皮肤性病学课件：带状疱疹（英文版）

HerpesZosterDefinition

HerpeszosteriscausedbyVaricella-Zostervirus(VZV),classicallyoccursunilaterallywithinthedistributionofasensorynerve,beingcharacterizedbyclusteredvesiclesandconsiderableneuralgia.PathogenandPathogenesis

Pathogen

Varicella-Zostervirus(VZV)ischaracterizedbyneurotropismanddermatotropism.Pathogenesis

VZVcausesvaricellainchildhood,andestablisheslatencyinsensorygangliaaftertheprimaryinfection.VZVmayreplicatelaterinlife,takingadvantage

ofthedeclineinimmunefunction,travelingdownthesensorynerveintotheskin,showingneuralgiaandclusteredvesicles.Theincidenceofherpeszosterincreaseswithadvancingageanddeclineinimmunefunction.Otherthanimmunosuppressionandage,thefactorsinvolvedinreactivationareunknown.ClinicalmanifestationsProdrome:

headacheandfeverhyperaesthesiapainintheaffectedarea.FeaturesoflesionsTheeruptioninitiallypresentsaspapulesandplaquesoferythemainthedermatome.Overafewdays,cropsofclusteredredpapulesforminadiscontinuousbandandquicklyevolvetoclearvesiclessurroundedbyerythema.Theeruptionmayhavefewlesionsorreachtotalconfluenceinthedermatome.Lesionsmaybecomehemorrhagic,necrotic,orbullous.

Thevesiclesslowlybecomepustulars,andrupturetoformcrusts,whichseparateintwotofourweeks,oftenwithscarring.Theregionallymphnodesareenlargedandtender.

Thetotaldurationoftheeruptiondependsonthreefactors:patientage;severityoferuption;presenceofunderlyingimmunosuppression.Distribution

cranialorspinalsensorynerve.thethoracic(55%)thecranial(20%),withthetrigeminalnervebeingthemostcommonsinglenerveinvolved.thelumbar(15%)thesacral(5%)Neuralgia

Thenatureofpainassociatedwithherpeszostervaries,butthreebasictypesofpainhavebeendescribed.theconstant,monotonous,usuallyburingordeep,achingpain;theshooting,lancinatingpain;thetriggeredpain.Thepainseverityisrelatedtotheagetheaffectedareatheextentoftheskinlesions.

HyperaesthiaTheskinintheaffectedareamaybehypersensitive,normallyInnocuousstimulation,suchasclothingtouchingtheskin,mayproducepain.

Incompleteherpeszoster

Therearemanyonlyneuralgiaandpapuloidlesionsbutwithnoblisters.

ComplicationsPostherpeticneuralgia(PHN)

Thepainpersistsaftertheskinlesionshavehealed,withthesamequalityasthatofacutezosterpain.Thetendencytohavepersistantpainisagedependent.OphthalmicZoster

Ocularinvolvementismostcommonlyintheformofuveitisandkeratitis.Lesscommonbutseverecomplicationsincludeglaucoma,opticneuritis,encephalitis,hemiplegiaandacuteretinalnecrosis.DisseminatedHerpesZosterAgeneralizedvaricelliformeruptionaccompanyingthesegmentaleruption.Ithasbeendefinedasmorethan20lesionsoutsidetheaffecteddermatome.Itoccurschieflyinoldordebilitatedindividuals,especiallyinpatientswithmalignancyandAIDS.RamsayHuntsyndromeResultsfrominvolvementofthefacialandauditorynervesbytheVZV.Herpeticinflammationofthegeniculateganglionisfelttobethecauseofthissyndrome.Thepresentingfeaturesinclude:herpesauricularis,facialparalysis,andauditorysymptoms.VZV.Herpeticinflammationofthegeniculateganglionisfelttobethecauseofthissyndrome.Thepresentingfeaturesinclude:herpesauricularis,facialparalysis,andauditorysymptoms.DiagnosisandMisdiagnosis

