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HerpesZoster
Departmentof
DermatologyandVenereology
DuMaotao2014-11-28
PapuleReviewPlaqueDoyouknowthefollowingskinlesions?ReviewBullaDoyouknowthefollowingskinlesions?VesicleHowtodescribethislesion?HerpesZoster
Definition
HerpeszosteriscausedbyVaricella-Zostervirus(VZV),classicallyoccursunilaterallywithinthedistributionofasensorynerve,beingcharacterizedbyclusteredvesiclesandconsiderableneuralgia.PathogenandPathogenesis
PathogenesisVZVcausesvaricellainchildhood,andestablisheslatencyinsensorygangliaaftertheprimaryinfection.VZVmayreplicatelaterinlife,takingadvantageofthedeclineinimmunefunction,travelingdownthesensorynerveintotheskin.Theincidenceofherpeszosterincreaseswithadvancingageanddeclineinimmunefunction.
Prodrome:
headacheandfeverhyperaesthesiapainFeaturesoflesionsTheeruptioninitiallypresentsaspapulesandplaquesoferythemainthedermatome.Overafewdays,cropsofclusteredredpapulesforminadiscontinuousbandandquicklyevolvetoclearvesicles.Typicalfeaturesoflesions
Lesionsmaybecomehemorrhagic,necrotic,orbullous.
Thevesiclesslowlybecomepustulars,andrupturetoformcrusts,whichseparatein2to4weeks,oftenwithscales.
Distributioncranialorspinalsensorynerve.thethoracic(55%)thecranial(20%),withthetrigeminalnervebeingthemostcommonsinglenerveinvolved.thelumbar(15%)thesacral(5%)Neuralgia
Thenatureofpainassociatedwithherpeszostervaries,butthreebasictypesofpainhavebeendescribed.theconstant,monotonous,usuallyburningordeep,achingpain;theshooting,lancinatingpain;thetriggeredpain.SpeciclclinicalmanifestationHerpeszosterophthalmicus
(ophthalmicbranchoftrigeminalnerve)
Ocularinvolvementismostcommonlyintheformofuveitisandkeratitis.RamsayHuntsyndromeThepresentingfeaturesinclude:herpesauricularis,facialpalsy,andauditorysymptoms.VZV.Herpeticinflammationofthegeniculateganglionisfelttobethecauseofthissyndrome.Thepresentingfeaturesinclude:herpesauricularis,facialparalysis,andauditorysymptoms.DisseminatedHerpesZoster
Ageneralizedvaricelliformeruptionaccompanyingthesegmentaleruption.Ithasbeendefinedasmorethan20lesionsoutsidetheaffecteddermatome.
Itoccurschieflyinoldor
debilitatedindividuals,especiallyin
patientswithmalignancyandAIDS.
MisdiagnosisPainususllyprecedestheeruptionby1-5days,sometimesitmaybemisdiagnosedtootherdiseases,dependingondifferentpart.AppendicitisCholecystitisAnginapectorisTreatmentRestAntivirivaltherapy:acyclovir(ACV)0.85timesdailyvalacyclovir(VCV)1.03timesdailyfamciclovir(FCV)0.53timesdailyfor7days
Inophthalmiczoster,disseminatedzoster,RamysayHuntSyndrome,patientsfailinginoraltherapy,intravenousACVshouldbeused.
VitaminB:
helptorelieftheinflammationoftheinvolvednerveandreliefthepain.VitB125mgpotidVitB120.5mgimqdAnalgesic:
AspirinIndomethacinGabapentinPregabalinAmitriptyline
Improvingimmunefunction:transferfactorthymicpeptide
Systemiccorticosteroidtherapy
prednisone10mgtid(4-7days)Phys
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