Efficacy of low dose gabapentin in acute herpes zoster for preventing postherpetic neuralgia: a prospective controlled study

Postherpetic neuralgia (PHN) is a sequela of herpes zoster that adversely affects quality of life seriously. The risk factors for PHN are well known but the effective interventions that reduce the incidence of PHN are less studied. The objective of this study is to evaluate the efficacy of treatment with gabapentin in patients with acute herpes zoster for preventing PHN. We performed a prospective randomized controlled study of 120 participants diagnosed with acute herpes zoster, aged 50 and over and complaining moderate to severe pain. All patients were treated with valacyclovir and acetaminophen. Half of the participants were assigned to the gabapentin group and received gabapentin 300 mg three times a day additionally. The intensity of pain at every visit and the incidence of PHN in both groups were measured. Total 52 and 49 patients in the gabapentin group and the control group, respectively, had completed 12 weeks of follow‐up period. Although the incidence of PHN was higher in the control group, the difference was not statistically significant (6.1% vs. 3.8%, p = 0.67). Our results indicate that the use of low‐dose gabapentin in acute herpes zoster seems not effective in the prevention of PHN.     

血清BDNF、NSE表达水平与带状疱疹后神经疼痛的相关性研究

 目的:研究血清脑源性神经营养因子(BDNF)、神经元特异性烯醇化酶(NSE)表达水平与带状疱疹（HZ）后神经疼痛的相关性。方法：纳入2018年1月-2019年12月在本院就诊的HZ患者,其中PHN组45例,非PHN组147例,比较两组血清BDNF、NSE水平及不同疼痛程度的PHN患者血清BDNF、NSE水平,并对BDNF、NSE水平与PHN疼痛的关系进行Pearson相关性分析。结果： PHN组BDNF水平明显低于非PHN组［（13.48±5.17） ng/mL比（16.32±6.45） ng/mL］,NSE水平明显高于非PHN组［（15.03±5.63） μg/L比（11.40±3.67） μg/L］,t值分别为2.70、5.07,P值均＜0.05;不同疼痛程度的PHN患者BDNF、NSE水平差异有统计学意义（F值分别为10.56、10.06,P值均＜0.05）;Pearson相关性分析显示,BDNF与PHN患者VAS评分明显负相关（r=-0.48,P＜0.01）,NSE则与PHN患者VAS评分明显正相关（r=0.48,P＜0.01）。结论：血清BDNF、NSE与PHN患者疼痛存在明显相关性,值得临床重视。     

Systemic corticosteroids do not prevent postherpetic neuralgia.

We review the use of corticosteroids in preventing postherpetic neuralgia (PHN) in a retrospective study over 5 years and 10 months. Out of 113 patients evaluable, 46 (40%) had PHN. 21 of these 46 patients (38%) had received prednisone (p = 0.49; n.s.). Duration and intensity of PHN were not different in the prednisone-treated group. This long-term study does not support the use of prednisone for preventing PHN.     

Subcutaneous botulinum toxin‐A injection for treating postherpetic neuralgia

Postherpetic neuralgia (PHN) is a debilitating disease characterized by continuous, intense pain following an outbreak of herpes zoster. The pain associated with PHN can severely affect a patient's quality of life, quality of sleep, and ability to participate in activities of daily living. The aim of this study was to explore the clinical efficacy of the subcutaneous injection of botulinum toxin‐A (BTX‐A) for the treatment of PHN. Thirteen patients with PHN were enrolled in this study and treated once with BTX‐A. The effects of BTX‐A on pain were measured with the visual analogue scale (VAS) 1, 2, 4, 8, 12, and 16 weeks after administration. Compared with pretreatment scores, VAS pain scores decreased at 2 weeks post‐treatment in all patients. All patients felt varying degrees of pain relief but remained comfortable. Compared with oral analgesic drugs, VAS scores were significantly different at 2, 4, 8, 12, and 16 weeks post‐treatment (p < .05). These results demonstrated that subcutaneous administration of BTX‐A can decrease pain in patients with PHN.     

