1、HerpesZosterDepartmentofDermatologyandVenereologyDepartmentofDermatologyandVenereology DuMaotaoDuMaotao2014-11-282014-11-28 PapuleReviewPlaqueDo you know the following skin lesions?ReviewBullaDo you know the following skin lesions?VesicleSkinlesionsjustlikeletters.Withoutthem,wewillnotbeabletoreadth
2、eliteratureofskin.Dr.DarierHowtodescribethislesion?HerpesZosterDefinitionHerpeszosteriscausedbyVaricella-Zostervirus(VZV),classicallyoccursunilaterallywithinthedistributionofasensorynerve,beingcharacterizedbyclusteredvesiclesandconsiderableneuralgia.PathogenandPathogenesisPathogenVaricella-Zostervir
3、us(VZV)ischaracterizedbyneurotropismanddermatotropism.Itsoonloseactivityinthedryenvironment.ElectronmicrographofVaricellazostervirus PathogenesisVZVcausesvaricellainchildhood,andestablisheslatencyinsensorygangliaaftertheprimaryinfection.VZVmayreplicatelaterinlife,takingadvantageofthedeclineinimmunef
4、unction,travelingdownthesensorynerveintotheskin.PathogenesisskinskinskinskinnervenerveganglionganglionTheincidenceofherpeszosterincreaseswithadvancingageanddeclineinimmunefunction.ClinicalmanifestationsProdrome:nheadacheandfevernhyperaesthesianpainFeaturesoflesionsTheeruptioninitiallypresentsaspapul
5、esandplaquesoferythemainthedermatome.Overafewdays,cropsofclusteredredpapulesforminadiscontinuousbandandquicklyevolvetoclearvesicles.TypicalfeaturesoflesionsLesionsmaybecomehemorrhagic,necrotic,orbullous.Thevesiclesslowlybecomepustulars,andrupturetoformcrusts,whichseparatein2to4weeks,oftenwithscales.
6、Thetotaldurationoftheeruptiondependsonthreefactors:npatientage;nseverityoferuption;npresenceofunderlyingimmunosuppression.Distributioncranialorspinalsensorynerve.thethoracic(55%)thecranial(20%),withthetrigeminalnervebeingthemostcommonsinglenerveinvolved.thelumbar(15%)thesacral(5%)NeuralgiaThenatureo
7、fpainassociatedwithherpeszostervaries,butthreebasictypesofpainhavebeendescribed.ntheconstant,monotonous,usuallyburningordeep,achingpain;ntheshooting,lancinatingpain;nthetriggeredpain.HyperaesthesiaTheskinintheaffectedareamaybehypersensitive,normallyInnocuousstimulation,suchasclothingtouchingtheskin,
8、mayproducepain.SpeciclclinicalmanifestationHerpeszosterophthalmicus(ophthalmicbranchoftrigeminalnerve)Ocularinvolvementismostcommonlyintheformofuveitisandkeratitis.RamsayHuntsyndromenResultsfrominvolvementofthefacialandauditorynervesbytheVZV.nHerpetic inflammation of the geniculateganglionisfelttobe
9、thecauseofthissyndrome.VZV.Herpetic inflammation of the geniculateganglionisfelttobethecauseofthissyndrome.Thepresentingfeaturesinclude:herpesauricularis,facialparalysis,andauditorysymptoms.RamsayHuntsyndromenThepresentingfeaturesinclude:herpesauricularis,facialpalsy,andauditorysymptoms.VZV.Herpetic
10、 inflammation of the geniculateganglionisfelttobethecauseofthissyndrome.Thepresentingfeaturesinclude:herpesauricularis,facialparalysis,andauditorysymptoms.DisseminatedHerpesZostern nAgeneralizedvaricelliformeruptionaccompanyingthesegmentaleruption.n nIthasbeendefinedasmorethan20lesionsoutsidetheaffe
11、cteddermatome.n nItoccurschieflyinoldordebilitatedindividuals,especiallyinpatientswithmalignancyandAIDS.DiagnosisnTypicallesions:cropsofclusteredvesiclessurroundedbyerythema,forminginadiscontinuousband.nThedistributionofasignaldorsalnerveroot.nObviousneuralgiaMisdiagnosisPainususllyprecedestheerupti
12、onby1-5days,sometimesitmaybemisdiagnosedtootherdiseases,dependingondifferentpart.AppendicitisCholecystitisAnginapectorisTreatmentnRestnAntivirivaltherapy:acyclovir(ACV)0.85timesdailyvalacyclovir(VCV)1.03timesdailyfamciclovir(FCV)0.53timesdailyfor7daysIn ophthalmic zoster,disseminatedzoster,RamysayHu
13、ntSyndrome,patientsfailinginoraltherapy,intravenousACVshouldbeused.nVitaminB:helptorelieftheinflammationoftheinvolvednerveandreliefthepain.VitB125mgpotidVitB120.5mgimqdnAnalgesic:AspirinIndomethacinGabapentinPregabalinAmitriptylinenImprovingimmunefunction:transferfactorthymicpeptidenSystemiccorticosteroidtherapyprednisone10mgtid(4-7days)nPhysicaltherapynTopicaltherapyantiinflammationdrythelesionsConclusionDefinitionPathogenPathogenesisClinicalmanifestationsDiagnosisandmisdiagnosisTreatment