Background: Treating pain, itch, and numbness associated with Herpes zoster (HZ) is challenging. Thus, alternative (or complementary) therapeutic approaches are needed. One such approach could be high-dose intravenous ascorbic acid (HDIAA) therapy, known for its antiviral properties. This report describes two patients with trigeminal neuralgia and painful trigeminal neuropathy due to acute HZ who were successfully treated with HDIAA after conventional treatment failed.
Case presentation: Case 1: A 63-year-old male with a ten-day history of HZ complained of severe pain and itch in the forehead, eye, and scalp on the left side. A vesicular rash was observed in the left V1 distribution, with eyelid edema and conjunctival hyperemia. Neurological examination revealed trigeminal V1 neuralgia following acute HZ. Case 2: A 61-year-old male with a one-month history of HZ presented with severe numbness and moderate pain in the right side of his face. Neurological examination revealed painful trigeminal V1 neuropathy attributed to HZ.
Treatment and outcomes: Both patients were administered ascorbic acid IV at a dose of 20 g daily for 5 days. The main outcomes were a significant reduction in pain (from 9/10 to 2/10 on the Visual Analogue Scale) and itch (from "severe" at baseline to "moderate") in patient 1, and numbness (by 80%) and pain (completely) in patient 2. At follow-up, all HZ-related symptoms had resolved except for mild residual itch in case 1. No side effects or discomfort were noted.
Conclusion: These cases demonstrate the potential of HDIAA in the treatment of HZ-related neuropathic symptoms and highlight the need for clinical trials to confirm the efficacy of this therapy.
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