***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A double-blind r and om selection comparison was made of the therapeutic effects in acute herpes zoster of 40 % idoxuridine ( IDU ) dissolved in dimethyl sulphoxide ( DMSO ) compared with DMSO and saline flavoured with garlic .  Thoracic ( 80 patients ) and trigeminal ( 42 patients ) zoster were investigated separately . The patients were evaluated daily until skin healing and then at 1 , 3 and 6 months by registering pain , paraesthesia and sensitivity disturbances as well as by clinical and photographic evaluation of the skin lesions . Duration of pain was positively correlated to age , to delayed healing and to elevated temperature in the acute phase of zoster . The period of pain before skin eruption was considerably longer in thoracic than in trigeminal zoster , while the latter was associated with a more severe inflammatory reaction , more neurologic sequelae , but also by a faster healing of the skin lesions .  IDU was highly effective in shortening the period of pain and improving skin healing in trigeminal zoster , while no effect of IDU was observed in thoracic zoster . The reason for this difference is presently not understood The antiviral effect of 5 % idoxuridine in dimethyl sulphoxide intermittently applied and of 40 % idoxuridine in dimethyl sulphoxide continuously applied for four days to the lesions in patients with zoster of recent onset was studied in two double-blind controlled trials . Most , but not all , of the patients receiving intermittent active treatment had pain for a short period only . The effect of continuous treatment was striking : pain had disappeared within nine days in all the patients and healing was accelerated . The results were statistically significant A double-blind , r and om selection comparison was made of the therapeutic effects in acute herpes zoster of ( A ) 40 % idoxuridine ( IDU ) dissolved in dimethyl sulphoxide ( DMSO ) , or one of the following ointments : ( B ) a basis of polyethylene glycol , ( C ) a basis with 60 % DMSO , ( D ) a basis with 5 % IDU and 60 % DMSO , and ( E ) a basis with 40 % IDU and 60 % DMSO . Each group comprised 20 patients . The patients were evaluated daily until skin healing and then at 1,3 , and 6 months by registering 4 neurological signs , 5 clinical evaluations of skin pathology and 4 photographic evaluations of the skin lesions . A ' profile ' of the effect of each treatment was computed by calculating normalized means for each of the 13 variables . A non-r and om distribution of the clinical and photographic variables indicated a statistically significant , but small therapeutic effect of treatment A on skin healing , whereas no convincing effect on pain or sensitivity disturbances was established . Treatments B-E were without positive effects . The information given by the highly interdependent variables were computed for each variable and for groups of variables after appropriate scoring . It was found that the photographic evaluation contributed evidence independent of the clinical evaluation of skin pathology . A multiple correlation analysis revealed that age was positively correlated to the duration of pain and to delayed healing , that rapid healing was intimately connected to no or short-lived pain , and surprisingly that zoster in the trigeminal area healed faster than in other locations without being correlated to less pain . Treatment A must necessarily be reevaluated taking into account proper controls as well as age and affected dermatomes Oral acyclovir , 800 mg five times per day for seven days , was compared with placebo in a r and omized , double-blind trial conducted at three centers in the United Kingdom . The study group consisted of 364 elderly immunocompetent patients with herpes zoster who were entered within 72 hours of the onset of rash .  Acyclovir significantly reduced the times to last new lesion formation ( p less than 0.01 ) , loss of vesicles ( p less than 0.01 ) , and full crusting ( p = 0.03 ) . No significant hastening of rash healing was seen in those who started therapy later than 48 hours after the onset of rash . There was also a significant reduction pain during treatment with acyclovir ( p = 0.02 ) . Acyclovir produced no effects on the frequency or severity of post-herpetic neuralgia . No clinical ly important adverse effects of acyclovir were reported In a double-blind r and omised trial , 38 elderly patients with acute herpes zoster received either isoprinosine ( IP ) or placebo . IP neither shortened the acute phase of herpes zoster nor prevented postherpetic neuralgia . Transient asymptomatic hyperuricaemia affected one third