Herpes zoster, also known as “snake bile sores” and “snake wrapped around the waist”, is customarily treated in folklore with lime water, quail mouth painting, ink painting and other prescriptions. Every year in spring and autumn, the dermatology department encounters a large number of patients with herpes zoster, some of them are not well treated at home, the aftermath of neuralgia or due to pain in other departments of the hospital to see the examination, no disease was found to turn, the patient’s symptoms are serious and very painful.
As a result of delayed treatment, some also suffer from blindness and loss of hearing, and some patients even have the tendency to want to commit suicide due to pain. Let’s take a systematic look at shingles.
Herpes zoster is a skin disease characterized by clustered small blisters distributed along unilateral peripheral nerves caused by varicella-zoster virus, often accompanied by significant localized skin or visceral neuralgia.
Clinical manifestations
The disease occurs in adults and is more common in spring and autumn.
(A) Typical manifestations Before the onset of the rash, there may be mild malaise, low-grade fever, poor circulation and other systemic symptoms, and the affected skin may feel burning sensation or neuralgia for 1 to 3 days, or the rash may develop without antecedent symptoms. The most common sites are the intercostal nerve, cervical nerve, trigeminal nerve and lumbosacral nerve innervation area. The affected areas often appear as erythematous spots and soon appear as corn to soybean-sized papules in clusters that do not fuse, followed by rapid transformation into blisters with tense, shiny walls and clarified fluid surrounded by a red halo, with normal skin between clusters of blisters;
The lesions are arranged in a band along a peripheral nerve, mostly on one side of the body. Neuralgia is one of the characteristics of the disease and may occur before the onset of the disease or with the lesions, and is often more intense in older patients. The duration of the disease is usually 2-3 weeks, or 3-4 weeks in the elderly, with temporary pale erythema or hyperpigmentation after the blisters dry up and the crusts fall off.
(B) special performance
1. Ocular herpes zoster is mostly seen in the elderly, with severe pain, and can involve the cornea to form ulcerative keratitis.
2. Ear herpes zoster is caused by viral invasion of the facial and auditory nerves, manifesting as 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, a triad of facial palsy, otalgia and herpes in the external ear canal may appear, called Ramsay-Hunt syndrome.
3, postherpetic neuralgia herpes zoster is often accompanied by neuralgia, but it mostly disappears after the lesions have completely faded or within 1 month, and in a few patients the neuralgia can last for more than 1 month, called postherpetic neuralgia.
4, other atypical herpes zoster caused by differences in the resistance of the patient’s organism, can be manifested as atonic, incomplete, herpetic, hemorrhagic and gangrenous, pancytopenia, the virus can occasionally be disseminated through the blood
The virus may occasionally spread through the bloodstream to produce a widespread varicella-like rash and invade organs such as the lungs and brain, called disseminated herpes zoster.
Diagnosis and differential diagnosis
The prodromal phase of the disease or the rash-free form should be differentiated from intercostal neuralgia, pleurisy, appendicitis, sciatica, urinary tract stones, etc.
Prevention and treatment
The disease is self-limiting, and the principles of treatment are antiviral, analgesic, anti-inflammatory, and prevention of complications.
1. Internal drug treatment
(1) antiviral drugs: acyclovir 1000mg/d, divided into 5 oral doses, the course of 5-10 days, or 1200mg/d, divided into 3 oral doses, the course of 5 days; or valacyclovir 3000mg/d, divided into 3 oral doses, the course of 7 days; or famciclovir 1500mg/d, divided into 3 oral doses, the course of 7 days.
(2) Analgesia: Depot pain tablets, anti-inflammatory pain and carbamazepine, gabapentin, oxycodone, etc. can be used as appropriate.
(3) Nutritional nerve drugs such as oral or intramuscular injection of vitamin B1 and B12, methylcobalamin, etc. can be applied.
(4) Glucocorticoids: early and reasonable application of glucocorticoids can inhibit the inflammatory process and reduce the post-inflammatory fibrosis of the ganglion. Older fit patients with disease duration within 7 days can take prednisone 30mg/d orally for 3-5 days.
2.Topical drug treatment
(1) Topical medication: mainly dry and anti-inflammatory. When the herpes is not broken, you can use topical glycolate lotion, acyclovir cream or penciclovir cream; after the herpes breaks down, you can use 3% boric acid solution or 1:5000 furacilin solution wet compress, or topical 0.5% neomycin ointment or mupirocin ointment, as appropriate.
(2) Eye treatment: 3% acyclovir eye ointment, ganciclovir ointment or drops can be used topically
3.Physical treatment Microwave, spectrum therapist, red and blue light and other local irradiation can relieve pain and promote the drying and crusting of lesions.
4.Other treatments Nerve root block analgesia can be used for those with severe neuralgia.