Herpes zoster is an acute inflammatory skin disease caused by the varicella zoster virus, known in Chinese medicine as “tangled waist fire dragon”, “tangled waist fire dan”, and commonly known as “spider sores”. It is characterized by clustered blisters, which are distributed in clusters along one side of the peripheral nerve, accompanied by significant neuralgia. The first infection is chickenpox, but later the virus can be latent in the posterior spinal ganglion for a long time, and weakened immune function can trigger the varicella zoster virus to become active again, grow and multiply, and spread along the peripheral nerve to the skin, resulting in herpes zoster. Patients with herpes zoster generally acquire lifelong immunity to the virus.
Etiology
Herpes zoster is caused by the herpes blister-zoster virus. Children who are immune to this virus are infected and develop chickenpox. Some patients become infected and become viral carriers without developing symptoms. The virus is neurophilic and can be latent in the neurons of the posterior root ganglion of the spinal nerve for a long time after infection. The rash is generally unilateral and distributed by nerve segments, with clusters of herpes, and is accompanied by pain; the older the age, the more severe the neuralgia. The disease is known as herpes zoster in modern medicine and as snake bile sores and tangled dragons in folklore.
Clinical symptoms
The prevalent age is mostly middle-aged and elderly. Long-term use of steroidal corticosteroids or immunosuppressants is common. The duration of the disease is usually about half a month. The skin areas innervated by the intercostal nerve and trigeminal nerve are the most common sites. The rash is characterized by the appearance of clusters of papules and blisters, corn to green bean size, with clear fluid, which may be bloody or necrotic ulcers in severe cases. The rash is characterized by a unilateral distribution in the form of bands. Self-perceived symptoms are painful and intolerable. The pain may occur before the rash appears and is manifested by sensory hypersensitivity and pain induced by light touch. The pain often persists until the rash has completely resolved, sometimes for several months. The rash begins as a redness of the skin, followed by clusters of green bean-sized papules, which rapidly evolve into blisters 1-2 days later, with the blisters developing along the proximal end of the nerve in a band-like arrangement. After healing, temporary erythema or hyperpigmentation remains.
Treatment.
I. Nerve nutrition
Oral or intramuscular injection of B antibiotics, such as B1:100mg, B12:250vg, or B1, methylcobalamin 250-500vg, etc.
II. Antiviral
Famciclovir Tablets,0.125g;orally,once every 8 hours.
Vanaciclovir, 300 mg, orally; 2 times/day.
Acycloguanosine, 200 mg; orally; 5 times/day.
Polymyxin, 2 mg; intramuscularly; 1 time/2 days.
Interferon, 3 million U; intramuscular injection; 1 time/day.
Pain relief
Take analgesic tablets such as painkillers orally.
Ibuprofen (fenpropathrin) 300 mg orally 2 times/day.
Morphine controlled-release tablets, 30 mg; orally if necessary.
Paraspinal ganglion closure therapy.
IV. Hormone
Early oral prednisone is effective in reducing inflammation and pain and preventing the occurrence of posterior neuralgia.
9966331 regimen (prednisone 45 mg for 2 days, 30 mg for 2 days, 15 mg for 2 days, 5 mg for 1 day).
V. Topical treatment
For early erythema blistering, topical astringent medication such as glycopyrrolate lotion can be used;
With erosion and necrosis, 0.1% Levanore liquid can be used as wet compress and topical antimicrobial ointment.
Rifampin coating agent has a protective, antibacterial effect.
Local drops of herpes net eye drops and topical antibiotic eye ointment.
Acyclovir ointment is applied to the affected area 3 to 4 times a day.
VI. Physical therapy
Ultraviolet radiation has the effect of promoting the absorption of inflammation and shortening the course of the disease. Infrared rays and audio-teletherapy can be used for later stage neuralgia.