Prophylactic variolinum-6x is proven by Dr. Burnett. For treatment 1M or higher Dr. Qaisar Ahmed MD, DHMS.
Note: Never advise Variolinum to the patients with weak immune system especially in lower potencies. Dr. Qaisar Ahmed MD, DHMS, Is. Jurisprudence.
Hepar Sulph
Abscesses: suppurating glands are very sensitive. Papules prone to suppurate and extend. Acne in youth. Suppurate with prickly pain. Easily bleed. Angio-neurotic oedema. Unhealthy skin: every little injury suppurates. Chapped skin, with deep cracks on hands and feet. Ulcers, with bloody suppuration, smelling like old cheese. Ulcers very sensitive to contact, burning, stinging, easily bleeding. Sweats day and night without relief. “Cold sores” very sensitive. Cannot bear to be uncovered; wants to be wrapped up warmly. Sticking or pricking in afflicted parts. Putrid ulcers, surrounded by little pimples. Great sensitiveness to slightest touch. Chronic and recurring urticaria. Monkeypox. Smallpox. Herpes circinate. Constant offensive exhalation from the body.
Natrium Sulphuricum
Itching while undressing. Jaundiced, watery blisters. Sycotic excrescences; wart-like red lumps all over body. Monkeypox.
Medorrhinum
Yellowness of ski, Intense and incessant itching (and pricking) all over (back, vagina, labia etc). Fiery red band passing down neck, back, and perineum, and involving genitals and pubes. Fiery red rash about anus in babies the water/wetting scalds it terribly. Herpes zoster or shingles.
Scald-head. Tinea capitis, eyelids involved. Copper-colored spots (syphilitic) remaining after eruptions, thin yellow-brown and detach in scales, leaving skin clear and free. Small pedunculated warts, with pinheads, like small button mushrooms, on various parts of body and thigh. Favus. Fetid odor of body. Pains along urethra while urinating, drawing burning. (Suppressed gonorrhea).
Aconitum Napellus
Amaurosis, Anger, Apoplexy, Asthma, Bronchitis, Catalepsy, Catheter fever, Chest affections, Chickenpox, Monkeypox, Smallpox, Enteritis, Erythema nodosum, Excitement, Eye affections, Face flushing. Fear and its effects. Glands swollen. Glossitis. Hodgkin’s disease. Hyperpyrexia. Influenza. Jaundice.
Measles, Miliaria, Mumps, Esophagus inflammation, Pleurisy, Puerperal fever. Purpura. Quinsy. Remittent fever. Roseola. Scarlatina. Shivering. Sleeplessness, Tetanus. Tetany. Thirst. Throat affections. Tongue/mouth affections, Traumatic fever. Urethra, spasmodic stricture, Urethral fever. Urine, suppression of. Uterus prolapsus. Vaccination side effects, Yawning. Yellow fever.
Bryonia Alba
Bryonia should be advise in first stag; Symptoms are: Aphthae. Apoplexy. Asthma. Bilious attack. Breast, inflamed. Bronchitis. Cancer, Chlorosis. Constipation. Consumption. Coryza. Cough.
Eczema. Enteric fever. Eruptions. Gastroenteritis. Hemorrhages. Hands, swollen. Headache. Heart inflammation. Influenza. Intermittent fevers. Jaundice. Joints, pain in. Lactation, Liver malfunctioning.
Lumbago. Measles, Monkeypox, Smallpox, Scarlatina, Pleurisy, Suppressed eruptions and their bad effects. Meningitis. Menstruation, vicarious. Miliaria. Milk fever. Myalgia. Nephritis. Nosebleed. Peritonitis. Phlegmasia alba dolens. Pleurodynia.
Morning cough, Puerperal fever. Pyuria. Relapsing fever. Remittent fever. Rheumatism. Screaming. Side, pain in. Sleep, anxious dreams in. Spina bifida. Stiff neck. Thirst. Tongue, coated. Toothache. Trachea, pain in. Vertigo. Waking, starts and screams on. Water-brash. Whooping-cough. Yellow fever.
Sulphur
Acne. Adenoids. Ague. Anemia. Anus, prolapse of. Asthma. Atelectasis. Bedsores. Biliousness. Boils. Catarrh. Chagres fever. Chancre. Cheloid. Consumption. Corns. Cough. Crusta serpiginosa. Dental fistula. Diabetes. Diarrhea. Dysentery. Eczema. Eruptions. Eyes affections. Freckles. Ganglion. Gland’s affections. Gleet. Headache. Herpes. Influenza. Intermittent. Irritation. Itch. Jaundice. Lupus. Monkeypox.
Nettle Rash. Rectum affections. Skin affections. Ulcers. Urticaria. Vaccination. Warts. White swelling.
Apis Melifistida
Abscess, Apoplexy. Carbuncle. Chancre. Dissection wounds. Dropsy. Erysipelas. Erythema nodosum. Eyes affections; optic neuritis. Feet burning. Gangrene. Hands swelling. Injuries. Intermittent fever. Irritation. Labial inflammation.
Punctured wounds. Scarlatina, Monkeypox, Smallpox. Self-abuse. Suppressed eruptions and their effects. Sycosis. Syphilis. Throat, sore. Tongue edema; ulceration of. Trachea, irritation of. Tumors. Typhus. Urethritis. Vaccination. Varicose veins. Variola. Wounds.
Antimonium Tartaricum
Similarity of the smallpox pustule to those produced by Tartar emetic (Monkeypox). Hughes recognizes it almost as a routine agent. Vesication and pustulation.
Asphyxia neonatorum. Chickenpox, Smallpox, Monkeypox. Cholera morbus. Coccygodynia. Cough. Group. Delirium-Tremens. Dyspepsia. Ecthyma. Eyes, inflamed. Impetigo. Intermittent fever. Laryngitis.
Lumbago. Myalgia. Paralysis agitans. Plica-polonica. Psoriasis. Rheumatism. Ringworm. Screaming. Stiff neck. Sycosis. Synovitis. Taste, altered. Thirst. Tongue, coated. Tremors. Varioloid. Vomiting. Whooping-cough.
Thuja Occidentalis
Boenninghausen employed this remedy with success and believed it to be the best curative and preventive agent in smallpox, Monkeypox and Chickenpox. It suits especially the eruptive stage, with milky, flat, painful and offensive pustules upon a dark inflamed area. Variola.
Vaccinum
Vaccine poison is capable of setting up a morbid state of extreme chronicity, named by Burnett Vaccinosis, symptoms like those of Hahnemann’s Sycosis. Neuralgias, inveterate skin eruptions, chilliness, indigestion with great flatulent distension. Irritable, impatient ill-humored, nervous.
Inflamed and red lids. Skin hot and dry. Pimples and blotches. Eruption like variola.
Arsenicum Album
Desquamation of the skin of the body. Skin dry as parchment, cold and bluish. Yellowish/pale skin. Shootings, hot itching, and violent burning in the skin. Reddish or bluish spots in the skin. Petechiae. Inflamed spots, as from morbilli, chiefly in the head, face, and neck.
Miliary eruptions, red and white. Conical pimples, whitish or reddish, with burning itching. Nettle Rash. Eruption of painful black pustules, sometimes itchy pimples, small and tickling. Eruption of small red pimples, which increase and change into gnawing ulcers, covered with a scurf. Vesicular eruptions.
Herpes, with vesicles, and violently burning, especially at night, or with coverings, like fish-scales. Skin jaundiced; general anasarca; black blisters. Pustules filled with blood and pus. Tetters spots, covered with phlyctenules and furfur, with burning nocturnal pains.
Ulcers with raised and hard edges, surrounded by a red and shining crown; with the bottoms like lard, or of a blackish blue color, with burning pains or shooting, principally when the parts affected become cold. Ulcers, hard on the edges, stinging, burning spongy; with proud flesh; turning black; flat; pus thin, ichorous (cancers), Fetid smell, ichorous suppuration, ready bleeding, putridity, and bluish or greenish color of the ulcers.
