Herpes zoster Herpes zoster (herpes zoster) is caused by varicella-zoster virus (herpesvaricella-zostervirus, VZV) and is characterized by clusters of small blisters distributed along a unilateral peripheral nerve, often accompanied by significant neuralgia. Clinical manifestations The incidence of the disease is higher in summer and autumn. In the pre-onset phase, there are often symptoms of low-grade fever and malaise, and there will be pain and burning at the site of the rash, and trigeminal nerve herpes zoster may present with toothache. The disease is most commonly known as herpes zoster of the thoracoabdominal or lumbar region, accounting for about 70% of the entire lesion, followed by herpes zoster of the trigeminal nerve, accounting for about 20%, with damage distributed along the three branches of the trigeminal nerve. However, the trigeminal nerve is more susceptible than the spinal nerve in elderly people over 60 years of age. Herpes begins as an irregular or oval-shaped erythematous patch on the facial skin, and after a few hours, blisters develop on the erythematous patch, which gradually increase and can merge into large blisters – in severe cases, they can be hemorrhagic, or pustules if there is secondary infection. After a few days, the blister pulp is cloudy and absorbed, and finally a crust is formed, and the crust is removed in 1 to 2 weeks, and the pigment left behind gradually fades away, generally leaving no scar, and the damage does not go beyond the midline. The duration of the disease in the elderly is often 4 to 6 weeks, with some exceeding 8 weeks. Damage to the oral mucosa is more dense with herpes and larger ulcerated surfaces, and lesions of the lip, cheek, tongue, and palate are limited to unilateral. The first branch can involve the corneal mucosa and even blindness, in addition to the first branch; the second branch involves the lip, palate and lower temporal, zygomatic and infraorbital skin; the third branch involves the tongue, lower lip, cheek and chin skin. In addition, viral invasion of the geniculate ganglion may result in herpes of the external auditory canal or tympanic membrane. When the geniculate ganglion is involved and the motor and sensory nerve fibers of the facial nerve are also invaded, it manifests as a triad of facial palsy, otalgia and herpes of the external auditory canal, called Ramsay-Hunt syndrome. Herpes zoster is often accompanied by neuralgia, but it mostly disappears within 1 month after the complete resolution of the skin mucosal lesions, and may persist for more than 1 month in a few patients, called postherpetic residual neuralgia, which is common in elderly patients and may exist for more than 6 months. Disease treatment Anti-viral drugs should be applied as early as possible. Commonly used drugs: Acyclovir 200mg orally 5 times a day for 5-10 days or 400mg 3 times a day for 5 days; Valacyclovir 1000mg 3 times a day for 7 days; Famciclovir 500mg 3 times a day for 7 days. The dosage should be reduced if the kidney function is decreasing. Pain relief Commonly used drugs: analgesic, 1 tablet. Carbamazepine 0.1g per tablet, half a tablet at the beginning, gradually increase to 1 tablet 3 times a day, the pain relief effect is obvious. Nutritional drugs Commonly used drugs: vitamin B1, 10mg, orally 3 times a day; vitamin B120.15mg, intramuscular injection, once a day. Glucocorticoids The application of glucocorticoids is controversial, but it is believed that early use can reduce the host inflammatory response and tissue damage, especially for the prevention of persistent cerebral nerve palsy and serious ocular disorders. Healthy elderly patients within 7 days of disease duration should receive 30 mg of prednisone orally daily for 7 days.