Background: Acute herpetic neuralgia (AHN) due to a reactivated varicella zoster virus infection is a common problem. Furthermore, about 18% of all patients with confirmed herpes zoster (HZ) develop postherpetic neuralgia (PHN). The leading factors of the prognosis and persistence of symptoms are patient age and the size of the lesions. Animal studies came to a similar conclusions that in both AHN and PHN, inflammatory cytokines such as IL-6 and IL-8 could serve as predictive markers and that a positive influence of vitamin C administration, by modifying cytokine metabolism, could be demonstrated.
Case report: Two patients (females aged 67 and 53 years) from an average and unselected patient group of a general practice with confirmed AHN were observed in the course of their illness. They received the basic analgesic (according to the WHO step scheme) and viral-static therapy. Furthermore, 15 g of vitamin C was administered intravenously every second day over a period of two weeks. Sudden and total remission of the neuropathic pain (measured on the basis of the visual analogous-scale, VAS) could be observed. Remission of the cutaneous lesions was noted within 10 days.
Conclusions: The use of the vitamin C appears to be an interesting component of alternative therapeutic strategies in the treatment of HZ. Especially for therapy-resistant cases of PHN, vitamin C administration should be examined as an additional option. To test and confirm the clinical findings, randomized clinical studies concerning the use of vitamin C in the concomitant treatment of zoster-associated neuralgia should be performed.