Thin crusts or proud flesh on the ulcers. Want of secretion in the ulcers. Carbuncles (burning). Inflammatory tumors with burning pains. Warts. Ulcers inform of a wart. Chilblains. Varices. Discolored nails.
Lachesis
Ecchymosis: wounds and ulcers bleed readily and copiously (small wounds bleed a good deal; ulcers bleed readily; cicatrices bleed readily; pain in old cicatrices), wounds bleeding a great while; skin very hard to heal, masses of blood pass through the pores.
Varicose swellings. Dropsical swelling over whole body. Hard and pale tumefaction. Skin yellow, green, lead-colored, or bluish-red or blackish, chiefly round the wounds and ulcers. Yellow, red, copper-colored spots. Pale, livid spots, with fainting fits. Dry, miliary itch, with eruption of large vesicles of a yellow or of a bluish black color, with swelling of parts affected, and pains which drive to despair.
Miliary eruption, which subsequently resembles nettle-rash, scarlatina, or morbilli. Erysipelas and vesicular eruptions with a red crown. Excoriated places, on touching which a burning pain is felt. Rupia and other skin affections, with angioleucitis (Cooper).
Ulcers, surrounded by pimples, vesicles, and other small ulcers (on a purple skin). Ulcers with great sensitiveness to touch, uneven bottom, ichorous, offensive discharge when touched, especially around the lower extremities.
Gangrenous ulcers. Gangrenous blisters. Superficial ulcers, foul at bottom, with a red crown. Cancerous ulceration (of wounds), or putrefaction of the flesh, which becomes detached from the bones, and falls off piecemeal. Gangrenous wounds, with inflammatory fever, weak, quick, and intermittent pulse, fainting nausea, spasmodic and bilious vomiting, convulsions, and cold sweats. Papule, warts, hard swellings.
Panaris. Red and itching lumps and tuberosities. Carbuncles, with copper-colored surroundings and many smaller boils around them. Flat exanthemata which do not fill up; pustulous exanthemata; spongy excrescences.
Crotalus Horridus
Swelling and discoloration, skin tense and shows every tint of color, with excruciating pain. Vesication. Sallow. Yellow color of the whole body. Great sensitiveness of skin of right half of body. Purpura hemorrhagic. Hemorrhage from every part of body. Bloody sweat. Chilblains, felons. Dissecting wounds. Pustular eruptions. Insect stings. Post-vaccination eruptions. Bad effects of vaccination. Lymphangitis and septicemia. Boils, carbuncles, and eruptions are surrounded by purplish, mottled skin and oedema. Anthrax. Sore sensation relieved by pressure.
Baptisia
Great burning and heat in skin; Livid spots over body and limbs. Eruption like measles or urticaria. Confluent smallpox, Monkeypox, tardy eruption. Foul, gangrenous, eating syphilitic sores.
Anacardium Orientale
Intense itching, eczema, with mental irritability; vesicular eruption; swelling, urticaria; eruption like that of Poison-Oak (Xerophily; Grindel; Croton). Lichen planus; neurotic eczema. Warts on hands. Ulcer formation on forearm.
Sarracenia
Polyctenid herpes. Psoriasis. Scrofulous eruptions. Variola; (the decoction taken when eruption is out and beginning to pustulate aborts secondary fever and prevents pitting). Monkeypox.
Eruption out, pustules dissipate, first on face, fever lessens, urine though scanty and dark becomes abundant and pale, strength returns. Eruptions similar to crusta lactea; on forehead and hands papular eruptions, changing to vesicular, with the depression as in smallpox lasting from seven to eight days.
Hydrastis Canadensis
Small-pox internally and locally. The power of Hydrastis over smallpox seen in modifying the disease, abolishing its distressing symptoms, shortening its course, lessening its danger and greatly mitigating its consequences.
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