of IP treated patients . Shortcomings in study design and misleading interpretation of results are common in previously published clinical trials of herpes zoster and postherpetic neuralgia . Guidelines for future studies are proposed Oral acyclovir therapy for herpes zoster has been studied in double-blind , placebo-controlled trials of two dosages , 400 mg and 800 mg five times per day for 10 days . Compared with placebo recipients , recipients of the high-dosage acyclovir experienced a significantly shortened period of viral shedding , significantly accelerated time to 50 percent scabbing , significantly accelerated time to 50 percent healing , and after two days of therapy , significantly less frequent formation of new lesions . The duration and severity of acute pain were less in acyclovir recipients , with differences in pain severity achieving statistical significance ( p = 0.03 ) between Days 3 and 10 and correlating with the treatment differences in new lesion formation . In studies of the 400 mg five times per day dose schedule , differences between acyclovir and placebo recipients were not significant . In a six-month follow-up of recipients in the higher dosage study , the acyclovir recipients experienced less post-zoster pain than placebo recipients ; differences in the prevalence of pain were most significant for the presence of a persistent pain in the first three months of follow-up . Oral acyclovir at these dosages appears to be free of adverse reactions . In summary , oral acyclovir at a dosage of 800 mg five times per day for 10 days for treatment of acute herpes zoster is superior to 400 mg five times per day and favorably alters the course of the disease Healthy patients with early painful herpes zoster were treated with corticosteroid orally or lactose tablets in a double-blind fashion . The duration of postherpetic neuralgia was shortened by treatment with the corticosteroid . Corticosteroid therapy did not affect pain during the first two weeks or the rate of skin healing . The duration of postherpetic neuralgia could not be predicted by the healing rate of the skin .  Control patients less than 60 years old had rapid resolution of their neuralgia while those more than 60 years old had slower resolution of the pain .  Corticosteroid therapy did not cause generalization of the eruption Zoster is a common disease that may be associated with severe and protracted pain .  Antiviral therapy with acyclovir intravenously has been shown to modify the course of the disease and reduce pain during the acute phase . The results of two studies using doses of 400 mg and 800 mg of acyclovir orally are outlined . The data suggest a significant benefit of the higher dose treatment on the course of the illness and the pain A double-blind , r and omised trial evaluated the efficacy of oral acyclovir , 800 mg 5 times daily for 7 days , in  acute herpes zoster and postherpetic neuralgia . Forty patients aged 16 years or over , presenting to their general practitioners within 3 days of rash onset , received acyclovir , while 43 patients received placebo . Acyclovir reduced the extent and duration of the rash , the spread of the rash to adjacent dermatomes and the incidence of disseminated lesions . It shortened the period of new lesion formation and reduced the incidence of ulceration . The weekly prevalence of pain was reduced on acyclovir by the fourth week , with a reduction in the monthly prevalence of chronic pain in the second and third months and a reduction in associated local neurological symptoms between months 3 - 6 . Total analgesic use in the first 4 weeks was reduced by acyclovir , but during follow up there was no difference in the prevalence of analgesic use between groups . There were slightly fewer medical events on acyclovir in the second week , but the frequency was the same in each group for the rest of the 6 months . Biochemical and haematological tests showed no adverse effects of treatment In a r and omised , double-blind , controlled study of the effect of prednisolone on the development of  post-herpetic neuralgia 78 patients with herpes zoster whose pain and exanthema had been present for less than 96 h were given 800 mg acyclovir five times daily for 7 days and prednisolone in a total dose of 575 mg , starting with 40 mg daily in the first week and tapering off over the next 2 weeks . 