Etiology.
Caused by varicella a zoster virus infection, this virus has pro-neural and skin characteristics, it has been determined that varicella virus and herpes zoster virus are the same virus.
Symptoms.
The rash is often preceded by local pain, or mild fever, malaise, or no antecedent symptoms.
The rash is often arranged in a band along one side of the peripheral nerve distribution, usually not exceeding the midline of the body, mostly in the intercostal nerve or trigeminal nerve, lumbosacral nerve innervation area, the duration of the disease is 2-4 weeks, after healing is lifelong immunity, generally not easy to recur, (immunocompromised people exception).
Neuralgia is one of the characteristics of the disease, and the pain can appear before the onset of the rash or accompany the rash, and the older the patient is, the more intense the pain. In elderly patients, persistent neuralgia can remain for months after the lesions have resolved.
Due to the different immune status of the body and the different nerve invasion, the following specific types of herpes zoster occur.
1. Herpes zoster: only erythema, papules, and blisters do not form, and they subside on their own.
2. Hemorrhagic herpes zoster: the content of the blisters is blood.
3. Gangrenous herpes zoster: necrosis in the center of the blisters, brown crust, ulcers under the scabs, and scars after healing.
4. Herpes zoster generalized: the virus spreads through the bloodstream and causes a generalized chickenpox-like rash with high fever, pulmonary and cerebral symptoms of systemic toxicity, which can be serious and lead to death.
5, ocular herpes zoster: If the cornea is involved, the blisters will break and form ulcerative keratitis, leaving corneal scars and blindness after healing, or even total uveitis in severe cases.
6. Ear herpes zoster: Due to the virus knee ganglion, it affects the sensory nerve fibers of the facial and auditory nerves, causing blisters in the external ear canal, facial paralysis, and inner ear dysfunction (tinnitus and ear pain) called Ramsay-Hunt syndrome.
7. Visceral herpes zoster: The virus invades the visceral nerve fibers of the sympathetic and parasympathetic nerves from the spinal ganglia, causing gastrointestinal and urinary tract symptoms.
Diagnosis.
It is not difficult to diagnose based on the characteristics of clusters of blisters, distribution along one side of the nerve, arrangement in a band, and pain. However, neuralgia occurring before the rash needs to be differentiated from pleurisy, orchitis, sciatica, etc.
Treatment.
The principles of its treatment are pain relief, anti-inflammatory, anti-viral, local protection and prevention of secondary infection.
(A) give analgesics and nerve-nourishing drugs, (such as vitamin B1, vitamin B12) acupuncture therapy, physiotherapy (audio therapy). All have different degrees of anti-inflammatory and pain-relieving effects.
(B) corticosteroids, some advocate for early elderly patients, oral prednisone, 30mg daily , once a day, can reduce inflammation, stop the toxic and destructive effects on the affected ganglia and nerve fibers, reduce the formation of posterior nerves, but some advocate caution to avoid the spread of the virus.
(C) antiviral drugs.
1, commonly used are virus spirit 0.2g , three times a day orally;
2, polycystin injection, each 2ml, intramuscular injection, once a day;
3.Algocytidine, 1~1.5mg per kg of body weight per day plus 5% glucose 500ml, intravenous drip, once a day; 4.Acycloside, 7.5mg per kg of body weight added to 120ml of balanced salt solution, intravenous drip, maintain 2 hours drip, twice a day, 8 hours interval.
(iv) In order to enhance the immune function of the body, human leukocyte transfer factor or alpha-interferon has been used in recent years in China.
(v) Local therapy: symptomatic treatment according to the lesions, antibiotics added to zinc oxide oil to protect the trauma, or 1% dacronin cream, 5% benzocaine cream to relieve pain.
(vi) Chinese medical treatment.
If heat is prevalent – clear heat and detoxify dampness, use gentian diarrhea liver soup plus reduction.
Dampness – strengthen the spleen and detoxify the dampness, using De-Dampness and Stomach Scutellaria Tang plus or minus.
For Qi stagnation and blood stasis – invigorate the blood to remove stasis, move Qi to relieve pain, add and subtract with Blood Stasis Dispersing Soup.