HerpsZoster(带状疱疹)

HerpesZoster,DepartmentofDermatologyandVenereologyDuMaotao2014-11-28,Papule,Review,Plaque,Doyouknowthefollowingskinlesions?,Review,Bulla,Doyouknowthefollowingskinlesions?,Vesicle,Skinlesionsjustlikeletters.Withoutthem,wewillnotbeabletoreadtheliteratureofskin.Dr.Darier,Howtodescribethislesion?,HerpesZoster,DefinitionHerpeszosteriscausedbyVaricella-Zostervirus(VZV),classicallyoccursunilaterallywithinthedistributionofasensorynerve,beingcharacterizedbyclusteredvesiclesandconsiderableneuralgia.,PathogenandPathogenesis,PathogenVaricella-Zostervirus(VZV)ischaracterizedbyneurotropismanddermatotropism.Itsoonloseactivityinthedryenvironment.,ElectronmicrographofVaricellazostervirus,PathogenesisVZVcausesvaricellainchildhood,andestablisheslatencyinsensorygangliaaftertheprimaryinfection.VZVmayreplicatelaterinlife,takingadvantageofthedeclineinimmunefunction,travelingdownthesensorynerveintotheskin.,Pathogenesis,skin,skin,nerve,ganglion,Theincidenceofherpeszosterincreaseswithadvancingageanddeclineinimmunefunction.,Clinicalmanifestations,Prodrome:headacheandfeverhyperaesthesiapain,FeaturesoflesionsTheeruptioninitiallypresentsaspapulesandplaquesoferythemainthedermatome.Overafewdays,cropsofclusteredredpapulesforminadiscontinuousbandandquicklyevolvetoclearvesicles.,Typicalfeaturesoflesions,Lesionsmaybecomehemorrhagic,necrotic,orbullous.,Thevesiclesslowlybecomepustulars,andrupturetoformcrusts,whichseparatein2to4weeks,oftenwithscales.,Thetotaldurationoftheeruptiondependsonthreefactors:patientage;severityoferuption;presenceofunderlyingimmunosuppression.,Distributioncranialorspinalsensorynerve.thethoracic(55%)thecranial(20%),withthetrigeminalnervebeingthemostcommonsinglenerveinvolved.thelumbar(15%)thesacral(5%),NeuralgiaThenatureofpainassociatedwithherpeszostervaries,butthreebasictypesofpainhavebeendescribed.theconstant,monotonous,usuallyburningordeep,achingpain;theshooting,lancinatingpain;thetriggeredpain.,HyperaesthesiaTheskinintheaffectedareamaybehypersensitive,normallyInnocuousstimulation,suchasclothingtouchingtheskin,mayproducepain.,Speciclclinicalmanifestation,Herpeszosterophthalmicus(ophthalmicbranchoftrigeminalnerve)Ocularinvolvementismostcommonlyintheformofuveitisandkeratitis.,RamsayHuntsyndromeResultsfrominvolvementofthefacialandauditorynervesbytheVZV.Herpeticinflammationofthegeniculateganglionisfelttobethecauseofthissyndrome.VZV.Herpeticinflammationofthegeniculateganglionisfelttobethecauseofthissyndrome.Thepresentingfeaturesinclude:herpesauricularis,facialparalysis,andauditorysymptoms.,RamsayHuntsyndromeThepresentingfeaturesinclude:herpesauricularis,facialpalsy,andauditorysymptoms.VZV.Herpeticinflammationofthegeniculateganglionisfelttobethecauseofthissyndrome.Thepresentingfeaturesinclude:herpesauricularis,facialparalysis,andauditorysymptoms.,DisseminatedHerpesZosterAgeneralizedvaricelliformeruptionaccompanyingthesegmentaleruption.Ithasbeendefinedasmorethan20lesionsoutsidetheaffecteddermatome.,Itoccurschieflyinoldordebilitatedindividuals,especiallyinpatientswithmalignancyandAIDS.,DiagnosisTypicallesions:cropsofclusteredvesiclessurroundedbyerythema,forminginadiscontinuousband.Thedistributionofasignaldorsalnerveroot.Obviousneuralgia,MisdiagnosisPainususllyprecedestheeruptionby1-5days,sometimesitmaybemisdiagnosedtootherdiseases,dependingondifferentpart.AppendicitisCholecystitisAnginapectoris,TreatmentRestAntivirivaltherapy:acyclovir(ACV)0.85timesdailyvalacyclovir(VCV)1.03timesdailyfamciclovir(FCV)0.53timesdailyfor7days,Inophthalmiczoster,disseminatedzoster,RamysayHuntSyndrome,patientsfailinginoraltherapy,intravenousACVshouldbeused.,VitaminB:helptorelieftheinflammationoftheinvolvednerveandreliefthepain.VitB125mgpotidVitB120.5mgimqd,Analgesic:AspirinIndomethacinGabapentinPregabalinAmitriptyline,Improvingimmunefunction:transferfactorthymicpeptideSystemiccort