18 ( 23 % ) of the patients had post-herpetic neuralgia at 6 months after the acute zoster , 9 ( 24.3 % ) having received prednisolone and 9 ( 22.5 % ) placebo . The 95 % CI for the difference between the placebo and prednisolone groups in the proportion of patients having pain at 6 months was minus 17 % to plus 20 % . Prednisolone , however , relieved pain for the first 3 days . The 1 - 2 week interval between admission and reappearance of pain and development of triggered pain seems to be the time needed to establish neuralgia . Once established , the type and intensity of pain remained largely unaltered Sixty-four patients with herpes zoster were entered into a r and omised double-masked , placebo-controlled trial of 5 % acyclovir cream applied five times daily for 5 days . Of these patients , 56 were included in the final analysis ( 26 acyclovir , 30 placebo ) . Significant and objective differences in either progression of the rash , severity of acute pain or incidence of post-herpetic neuralgia were not observed . Although significantly more rashes involuted in the acyclovir group , this isolated finding can not be explained . Twenty-two patients ( 12 acyclovir , 10 placebo ) experienced erythema or desquamation or both during treatment with the cream . The similar incidence of skin reactions in both groups suggests that they were related to the cream base rather than the acyclovir Seventy-one nonimmunocompromised patients with herpes zoster ophthalmicus , presenting within seven days of onset of characteristic skin eruption , were enrolled in a prospect i ve , longitudinal , r and omized , double-masked , placebo-controlled trial with oral acyclovir . In a previous interim report we noted more prompt resolution of dermatomal signs and symptoms with acyclovir treatment . There was also a reduction of viral shedding in acyclovir-treated patients coupled with a trend to greater rate of microdissemination of the virus in placebo-treated patients ( Cobo LM , et al. Ophthalmology 1985 ; 92:1574 - 83 ) . While further substantiating these findings , we report that a ten-day course of treatment with oral acyclovir ( 600 mg , five times a day ) is well-tolerated and significantly reduces the incidence and severity of the most common complications of herpes zoster ophthalmicus : dendritiform keratopathy , stromal keratitis , and uveitis . While this acyclovir treatment regimen reduces the zoster-related pain during the acute phase of the disease , especially in patients treated within 72 hours of onset of skin lesions , it has no evident effect on either incidence , severity , or duration of post-herpetic neuralgia in the patients studied In an uncontrolled open assessment of one patient , cimetidine relieved the pain and shortened the course of herpes zoster . A subsequent uncontrolled trial of  cimetidine in 21 patients with herpes zoster produced encouraging results in all but three patients . More recently , Mavligit and Talpaz[3 ] reported that cimetidine 300 mg q.d.s . for seven days produced a rapid improvement in the pain and pruritus of herpes zoster in four cancer patients whose immune systems were profoundly suppressed . Herpes zoster is thought to be associated with a state of depressed cellular immune function[4 ] . It is theoretically possible for H2 receptor antagonists such as cimetidine to modify cell-mediated immune responses since thymus dependent T-lymphocytes have been shown to possess H2 receptors[5 - 7 ] . In addition to a possible direct anti-viral effect[2 ] , cimetidine may augment the immune defences of the body which produce early control of the herpes zoster virus Sixty immunocompetent patients with herpes zoster of various dermatomes were treated 5 times a day for 5 days with either acyclovir at a dose of 400 mg or placebo A double-blind , placebo-controlled trial of amantadine hydrochloride ( Symmetrel ) in acute herpes zoster ( shingles ) was carried out in 100 patients in general practice . The cases were serologically proved . There was no difference in duration of pain between the drug and placebo groups when pain disappeared during the 28 days ' observation period . However , pain lasted more than 28 days in a significantly greater proportion of patients receiving placebo than of those on amantadine . Patients with pain after the 28-day observation period were significantly older than those whose pain disappeared during the study . The drug had no effect on rate of healing or appearance of new lesions Forty-seven out patients with herpes zoster , seen within five days of onset of the eruption , received ten days ' administration of oral levodopa and benserazide or placebo in a double-blind controlled study . Both the total patient group and high-risk group , 
    Output:
    
Firm recommendations for clinical practice are not possible because existing evidence neither confirms nor refutes the hypothesis that treatment during the acute phase of herpes zoster reduces pain later