Herps-Zoster(带状疱疹)(ppt文档).ppt

HerpesZosterDepartmentofDermatologyandVenereologyDepartmentofDermatologyandVenereology DuMaotaoDuMaotao2014-11-282014-11-28 PapuleReviewPlaqueDo you know the following skin lesions?ReviewBullaDo you know the following skin lesions?VesicleSkinlesionsjustlikeletters.Withoutthem,wewillnotbeabletoreadtheliteratureofskin.Dr.DarierHowtodescribethislesion?HerpesZosterDefinitionHerpeszosteriscausedbyVaricella-Zostervirus(VZV),classicallyoccursunilaterallywithinthedistributionofasensorynerve,beingcharacterizedbyclusteredvesiclesandconsiderableneuralgia.PathogenandPathogenesisPathogenVaricella-Zostervirus(VZV)ischaracterizedbyneurotropismanddermatotropism.Itsoonloseactivityinthedryenvironment.ElectronmicrographofVaricellazostervirus PathogenesisVZVcausesvaricellainchildhood,andestablisheslatencyinsensorygangliaaftertheprimaryinfection.VZVmayreplicatelaterinlife,takingadvantageofthedeclineinimmunefunction,travelingdownthesensorynerveintotheskin.PathogenesisskinskinskinskinnervenerveganglionganglionTheincidenceofherpeszosterincreaseswithadvancingageanddeclineinimmunefunction.ClinicalmanifestationsProdrome:nheadacheandfevernhyperaesthesianpainFeaturesoflesionsTheeruptioninitiallypresentsaspapulesandplaquesoferythemainthedermatome.Overafewdays,cropsofclusteredredpapulesforminadiscontinuousbandandquicklyevolvetoclearvesicles.TypicalfeaturesoflesionsLesionsmaybecomehemorrhagic,necrotic,orbullous.Thevesiclesslowlybecomepustulars,andrupturetoformcrusts,whichseparatein2to4weeks,oftenwithscales.Thetotaldurationoftheeruptiondependsonthreefactors:npatientage;nseverityoferuption;npresenceofunderlyingimmunosuppression.Distributioncranialorspinalsensorynerve.thethoracic(55%)thecranial(20%),withthetrigeminalnervebeingthemostcommonsinglenerveinvolved.thelumbar(15%)thesacral(5%)NeuralgiaThenatureofpainassociatedwithherpeszostervaries,butthreebasictypesofpainhavebeendescribed.ntheconstant,monotonous,usuallyburningordeep,achingpain;ntheshooting,lancinatingpain;nthetriggeredpain.HyperaesthesiaTheskinintheaffectedareamaybehypersensitive,normallyInnocuousstimulation,suchasclothingtouchingtheskin,mayproducepain.SpeciclclinicalmanifestationHerpeszosterophthalmicus(ophthalmicbranchoftrigeminalnerve)Ocularinvolvementismostcommonlyintheformofuveitisandkeratitis.RamsayHuntsyndromenResultsfrominvolvementofthefacialandauditorynervesbytheVZV.nHerpetic inflammation of the geniculateganglionisfelttobethecauseofthissyndrome.VZV.Herpetic inflammation of the geniculateganglionisfelttobethecauseofthissyndrome.Thepresentingfeaturesinclude:herpesauricularis,facialparalysis,andauditorysymptoms.RamsayHuntsyndromenThepresentingfeaturesinclude:herpesauricularis,facialpalsy,andauditorysymptoms.VZV.Herpetic inflammation of the geniculateganglionisfelttobethecauseofthissyndrome.Thepresentingfeaturesinclude:herpesauricularis,facialparalysis,andauditorysymptoms.DisseminatedHerpesZostern nAgeneralizedvaricelliformeruptionaccompanyingthesegmentaleruption.n nIthasbeendefinedasmorethan20lesionsoutsidetheaffecteddermatome.n nItoccurschieflyinoldordebilitatedindividuals,especiallyinpatientswithmalignancyandAIDS.DiagnosisnTypicallesions:cropsofclusteredvesiclessurroundedbyerythema,forminginadiscontinuousband.nThedistributionofasignaldorsalnerveroot.nObviousneuralgiaMisdiagnosisPainususllyprecedestheeruptionby1-5days,sometimesitmaybemisdiagnosedtootherdiseases,dependingondifferentpart.AppendicitisCholecystitisAnginapectorisTreatmentnRestnAntivirivaltherapy:acyclovir(ACV)0.85timesdailyvalacyclovir(VCV)1.03timesdailyfamciclovir(FCV)0.53timesdailyfor7daysIn ophthalmic zoster,disseminatedzoster,RamysayHuntSyndrome,patientsfailinginoraltherapy,intravenousACVshouldbeused.nVitaminB:helptorelieftheinflammationoftheinvolvednerveandreliefthepain.VitB125mgpotidVitB120.5mgimqdnAnalgesic:AspirinIndomethacinGabapentinPregabalinAmitriptylinenImprovingimmunefunction:transferfactorthymicpeptidenSystemiccorticosteroidtherapyprednisone10mgtid(4-7days)nPhysicaltherapynTopicaltherapyantiinflammationdrythelesionsConclusionDefinitionPathogenPathogenesisClinicalmanifestationsDiagnosisandmisdiagnosisTreatment