Objective:

Postherpetic pruritus is an underreported but significant sequelae of Herpes zoster infection. It can present isolated or in conjunction with postherpetic neuralgia. 

Background:

A 78-year-old woman who presented with Shingles in V1 dermatome distribution of the left trigeminal nerve developed postherpetic neuralgia and pruritus. Standard treatment with antivirals resolved the pain but the postherpetic itching persisted. Trials of antidepressant and nerve pain medications such as Duloxetine and Doxepin couldn’t alleviate the symptoms or were not tolerated. Topical corticosteroid cream provided the only relief at the time. However, it induced profound skin thinning. 

Design/Methods:

Due to concomitant blepharospasm, the patient was injected with a pattern Onabotulinum toxin targeting the blepharospasm and additional units were added in the areas of pruritus on the scalp and forehead. 

Results:

The result was complete resolution of blepharospasm and dramatic improvement of the itching. The symptoms reoccurred a few months later and subsequent treatments with Onabotulinum toxin were performed, and consistently had notable improvement. The only side effect was post injection bruising after the initial injections which subsided rapidly in the days following. 

Conclusions: