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To the Editor: In his Clinical Crossroads article discussing herpes zoster, Dr Whitley¹ stated that our Cochrane review² reported no benefit of valacyclovir for prevention of postherpetic neuralgia (PHN) at 4 or 6 months after rash onset. However, this is not accurate; our review did not include any trials of valacyclovir.

In addition, Whitley stated that "[p]revention of PHN is a major concern because antiviral drugs alone do not reliably prevent this complication." Although the results of randomized controlled trials and meta-analyses showing that antiviral drugs reduce the risk of developing PHN can be challenged, the overall findings support the use of antiviral therapy for herpes zoster to reduce the duration or incidence of prolonged pain.³ Cut points used to define PHN have ranged from 1 to 6 months after onset of zoster^{2, 4}; using a definition of PHN as pain present for more than 30 days after the onset . . . [Full Text of this Article]

Muke Zhou, MD; Dong Zhou, MD; Li He, MD
heli2003new@126.com
Department of Neurology
West China Hospital
Chengdu, China

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