Herpes zoster, commonly known as “spider sores”, “waist wound” and “snake wound”, is a viral skin disease caused by the varicella zoster virus and is characterized by clusters of small blisters along the unilateral peripheral nerves and It is a viral skin disease characterized by clusters of small blisters along the unilateral peripheral nerve and neuralgia.
The incidence of the disease increases significantly with age.
Prodromal symptoms: Generally, there is a mild fever, fatigue, general malaise, loss of appetite, and prodromal symptoms such as burning or tenderness of the affected skin for 1-5 days; however, there are also cases where the rash develops without prodromal symptoms.
Prevalent sites: intercostal nerve (53%), cervical nerve (20%), trigeminal nerve (11%) and lumbosacral nerve (11%) innervated areas, in that order.
Rash characteristics: The affected area first appears as a flushed spot, soon followed by clusters of corn- to soybean-sized papules, which rapidly turn into blisters with a tense, shiny wall surrounded by a red halo, with normal skin between the clusters of blisters. The lesions are arranged in a band along a peripheral nerve and are usually unilateral, not exceeding the midline. Local lymph node enlargement may be present.
Neuralgia is a characteristic feature of the disease and usually precedes the rash, manifesting as deep persistent pain, stabbing pain, or knife-like pain, often more intense in older patients. If the neuralgia persists after the lesions have subsided (usually after 4 weeks), it is called postherpetic neuralgia.
In most cases, the blisters absorb and dry up and crust over in 2-3 weeks, 4-6 weeks in the elderly, leaving temporary erythema or hyperpigmentation after healing.
Ocular herpes zoster: It is a viral invasion of the ophthalmic branch of the trigeminal nerve, mostly seen in the elderly, with severe pain and can involve the cornea to form ulcerative keratitis, and in severe cases, blindness due to scar formation.
Herpes zoster of the ear: This is caused by a virus invading the facial and auditory nerves, and manifests as a herpes in the ear canal and tympanic membrane. When the geniculate ganglion is involved and the motor and sensory nerve fibers of the facial nerve are also invaded, a triad of facial palsy, otalgia, and herpes in the ear canal can occur, called Ramsay-Hunt syndrome.
Tonoplastic type: no skin lesions only neuralgia.
Incomplete type: only erythema and papules appear without blistering and then subside.
Herpetiform, hemorrhagic, gangrenous.
Generalized herpes zoster: simultaneous involvement of more than 2 ganglia producing multiple lesions contralaterally or ipsilaterally.
Disseminated herpes zoster: the virus may occasionally spread through the bloodstream to produce a generalized varicella-like rash and invade the brain, lungs, and other organs.
Systemic treatment
Antiviral: acyclovir, famciclovir, famciclovir, etc., early adequate dose, 7-10 days of treatment.
Analgesic: depot tablets, indomethacin, fotarine, anti-inflammatory pain, carbamazepine, etc.
Corticosteroids: prednisone 30 mg daily for 3-5 days.
Vitamins: Vitamin B1 and B12 Nerve nutrition.
Immunotherapy:transfer factor, thymidine.
Topical therapy
Topical medication: anti-inflammatory, drying, astringent, preventing secondary infection. When the herpes is not broken, use glyburide lotion, acyclovir cream, etc.; after the herpes is broken, use 3% boric acid solution or 0.02% furacilin wet compress.
Eye treatment: Acyclovir eye drops, eye ointment. Glucocorticoid preparations are prohibited.
Physical therapy
Local irradiation with helium-neon laser can reduce inflammation and pain and shorten the course of the disease.
It can be combined with acupuncture treatment.