Herpes zoster is a skin disease caused by varicella-zoster virus (VZV) infection, with neuralgia and herpes as the main manifestations. The common people call this disease “herpes zoster” or “snake sores”. Insufficient sleep, overexertion, and chronic diseases that lead to low immune function are the main triggers for the onset of the disease. The authors have studied the ultrastructure of the skin tissue of varicella-zoster patients in vivo, and the results showed that VZV has a strong affinity with epidermal cells and nerves, in addition to many types of cells such as vascular endothelial and perithelial cells and fibroblasts to varying degrees. When the body is immunocompromised, VZV can invade a variety of tissues and organs, including the skin and nerves. In addition to the typical cutaneous herpes zoster, many complications sometimes occur clinically. Although the incidence of complications is not high, they are often symptomatic and even cause serious sequelae. The clinical manifestations and treatment of herpes zoster and its major complications are described in the light of the literature and the authors’ experience. Typical clinical manifestations of cutaneous herpes zoster The rash is often distributed unilaterally along one side of the body in an area of the skin innervated by a peripheral nerve, preferably in the intercostal, cervical, trigeminal and lumbosacral nerves. The rash is often preceded by neuralgia or a burning sensation in the skin. Erythema occurs in the area of certain nerves, followed by clusters of papules, blisters, and sometimes pustules and hemorrhages. Some patients with untimely early treatment or older, weaker patients are prone to persistent posterior neuralgia for months or years, causing great pain to the patient. In the early stage of the disease, while antiviral treatment, the combination of Chinese and Western medicine is used to actively control the inflammation of the nerve caused by viral infection, which can shorten the duration of neuralgia and reduce the occurrence of posterior neuralgia. The earlier the treatment, the better the results. The clinical manifestations of herpes zoster complications 1, neuralgia VZV has a strong affinity with nerves, and after the initial infection with VZV (clinically manifested as chickenpox or occult infection), the virus invades the sensory nerve endings of the skin and moves centripetally along the nerve fibers, persistently latent in the posterior root ganglion of the spinal cord. Under the stimulation of various triggers, VZV can be reactivated, causing neuralgia due to inflammation and necrosis of the ganglion; at the same time, VZV moves along the sensory nerve to the skin and segmental blistering disease occurs. The incidence of neuralgia is high throughout the entire course of herpes zoster, and the length of pain varies; the older the age, the more intense the pain, the longer the pain, and the higher the incidence of postherpetic neuralgia. 2, ocular herpes zoster virus invasion of the ophthalmic branch of the trigeminal nerve, the elderly and immunocompromised people are more common, there is a comparative analysis of 21 cases of herpes zoster eye disease in the elderly group and 20 cases in the adult group. Complications in the elderly group were conjunctivitis (100%;), keratitis (100%;), sclerositis (19.05%;), iridocyclitis (43%;), glaucoma (28.57%;), optic neuritis (9.52%;), and cranial nerve injury (4.76%;). The adult group had conjunctivitis (100%;), keratitis (85%;), and iridocyclitis (30%;). The mean time required for cure was 46.3 days in the elderly group and 19.4 days in the adult group, which was longer in the elderly group than in the adult group. Ramsay-Hunt syndrome: The triad of facial palsy, otalgia and herpes of the external auditory canal is caused by the involvement of the geniculate ganglion, which affects the motor and sensory nerves of the facial nerve. Vernet syndrome: Vernet syndrome, also known as jugular foramen syndrome, is characterized by dysphagia, choking and coughing, hoarseness, inability to lift the soft palate on the affected side, loss of gag reflex, and weakness of shrugging and neck rotation on the affected side. The posterior group of cranial nerves of the linguopharyngeal, vagus and collateral nerves pass through the jugular foramen, and the inflammation of herpes zoster can lead to paralysis of the linguopharyngeal, vagus and collateral nerves on one side, resulting in the above symptoms. 4. Herpes zoster meningoencephalitis virus directly invades the central nerve from the anterior and posterior roots of the spinal nerve upwards, manifesting as headache, vomiting, convulsions, and sensory or motor disturbances. There was a clinical analysis of 12 cases of herpes zoster encephalitis in the literature. Patients had a rapid onset of illness, with varying degrees of fever, headache, nausea, and vomiting, including 6 cases with combined pyramidal signs, 3 cases with psychiatric symptoms, 3 cases with dull expression and memory loss, and 3 cases with coma. The EEG examination was abnormal in 8 cases, including 3 cases with diffuse abnormalities, mainly high amplitude slow waves, and 5 cases with abnormalities confined to one cerebral hemisphere. The cerebrospinal fluid examination was abnormal in 7 cases, showing high pressure, mild increase in protein and cell count, mainly mononuclear cells. 5, VZV-induced myocardial damage has been reported in the literature for 2 cases of VZV-induced myocardial damage, both female, aged 62 and 65 years old, respectively, in the left thoracic region and right lumbar region, with sudden onset of extreme weakness, palpitations and chest tightness, and heart rate of more than 110 beats per minute after the 7th and 9th days of herpes subsidence, respectively, with highly sensitive and specific indicators of myocardial cell damage – Troponin I (CTNI) was significantly elevated, and the cardiac enzyme profile was normal. The condition gradually improved with the administration of energy combination and rest. 6, herpes zoster spinal root motor paralysis virus invades the anterior root of the spinal cord and the anterior horn motor neurons, and causes muscle weakness or paralysis in the corresponding area. The author has reported 11 cases of herpes zoster motor paralysis, including 3 cases of Ramsay-Hunt syndrome, manifesting as drooping eyelids on the affected side, restricted eyebrow lifting, and traction of the corners of the mouth to the healthy side when teeth are bared; 1 case of Vernet syndrome, manifesting as difficulty in swallowing, choking, inability to lift the left soft palate, and weakness in shrugging and neck rotation on the affected side; 5 cases of motor paralysis of the upper limbs, manifesting as weakness in lifting and reduced grip strength; and 2 cases of motor paralysis of the lower limbs, manifesting as weakness in lifting and reduced grip strength. Two cases of motor paralysis of the lower limbs showed muscle weakness of the lower limbs. The treatment with anti-viral and tonic temperature and Yang to activate blood achieved satisfactory results. Treatment of herpes zosterAfter developing herpes zoster, one should visit the dermatology department without delay. In the early stage of the disease, along with antiviral treatment, a combination of Chinese and Western medicine is used to actively control the neuroinflammation caused by viral infection, which can shorten the duration of neuralgia and reduce the occurrence of post-neuralgia. The earlier the treatment, the better the effect.
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