Typology and treatment principles of herpetic dermatoses

  The two most common types of herpetic dermatoses are aspergillosis and pemphigoid aspergillosis. Of these, aspergillosis is subdivided into four types, including the common, deciduous, erythematous and proliferative types. Pemphigus vulgaris occurs in middle-aged adults and most do not have significant itching. Pemphigus vulgaris occurs in older adults, and most of the itching is very pronounced. The basic lesions are: erythema, blisters, pustules, vesicles and crusts.  Treatment for pemphigus and pemphigoid is usually hormonal. There are many types of hormones, such as prednisone, methylprednisolone, dexamethasone, asenosine, and so on. Among them, prednisone and methylprednisolone have relatively fewer side effects. Treatment principle: apply sufficient dose in early stage, gradually reduce the dose after the skin lesion is controlled, and maintain small dose for a long time. For patients with pemphigus, the total duration of hormone administration is usually 4-5 years; for patients with herpetiform aspergillosis, the total duration of hormone administration is usually 3-4 years. After early control, the dose is reduced more quickly, and gradually slows down later, with the final dose being very small, possibly 1-2 tablets to be maintained for a long time. Some patients reduce the dose quickly or stop the medication on their own for fear of side effects, which can lead to relapse.  In addition to hormones, some patients need a combination of immunosuppressive agents, such as methotrexate, cyclophosphamide, azathioprine, cyclosporine A, and raglan polysaccharide. Some elderly patients with milder lesions, such as those limited only to the extremities and trunk rarely, can be treated without internal hormones and only with tretinoin polysaccharide, or minocycline + niacinamide, and some patients can get relief. In addition, it is recommended to use topical hormone ointment on the lesions, while keeping them clean to prevent infection.