Thermography as a predictor of postherpetic neuralgia in acute herpes zoster patients: a preliminary study

Background/purpose: Infrared thermal images in patients suffering from herpes zoster (HZ) may exhibit thermal asymmetry due to the unilateral distribution of HZ lesions. This study examined the usefulness of infrared thermography in acute HZ as a predictor for the development of postherpetic neuralgia (PHN). Methods: The authors collected demographic and clinical data including age, sex, onset of skin lesion, pain intensity by a visual analogue scale (VAS) and the development of PHN from a total of 55 patients diagnosed with HZ. We evaluated the body surface thermographic parameters between the lesion and contralateral normal skin: maximal difference in the temperature (ΔT) and the size of the body surface area (BSA) showing thermal asymmetry. Results: Temperatures of the lesions were found to be warmer than the control side in most patients with acute HZ. We compared the patient group who developed PHN with those who did not. In univariate analysis, patients with PHN were older (P=0.004), had a higher VAS score for pain (P<0.001), higher ΔT (P<0.001) and larger BSA (P=0.001). In logistic regression analysis to identify independent risk factors of PHN, older age (>60 years old) and ΔT more than 0.5 °C were found to be statistically significant.     

Intravenous immunoglobulin in autoimmune chronic urticaria

Histamine releasing autoantibodies play a central role in the pathogenesis of chronic urticaria (CU) in approximately 30% of affected patients. We investigated the therapeutic effect of high-dose intravenous immunoglobulin (IVIG) on disease activity in patients with severe CU of autoimmune aetiology. Autoimmune urticaria was diagnosed by the development of a weal-and-flare reaction to the intradermal injection of autologous serum and by serum-induced histamine release from the basophil leucocytes of healthy donors in vitro . Ten patients with severe, autoimmune CU, poorly responsive to conventional treatment, were treated with IVIG 0.4 g/kg per day for 5 days. The outcome on cutaneous wealing and itch was monitored using urticaria activity scores, visual analogue scales and autologous intradermal serum tests. Clinical benefit was noted in nine of 10 patients; three patients continue in prolonged complete remissions (3 years follow-up), two had temporary complete remissions, and symptoms in four patients improved subsequent to treatment. There was significant improvement in the urticaria activity scores and visual analogue scores at 2 ( P  < 0.01) and 6 weeks ( P  < 0.01) post-IVIG compared with the baseline values (Wilcoxon matched pairs). The diminution in urticarial activity in the majority of patients corresponded with a reduced weal-and-flare response to the intradermal injection of autologous post-treatment serum compared with the pretreatment serum. Minor side-effects were common, but there were no serious or long-term adverse effects. IVIG represents a novel therapeutic option in selected patients with recalcitrant CU associated with histamine releasing autoantibodies.     

带状疱疹后遗神经痛的危险因素分析

目的 评估带状疱疹患者发生后遗神经痛(postherpetic neuralgia,PHN)的相关风险因素.方法 收集安徽医科大学第一附属医院皮肤性病科2017年1月至2018年1月间确诊的带状疱疹住院患者256例,采用问卷调查及电话等随访方式,综合评估患者发病年龄、性别等因素与PHN的关联性.结果 256例患者最终随...     

臭氧自血疗法联合药物治疗带状疱疹后神经痛的疗效评价

 目的探讨臭氧自血疗法联合药物治疗带状疱疹后神经痛（PHN）的效果。方法纳入118例PHN患者并随机分为对照组和观察组,每组59例。对照组采用双氯芬酸、普瑞巴林和甲钴胺药物口服治疗,观察组在此基础上联合臭氧自血疗法,均治疗1个月。使用VAS评分、SF-MPQ评分及WHOQOL-BREF量表评估治疗前、治疗后1周、2周和1个月时所有PHN患者的症状改善情况,同时检测血浆β-内啡肽、P物质、IL-1β和TNF-α的水平。结果完成研究103例,其中对照组52例,治疗组51例。与对照组相比,观察组患者治疗后1个月时VAS评分(t=2.38）、SF MPQ评分(t=2.72)和WHOQOL BREF评分(t=2.54)均有统计学差异(均P<0.05),观察组血浆β-内啡肽水平(t=2.61)明显提高,P物质水平(t=2.48)、IL-1β(t=2.32)和TNF-α(t=2.40)水平明显下降(均P<0.05)。结论臭氧自血疗法联合药物治疗优于单纯药物治疗PHN。     

Cryoanalgesia for post-herpetic neuralgia: a new treatment

The existent therapeutic options for post-herpetic neuralgia (PHN) are varied, albeit not sufficiently effective. The aim of this study was to try a new treatment modality for PHN. A spray of liquid nitrogen (LN) was used in 47 patients suffering from PHN as a stimulator of a mechanism not yet completely understood. The LN spray was carefully applied (so as not to freeze the skin surface) along the diseased sensory nerve dermatome, at weekly sessions lasting for 30 seconds each, with a mean of three applications per patient. The area corresponding to the dermatomes affected by the herpes zoster satisfactorily attenuated the herpetic neuralgia in all patients. Before the sixth treatment session, good or excellent improvement was obtained in 94% of the study patients. Pain was eliminated with one session in nine patients (19%), and with two sessions in eight patients (17%). We conclude that this non-freezing technique is absolutely safe and injury-free, and is very efficient in calming PHN.     

Number of Langerhans immune cells in painful and non-painful human skin after shingles

During injury or inflammation, paracrine sensitization of peripheral sensory neurons by immune cells contributes to the sensation of pain. It is less clear whether this neural sensitization contributes to neuropathic pain after neural injury as well. Shingles (herpes zoster) is a common disease that leaves some patients with prolonged neuropathic pain known as postherpetic neuralgia (PHN). Sensitization of cutaneous neurons has been hypothesized to contribute to PHN. Langerhans cells (LC), the Ia(+) macrophages of the skin, contact epidermal neurites and, when activated, synthesize molecules with the ability to sensitize axons. For these reasons, we examined morphological evidence for activation of LC in subjects with established PHN. We also evaluated the relationship between numbers of LC and nociceptive epidermal nerve endings; these are markedly reduced in PHN. We used design-based stereology to estimate the number of CD1a(+) LC in biopsies of painful and non-painful skin from ten adults with or without PHN after shingles on the torso. There were no differences in the number of LC in previously shingles-affected and normal-control skin biopsies. The number of LC also remained at normal levels in biopsies with near-loss of innervation from shingles. LC numbers were unrelated to the presence or severity of pain. These data suggest that neuropathic pain in established PHN is not associated with increased numbers of cutaneous macrophages, and that the number of cutaneous macrophages in skin from the human torso is independent of the number of epidermal nerve endings.     

Brivudin compared with famciclovir in the treatment of herpes zoster: effects in acute disease and chronic pain in immunocompetent patients. A randomized, double-blind, multinational study

OBJECTIVE: This was a double-blind, randomized multicentre trial comparing efficacy and safety of brivudin (125 mg, once a day) and famciclovir (250 mg, three times a day), both given orally for 7 days, in the treatment of herpes zoster. METHODS: A total of 2027 immunocompetent zoster patients>or=50 years with zoster-related pain at presentation were included. Outcome measures embraced prevalence of postherpetic neuralgia (PHN), defined as at least moderate pain 3 months after treatment initiation, duration of PHN, prevalence and duration of zoster-associated pain (ZAP), duration of vesicle formation and rash healing. RESULTS: The prevalence of PHN at month 3 was 11.3% with brivudin and 9.6% with famciclovir [per-protocol (PP) population]. Equivalence of the two drugs could be demonstrated (P=0.01, PP and intention-to-treat analysis). The median duration of PHN was 46.5 days with brivudin and 58 days with famciclovir (P=0.54, PP analysis). Prevalence and duration of ZAP did not differ significantly between treatment groups. The prevalence of PHN was higher in patients>or=65 years (brivudin: 16.4%, famciclovir: 16.4%), and in patients with severe rash (brivudin: 13.4%, famciclovir: 15.7%), without significant differences between treatment groups. In patients>or=65 years, median duration of PHN was shorter with brivudin than with famciclovir (39.5 vs. 57.5 days), although the difference was not statistically significant. The two drugs had equivalent efficacy in being able to accelerate the stop of vesicle formation, and lesion healing. Adverse events were similar in nature and prevalence among groups. CONCLUSIONS: The study demonstrated equivalent efficacy of brivudin and famciclovir in the treatment of herpes zoster regarding the prevention of chronic pain and the resolution of signs and symptoms of acute herpes zoster. Compared with famciclovir, brivudin provides equivalent efficacy and safety at a more convenient once-daily dose schedule.     

Reduction of Postherpetic Neuralgia in Herpes Zoster

BACKGROUND: Persons 50 years of age and older are not only at increased risk of developing herpes zoster, they are also more likely to suffer the long-term morbidity of postherpetic neuralgia (PHN). PHN is pain persisting after the rash of herpes zoster has healed. PHN affects at least 40% of all herpes zoster patients over age 50 and over 75% of herpes zoster patients over age 75; PHN is the single most common neurologic condition in elderly patients. OBJECTIVE: The objective of this review is to evaluate interventions that may reduce or even eliminate PHN. No single therapy has been consistently effective for PHN. The most effective approach appears to be with the use of antiviral therapy early in the course of herpes zoster. The goals of ongoing studies in herpes zoster are to develop interventions that will further reduce the symptoms of PHN and/or to eliminate PHN by prophylaxis using the varicella vaccine. CONCLUSIONS: Reduction of PHN can best be achieved with the use of antiviral medication early in the course of herpes zoster; other classes of drugs are minimally effective in treating established PHN. Widespread use of the varicella vaccine may lead to secondary reductions in PHN in the distant future.     

