Therapy of herpes zoster neuralgia. Acute and residual neuralgia in herpes zoster

We discuss the latest findings regarding the therapy of acute herpes zoster and postherpetic neuralgia. Aside from the conventional modes of treatment. We especially refer to the therapy with aciclovir. In addition, we present the techniques of transcutaneous electrostimulation and neurosurgery.     

带状疱疹及后遗神经痛

带状疱疹是由潜伏在体内的水痘-带状疱疹病毒再次复发引起、主要影响中老年人的疾病.当带状疱疹的主要症状之一--神经痛持续时间超过疱疹临床治愈后的1个月时,称为带状疱疹后遗神经痛.该文主要从流行病学、发病机制、临床表现以及治疗方面对带状疱疹及后遗神经痛进行简要综述.     

Necrodestructive herpes zoster

Herpes Zoster (HZ) is a self-limiting viral infection of skin and mucosa caused by Varicella zoster virus. Cutaneous lesions of HZ usually heal without any scarring and hyper/hypopigmentation. Though, post-inflammatory depigmentation and deep scarring can occur in immunocompromised or HIV positive individuals. The present report is of a elderly immunocompetent female who had HZ involving the ophthalmic division (including nasociliary branch) of trigeminal nerve. The lesions over nose caused mutilating scarring resulting in complete obstruction of the right anterior nare.     

Disseminated herpes zoster

Eleven case of disseminated herpes zoster (DHZ) who were hospitalised in the Dermatovenereology ward from January 1992 to April 1995 were selected for this study. All had classical herpes zoster (HZ) but within another 2 to 15 days had developed aberrant vesicles on the trunk, limbs and face. None of them had serious associated immunosuppressive disorder or malignancy. However, 3 cases had diabetes mellitus, 2 were receiving prednisolone 15 mg daily for the last few days, 2 had anaemia and deficiencies and 1 had a urinary tract infection. Only one patient needed oral acyclovir therapy. All were cured without any sequelae.     

Childhood herpes zoster

Herpes zoster (HZ) in childhood is rather unusual. This reactivation of chickenpox, the primary varicella-zoster virus (VZV) infection that lies dormant within sensory ganglia, is seen with increased frequency in otherwise healthy children who acquire chickenpox either in utero or within the first year of life. Our patient is a good example of this; he was exposed to chickenpox at the age of 3 months (by his 2 siblings) and developed HZ at 6 years of age.     

Bilateral, asymmetric herpes zoster (herpes zoster duplex asymmetricus)

A 73-year-old female patient presented with asymmetric herpes zoster. She was treated successfully with systemic immunostimulants, vitamin B1 tablets and topical etheric acetyl-salicylic acid solution. No underlying malignancy, immunodeficiency or other systemic diseases could be detected.     

Revisiting childhood herpes zoster

Herpes zoster is rare in otherwise healthy children, but it is more common in association with immunosuppression. Maternal varicella infection during pregnancy and varicella occurring in the newborn represent risk factors for childhood herpes zoster. However, some controversies persist about risk factors, diagnosis, and the natural history of childhood disease. In a 2-year prospective study, 18 children with herpes zoster were clinically diagnosed in outpatient consultations in a hospital dermatology unit. Data about age, dermatome involvement, underlying disease, and history of previous varicella were recorded. Tzanck smears, biopsy specimens, and sera were obtained from 18, 4, and 10 children, respectively. The varicella zoster virus major envelope glycoprotein gE was detected in 16 of 18 smears and all four biopsies. Herpes simplex virus I was demonstrated in one of the smears. The established risk factors for childhood herpes zoster were only found in one child. Evidence for previous full-blown varicella and varicella with few lesions was recorded in 7 and 4 of the 17 immunocompetent children, respectively. No history of varicella was recalled in 6 of 17 cases, although a serologic clue of past varicella infection (IgM negative, IgG positive) was disclosed. Recurrent herpes zoster was diagnosed in one immunocompromised child. Zoster-associated pain was localized and the disease severity remained mild in all children. Established risk factors for childhood herpes zoster were only rarely found in our series of patients. In contrast, unrecognized varicella and varicella with few lesions were frequently recorded and may represent additional risk factors for shingles in childhood. Zosteriform herpes simplex virus infections should be differentiated from childhood herpes zoster, emphasizing the importance of precise viral identification.     

Paraneoplastic gangrenous-bullous herpes zoster

A female patient aged 65 is described. Two years after mastectomy for right-side mammary carcinoma she developed herpes zoster round the cicatrix; this condition anticipated metastases. The patient died of cancerous cachexia in 3 months after gangrenous herpes zoster.