Herpes zoster (herpes zoster) is a viral skin disease caused by varicella-zoster virus infection with clusters of herpes along the peripheral nerves and characterized by neuralgia. In Chinese medicine, it is called herpes zoster, herpes zoster or herpes zoster, herpes zoster and herpes zoster.
Etiology and pathogenesis
The pathogen is varicella-zoster virus, which has neurophilic and cutaneous properties. When people with no or low immunity to the disease (mostly children) are infected, they develop chickenpox or become latently infected and become viral carriers. When the immune function of the host cells is reduced, such as infectious diseases, tumors, radiotherapy, trauma, menstruation or overexertion, the virus latent in the ganglia is activated, causing neuralgia and segmental herpes in the affected ganglia, the corresponding sensory nerves and the skin of their innervated areas.
Clinical manifestations
The lesions are characterized by the appearance of corn- to green-bean-sized papules on the basis of erythema, which develop into clusters of blisters with clear content and tense, thick walls that are not easily ruptured, drying and crusting after a few days and peeling off after 2-4 weeks, leaving pigmentation. The onset is often unilateral and rarely exceeds the midline of the body. Sometimes it can be a large blister or the contents of the blister is bloody.
Preferred sites: the first branch of the trigeminal nerve skin distribution area, chest, lumbar, and nerve distribution area, other parts such as the neck, extremities, etc. can be involved.
Prevalent in spring and autumn: incubation period is 7d~14d, firstly, low fever, malaise and weakness, skin tingling or sensory allergy. Conscious symptoms are mainly neuralgia, often severe pain in elderly patients, lighter or occasionally itchy in children. The duration of the disease is about 2~3 weeks. After healing, lifelong immunity is obtained and recurrence is rare.
When the geniculate ganglion is involved, a triad of facial palsy, otalgia, and external auditory canal herpes, or Ramsey-Hunt syndrome, may occur. Neuralgia and papular lesions without blistering alone are called incomplete or strophic herpes zoster. It can also cause total ophthalmia leading to blindness or meningoencephalitis.
Diagnosis and differential diagnosis
The diagnosis is not difficult based on features such as clustered blisters, banded arrangement, unilateral distribution, and the presence of significant neuralgia. However, it should be distinguished from herpes simplex, contact dermatitis, acute appendicitis, and pleurisy.
Herpes simplex: it occurs at the junction of the skin and mucous membranes, with no regular distribution, small blisters, thin walls, easy to break, mild pain, and recurrent attacks.
Contact dermatitis: history of contact, confined to the site, unrelated to the distribution of nerves, self-conscious burning, itching, no neuralgia.
III. Acute appendicitis: right lower abdominal pain and rebound pain, anterior and posterior hemiband pain without herpes zoster, lumbar muscle tonicity, fever, and increased leukocytes.
Pleurisy: its pain is painful when breathing, not skin pain, no tenderness, systemic symptoms, auscultation, and X-ray can be considered together to identify.
In addition, the neuralgia of early herpes zoster or herpes zoster without rash is easily misdiagnosed as intercostal neuralgia and sciatica, etc.
Treatment
I. Systemic therapy
1. Antiviral drugs: mainly acyclovir, famciclovir and cytarabine, etc.
2.Anti-pain agents: ibuprofen (fenbid), carbamazepine, and vitamin B1, B12 and other neurotrophic drugs can be used. In severe cases, procaine can be used for local closure.
3.Immunomodulators: transfer factor, alpha-interferon, thymidine or gammaglobulin can be used as appropriate to reduce symptoms and shorten the course of treatment.
4.Glucocorticoid: For elderly and ocularly involved patients, early administration of moderate doses of prednisone has the effect of shortening the course of disease and relieving neuralgia.
II. Local therapy
Dryness and anti-inflammation should be the main treatment. If the herpes is not broken, topical application of furnace glycolic lotion can be applied; if the herpes has broken, wet application of 3% boric acid solution or topical application of Bactrim ointment is required as appropriate.
Physical therapy
Far infrared rays, helium-neon laser irradiation, ultraviolet radiation and spectrum electrotherapy have certain anti-inflammatory and pain-relieving effects. At present, our department has used ultraviolet radiation to treat thousands of patients with herpes zoster in the early stage of the disease, which has the effect of shortening the course of the disease and reducing neuralgia, especially for elderly patients.