A 35-year-old immunocompetent patient presents with painful grouped vesicles on an erythematous base in the T3 dermatome (cheek and upper lip) for 5 days. The treatment of choice and dosing for herpes zoster (HZ) involving the face is:

• A Acyclovir 400 mg 5 times/day for 7 days
• B Famciclovir 250 mg TDS for 7 days
• C IV acyclovir 10 mg/kg TDS for 7 days
• D Valacyclovir 1000 mg TDS for 7 days ✓

Explanation

For uncomplicated herpes zoster in immunocompetent adults, all three oral antivirals are effective but valacyclovir 1000 mg three times daily for 7 days is preferred due to its superior bioavailability (54% vs 15-20% for acyclovir). For herpes zoster, acyclovir requires higher doses (800 mg 5 times/day, not 400 mg which is for HSV). Famciclovir 500 mg TDS (not 250 mg) for 7 days is the correct famciclovir dose for HZ. IV acyclovir is indicated for HZ in immunocompromised patients, disseminated HZ, HZ ophthalmicus with ocular complications, or HZ encephalitis. Ophthalmic zoster (V1 dermatome) requires ophthalmology referral and antiviral treatment to prevent ocular complications.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.