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1、Herpes Zoster,Definition Herpes zoster is caused by Varicella-Zoster virus(VZV),classically occurs unilaterally within the distribution of a sensory nerve,being characterized by clustered vesicles and considerable neuralgia.,Pathogen and Pathogenesis Pathogen Varicella-Zoster virus(VZV)is characteri
2、zed by neurotropism and dermatotropism.,Pathogenesis VZV causes varicella in childhood,and establishes latency in sensory ganglia after the primary infection.VZV may replicate later in life,taking advantage of the decline in immune function,traveling down the sensory nerve into the skin,showing neur
3、algia and clustered vesicles.,Clinical manifestationsProdrome:headache and fever hyperaesthesia pain in the affected area.,Features of lesions The eruption presents as papules and erythema in the dermatome.Over a few days,crops of clustered red papules form in a discontinuous band and quickly evolve
4、 to clear vesicles surrounded by erythema.,The eruption may have few lesions or reach total confluence in the dermatome.Lesions may become hemorrhagic,necrotic,or bullous.,The vesicles slowly become pustulars,and rupture to form crusts,which separate in two to four weeks,often with scarring.The regi
5、onal lymph nodes are enlarged and tender.,ComplicationsPostherpetic neuralgia(PHN)The pain persists after the skin lesions have healed,with the same quality as that of acute zoster pain.a month,Ophthalmic Zoster Ocular involvement is most commonly in the form of uveitis and keratitis.,Ramsay Hunt sy
6、ndrome Results from involvement of the facial and auditory nerves by the VZV.The presenting features include:herpes auricularis,facial paralysis,and auditory symptoms.VZV.Herpetic inflammation of the geniculate ganglion is felt to be the cause of this syndrome.The presenting features include:herpes
7、auricularis,facial paralysis,and auditory symptoms.,Incomplete herpes zoster There are may only neuralgia and papuloid lesions but with no blisters.,Disseminated Herpes Zoster A generalized varicelliform eruption accompanying the segmental eruption.It has been defined as more than 20 lesions outside
8、 the affected dermatome.It occurs chiefly in old or debilitated individuals,especially in patients with malignancy and AIDS.,Diagnosis and MisdiagnosisDiagnosis Typical lesions:crops of clustered vesicles surrounded by erythema,forming in a discontinuous band,with enlarged regional lymph nodes.The d
9、istribution of a signal dorsal nerve root.Obvious neuralgia,Misdiagnosis:Pain ususlly precedes the eruption by 3 or 4 days,sometimes it may be misdiagnosed to other diseases,depending on different part.Appendicitis Cholecystitis Angina pectoris,TreatmentBed restAntivirival therapy:acyclovir(ACV)0.2
10、5 times daily valacyclovir(VCV)1.0 3 times daily famciclovir(FCV)0.5 3 times daily for 7 days,Vitamin B:help to relief the inflammation of the involved nerve and relief the pain.TTFD 25mg tid VitB12 0.5mg im qdAnalgesic:aspirin indomethacin,Nerve blocksImproving immune function:transfer factor(TF)Sy
11、stemic corticosteroid therapy:prednisone 10mg tidPhysical therapy Topical therapy:5%scl,In conclusion:Definition Pathogen Clinical manifestations Complications Diagnosis and misdiagnosis Treatment,Definition Herpes zoster is caused by VZV,classically occurs unilaterally within the distribution of a
12、sensory nerve,with the features of clustered vesicles and neuralgia.,Pathogen Varicella-Zoster virus(VZV)is characterized by neurotropism and dermatotropism.,Clinical manifestationsProdromeTypical lesionsDistributionNeuralgia,Complications,Postherpetic neuralgia(PHN),Ophthalmic Zoster,Disseminated Herpes Zoster,Ramsay Hunt syndrome,Diagnosis and MisdiagnosisTreatment Bed restAntivirival therapy Vitamin B Analgesic Nerve blocks,Improving immune function Systemic corticosteroid therapy Physical therapy Topical therapy,Thank you,
