A protracted, postherpetic neuralgic ulcer treated with risperidone and intranasal butorphanol

Abstract

PHI: postherpetic itch PHN: postherpetic neuralgia PP-NRS: peak pruritus numerical rating scale INTRODUCTION Postherpetic neuralgia (PHN) represents a type of peripheral neuropathic pruritus that occurs after an episode of shingles and is characterized by localized pain, paresthesia, and itch, termed postherpetic itch (PHI); all may simultaneously exist within the same dermatomal distribution. Although PHI has been reported to affect up to 58% of patients with shingles, its exact pathophysiologic mechanism is poorly understood, and there are no proven specific treatments. Herein, we describe the case of a patient who presented with a painful and severely pruritic ulcer located on the left side of the neck that developed in the setting of PHN refractory to conventional treatments. Although many standard treatments moderately reduced the associated pain, successful treatment of the pruritus and scratching frequency was achieved only with risperidone and intranasal butorphanol, which ultimately led to the resolution of the ulcer.