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Abstract: The patient, a 57-year-old female, who was usually in good physical condition, suddenly developed a bout of headache and the next day had many bright blisters on her left forehead, and was diagnosed with herpes zoster after consultation. The patient was recommended to be admitted to hospital. After antiviral and pain relief medication, the facial blisters gradually dried up, crusted and fell off, and the neuralgia basically subsided.
Basic information】Female, 57 years old
Disease Type】Herpes zoster
Hospital】Nanning Second People’s Hospital
Date of Consultation】April 2022
Treatment plan】Medication (acyclovir injection, gabapentin capsules, vitamin B complex tablets, potassium permanganate topical tablets, fusidic acid cream, acyclovir eye drops)
Treatment period】7 days of inpatient treatment, 1 week of outpatient review
Treatment effect】Facial blisters gradually dried up, crusted and fell off, and the neuralgia basically subsided.
I. Initial consultation
The patient is a 57-year-old middle-aged woman who suddenly developed a stabbing pain in her head 2 days ago without other discomfort such as nausea and vomiting, which was difficult to tolerate and affected her sleep and appetite, and went to the emergency department. The patient’s headache was slightly relieved after taking the painkillers, but he still felt difficulty sleeping. On the second day, his family found several blisters on his left forehead in the morning and rushed to the dermatology department. It was obvious that the rash did not exceed the midline and was only on the left side of the forehead, while the right side was completely normal. The patient was asked if he had any other previous medical history and was in good health. The diagnosis of herpes zoster was made based on the rash manifestation of unilaterally distributed clustered blisters and painful symptoms.
II. Treatment history
In view of the patient’s age and the fact that herpes zoster was growing on the head and had not been systematically examined in the past, he was admitted to the hospital for systematic examination and treatment. The patient was admitted to the hospital and had no other comorbidities such as hypertension or diabetes mellitus. During hospitalization, she was given acyclovir injection for antiviral treatment, gabapentin capsules for pain relief, vitamin B complex tablets for nerve nutrition, and topical potassium permanganate tablets and fusidic acid cream, and ophthalmology consultation was requested and acyclovir eye drops were given.
III. Treatment effect
After 1 week of treatment with antiviral, analgesic and nerve-nourishing drugs, the patient’s facial blisters gradually dried up, crusted and fell off, and the neuralgia basically subsided. According to the comparison before and after treatment, the diagnosis of herpes zoster was clear and the drug treatment was effective. The patient was discharged after 7 days of hospitalization and was asked to come to the outpatient clinic for a review in 1 week.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but the patient is suffering from herpes zoster of the head and face with severe pain, and the pain may persist for a longer period of time after the rash has improved. If the neuralgia persists for more than 3 months, it is called postherpetic neuralgia, which is more difficult to tolerate and can affect the quality of life. Therefore, patients should continue nerve nourishing treatment after discharge and follow up regularly to avoid postherpetic neuralgia as much as possible. If eye symptoms are significant, they should be reviewed by an ophthalmologist to determine if medication needs to be adjusted. Herpes zoster is caused by viral infection and is associated with decreased resistance, so patients should strengthen physical exercise to enhance resistance and avoid exposure to cold and strain.
V. Personal insight
At present, people are not sufficiently aware of herpes zoster, especially those with early neuralgia symptoms who think it is just a blister on the skin and observe it on their own for a few days or use unknown ointments to apply it, missing the best time to control the virus. In the case of this patient, the treatment of herpes zoster mainly includes antiviral, pain relief and nerve nutrition. There is a shingles vaccine available in China for adults over 50 years of age, and it is hoped that people who are able to do so will be vaccinated to prevent shingles.