Herps Zoster(帶狀皰疹)課件

HerpesZoster

Departmentof

DermatologyandVenereology

DuMaotao2014-11-28

PapuleReviewPlaqueDoyouknowthefollowingskinlesions?ReviewBullaDoyouknowthefollowingskinlesions?VesicleHowtodescribethislesion?HerpesZoster

Definition

HerpeszosteriscausedbyVaricella-Zostervirus(VZV),classicallyoccursunilaterallywithinthedistributionofasensorynerve,beingcharacterizedbyclusteredvesiclesandconsiderableneuralgia.PathogenandPathogenesis

PathogenesisVZVcausesvaricellainchildhood,andestablisheslatencyinsensorygangliaaftertheprimaryinfection.VZVmayreplicatelaterinlife,takingadvantageofthedeclineinimmunefunction,travelingdownthesensorynerveintotheskin.Theincidenceofherpeszosterincreaseswithadvancingageanddeclineinimmunefunction.

Prodrome:

headacheandfeverhyperaesthesiapainFeaturesoflesionsTheeruptioninitiallypresentsaspapulesandplaquesoferythemainthedermatome.Overafewdays,cropsofclusteredredpapulesforminadiscontinuousbandandquicklyevolvetoclearvesicles.Typicalfeaturesoflesions

Lesionsmaybecomehemorrhagic,necrotic,orbullous.

Thevesiclesslowlybecomepustulars,andrupturetoformcrusts,whichseparatein2to4weeks,oftenwithscales.

Distributioncranialorspinalsensorynerve.thethoracic(55%)thecranial(20%),withthetrigeminalnervebeingthemostcommonsinglenerveinvolved.thelumbar(15%)thesacral(5%)Neuralgia

Thenatureofpainassociatedwithherpeszostervaries,butthreebasictypesofpainhavebeendescribed.theconstant,monotonous,usuallyburningordeep,achingpain;theshooting,lancinatingpain;thetriggeredpain.SpeciclclinicalmanifestationHerpeszosterophthalmicus

(ophthalmicbranchoftrigeminalnerve)

Ocularinvolvementismostcommonlyintheformofuveitisandkeratitis.RamsayHuntsyndromeThepresentingfeaturesinclude:herpesauricularis,facialpalsy,andauditorysymptoms.VZV.Herpeticinflammationofthegeniculateganglionisfelttobethecauseofthissyndrome.Thepresentingfeaturesinclude:herpesauricularis,facialparalysis,andauditorysymptoms.DisseminatedHerpesZoster

Ageneralizedvaricelliformeruptionaccompanyingthesegmentaleruption.Ithasbeendefinedasmorethan20lesionsoutsidetheaffecteddermatome.

Itoccurschieflyinoldor

debilitatedindividuals,especiallyin

patientswithmalignancyandAIDS.

MisdiagnosisPainususllyprecedestheeruptionby1-5days,sometimesitmaybemisdiagnosedtootherdiseases,dependingondifferentpart.AppendicitisCholecystitisAnginapectorisTreatmentRestAntivirivaltherapy:acyclovir(ACV)0.85timesdailyvalacyclovir(VCV)1.03timesdailyfamciclovir(FCV)0.53timesdailyfor7days

Inophthalmiczoster,disseminatedzoster,RamysayHuntSyndrome,patientsfailinginoraltherapy,intravenousACVshouldbeused.

VitaminB:

helptorelieftheinflammationoftheinvolvednerveandreliefthepain.VitB125mgpotidVitB120.5mgimqdAnalgesic:

AspirinIndomethacinGabapentinPregabalinAmitriptyline

Improvingimmunefunction:transferfactorthymicpeptide

Systemiccorticosteroidtherapy

prednisone10mgtid(4-7days)Phys