DiagnosisTypicallesions:cropsofclusteredvesiclessurroundedbyerythema,forminginadiscontinuousband,withenlargedregionallymphnodes.Thedistributionofasignaldorsalnerveroot.ObviousneuralgiaMisdiagnosis:

Painususllyprecedestheeruptionby3or4days,sometimesitmaybemisdiagnosedtootherdiseases,dependingondifferentpart.AppendicitisCholecystitisAnginapectorisTreatmentBedrestAntivirivaltherapy:acyclovir(ACV)0.25timesdailyvalacyclovir(VCV)1.03timesdailyfamciclovir(FCV)0.53timesdailyfor7days

Inophthalmiczoster,disseminatedzoster,RamysayHuntSyndrome,patientsfailinginoraltherapy,intravenousACVshouldbeused.10mg/kg.Inimmunosuppressedpatients,intravenousACVshouldbealsousedbecauseoftheincreasedriskofdissemination.VitaminB:helptorelieftheinflammationoftheinvolvednerveandreliefthepain.TTFD25mgtidVitB120.5mgimqdAnalgesic:aspirinindomethacinnebumetone,NerveblocksImprovingimmunefunction:transferfactor(TF)Systemiccorticosteroidtherapy:prednisone10mgtidPhysicaltherapyTopicaltherapy:5%sclInconclusion:DefinitionPathogenPathogenesisClinicalmanifestationsComplicationsDiagnosisandmisdiagnosisTreatmentDefinition

HerpeszosteriscausedbyVZV,classicallyoccursunilaterallywithinthedistributionofasensorynerve,withthefeaturesofclusteredvesiclesandneuralgia.Pathogen

Varicella-Zostervirus(VZV)ischaracterizedbyneurotropismanddermatotropism.Pathogenesis

VZVcausesvaricellainchildhood.VZVestablisheslatencyinsensoryganglia.VZVmayreplicatetakingadvantageofthedeclineinimmunefunction,travelingdownthesensorynerveintotheskin,showingneuralgiaandclusteredvesicles.ClinicalmanifestationsProdromeTypicallesionsDistributionNeuralgiaIncompleteherpeszosterComplicationsPostherpeticneuralgia(PHN)OphthalmicZosterDisseminatedHerpesZosterRamsayHuntsyndromeDiagnosisandMisdiagnosisTreatmentAntivirivaltherapyBedrestVitaminBAnalgesicNerveblocksImprovingimmunefunctionSystemiccorticosteroidtherapyPhysicaltherapyTopicaltherapy

定义

带状疱疹是一种由水痘－带状疱疹病毒引起的以沿神经分布的群集的疱疹及神经痛为主要特征的病毒性皮肤病。

带状疱疹病因和发病机理病原体：水痘－带状疱疹病毒

Varicella-Zostervirus

水痘－带状疱疹病毒具有嗜神经和嗜皮肤（neurotropismanddermatotropism）的特性。

常见诱因：大剂量应用皮质类固醇激素、放疗、化疗、应用免疫抑制剂、过度疲劳、创伤、烧伤、器官移植、恶性肿瘤等。临床表现

前驱症状

皮肤感觉过敏或神经痛、全身不适、低热、食欲不振等

皮疹特点沿神经单侧分布，红斑基础上的簇集性水疱,可有丘疹、大疱、血疱、坏死等损害。

局部淋巴结可肿大、压痛

皮疹分布特点及好发部位：皮疹沿某一周围神经单侧分布好发于肋间神经、三叉神经第一支分布区。神经痛

为本病特征之一，与皮疹不成比例，可很剧烈，可为烧灼样、刀割样、针刺样等。部分患者有后遗神经痛

病程：2-4周顿挫性带状疱疹：仅有红斑、丘疹，无典型水疱大疱性带状疱疹:皮损严重，形成大疱出血性带状疱疹：疱内容物为血性坏疽性带状疱疹：老年或营养不良患者，皮损坏死，愈后留有瘢痕播撒性带状疱疹

年老体弱、或患恶性淋巴瘤等病的患者，在局部发疹后数日内，全身发生皮疹、伴高热、可并发脑、