皮肤性病学英文-陈爱军-带状疱疹英文教学.ppt

1、Herpes Zoster,Definition Herpes zoster is caused by Varicella - Zoster virus (VZV) , classically occurs unilaterally within the distribution of a sensory nerve, being characterized by clustered vesicles and considerable neuralgia,Pathogen and Pathogenesis Pathogen Varicella-Zoster virus (VZV) is cha

2、racterized by neurotropism and dermatotropism,Pathogenesis VZV causes varicella in childhood , and establishes latency in sensory ganglia after the primary infection. VZV may replicate later in life, taking advantage of the decline in immune function, traveling down the sensory nerve into the skin ,

3、 showing neuralgia and clustered vesicles,Clinical manifestations Prodrome: headache and fever hyperaesthesia pain in the affected area,Features of lesions The eruption presents as papules and erythema in the dermatome. Over a few days, crops of clustered red papules form in a discontinuous band and

4、 quickly evolve to clear vesicles surrounded by erythema,The eruption may have few lesions or reach total confluence in the dermatome. Lesions may become hemorrhagic, necrotic, or bullous,The vesicles slowly become pustulars, and rupture to form crusts , which separate in two to four weeks, often wi

5、th scarring. The regional lymph nodes are enlarged and tender,Complications Postherpetic neuralgia(PHN) The pain persists after the skin lesions have healed, with the same quality as that of acute zoster pain. a month,Ophthalmic Zoster Ocular involvement is most commonly in the form of uveitis and k

6、eratitis,Ramsay Hunt syndrome Results from involvement of the facial and auditory nerves by the VZV. The presenting features include : herpes auricularis, facial paralysis, and auditory symptoms. VZV. Herpetic inflammation of the geniculate ganglion is felt to be the cause of this syndrome. The pres

7、enting features include : herpes auricularis, facial paralysis, and auditory symptoms,Incomplete herpes zoster There are may only neuralgia and papuloid lesions but with no blisters,Disseminated Herpes Zoster A generalized varicelliform eruption accompanying the segmental eruption. It has been defin

8、ed as more than 20 lesions outside the affected dermatome. It occurs chiefly in old or debilitated individuals, especially in patients with malignancy and AIDS,Diagnosis and Misdiagnosis Diagnosis Typical lesions: crops of clustered vesicles surrounded by erythema, forming in a discontinuous band, w

9、ith enlarged regional lymph nodes. The distribution of a signal dorsal nerve root. Obvious neuralgia,Misdiagnosis: Pain ususlly precedes the eruption by 3 or 4 days, sometimes it may be misdiagnosed to other diseases, depending on different part. Appendicitis Cholecystitis Angina pectoris,Treatment

10、Bed rest Antivirival therapy: acyclovir (ACV) 0.2 5 times daily valacyclovir(VCV) 1.0 3 times daily famciclovir (FCV) 0.5 3 times daily for 7 days,Vitamin B: help to relief the inflammation of the involved nerve and relief the pain. TTFD 25mg tid VitB12 0.5mg im qd Analgesic: aspirin indomethacin,Ne

11、rve blocks Improving immune function: transfer factor (TF) Systemic corticosteroid therapy: prednisone 10mg tid Physical therapy Topical therapy: 5% scl,In conclusion: Definition Pathogen Clinical manifestations Complications Diagnosis and misdiagnosis Treatment,Definition Herpes zoster is caused by

12、 VZV, classically occurs unilaterally within the distribution of a sensory nerve, with the features of clustered vesicles and neuralgia,Pathogen Varicella-Zoster virus (VZV) is characterized by neurotropism and dermatotropism,Clinical manifestations Prodrome Typical lesions Distribution Neuralgia,Complications,Postherpetic neuralgia(PHN,Ophthalmic Zoster,Disseminated Herpes Zoster,Ramsay Hunt syndrome,Diag