Improvement of pruritus and quality of life of children with atopic dermatitis and their families after joining support groups

Introduction  Atopic dermatitis places a large burden on patients and their families, with greater risk of emotional disorders and behavioural problems. Preliminary evidence suggests that support groups and educational programs are helpful in reducing stress, disease and pruritus severity and improves quality of life (QoL).
Objectives  To evaluate the intensity of pruritus and the QoL in children with atopic dermatitis and their families after joining support groups.
Material and methods  Subjects were randomly assigned to intervention or control group and completed the Children's Dermatology Life Quality Index (CDLQI) and Family Dermatitis Impact (FDI). Pruritus was evaluated by the Yosipovitch's questionnaire for pruritus. Each patient/family unit was considered as one 'patient'. Participants were divided into two different groups: one with children under 16 years and the second with patients' relatives. Each unit was accompanied during 6 months.
Results  Thirty-two patients and their relatives completed the questionnaires satisfactorily. After intervention, pruritus intensity was similar ( P =  0.42), but the pattern of pruritus improved in the intervention group. Overall QoL for CDLQI instruments improved significantly ( P <  0.01) and, when specific domains were analysed, personal relationships ( P =  0.02) and leisure ( P =  0.04) showed marked enhancement. FDI scores failed to demonstrate differences in the QoL of patients' relatives after treatment.
Conclusion  The improvement on pruritus and QoL showed that atopic dermatitis patients had benefits with the attendance to support groups. We consider that these non-pharmacological approaches can be a very effective accessory tools in the management of recalcitrant forms of the disease.     

Bone mineral density and bone turnover markers in patients receiving a single course of isotretinoin for nodulocystic acne

Background  High-dose isotretinoin has been reported to have adverse effects on bone mineral density (BMD); however, studies evaluating changes in BMD with isotretinoin therapy at different dosages and with varying treatment durations have produced conflicting results.
Objective  To investigate the effect of a standard, single course of isotretinoin therapy on BMD and bone turnover markers in patients with nodulocystic acne.
Methods  Thirty-six patients (15 male, 21 female) with severe, recalcitrant, nodulocystic acne and 36 healthy controls (16 male, 20 female) were enrolled in the study. Patients received isotretinoin treatment for 4–6 months until a cumulative dose of 120 mg/kg had been achieved. BMD in the lumbar spine and femur was measured at baseline and at the end of therapy by dual-energy X-ray absorptiometry. Serum calcium, phosphate, parathormone, total alkaline phosphatase, osteocalcin, free deoxypyridinoline, and urinary calcium were also measured before and at the end of treatment.
Results  No significant differences were found in lumbar spine and femoral BMD between the patient and control groups at the beginning of the study ( P  > 0.05), and no statistically significant difference was observed between the BMD values in patients at the beginning vs. the end of treatment ( P  > 0.05). No statistically significant difference in bone turnover markers was found between patients and controls at the beginning of the study ( P  > 0.05), and no statistically significant changes in bone turnover markers were observed in patients at the beginning vs. the end of treatment ( P  > 0.05).
Conclusion  A single course of isotretinoin therapy has no clinically significant effect on bone metabolism.     

Adalimumab treatment for severe recalcitrant chronic plaque psoriasis

Aim.  To assess the efficacy and safety profile of adalimumab in patients with severe, recalcitrant chronic plaque psoriasis, and to assess short-term overlapping of other systemic treatment with adalimumab to prevent flaring of disease.
Methods.  This was a retrospective study comprising 39 patients with chronic plaque psoriasis treated with adalimumab between October 2005 and January 2008. All had failed treatment with other systemic agents, including biological therapies in 59% of patients. Patients were started on adalimumab 40 mg weekly or fortnightly, as clinically indicated. Severity of psoriasis was assessed by the Psoriasis Area and Severity Index (PASI). Therapeutic response was assessed by 75% improvement on PASI (PASI 75). All adverse events were recorded.
Results.  Results were analysed separately for those treated with adalimumab only and those on combination treatment. PASI 75 was achieved in 38% (8 of 21 patients at week 16), 62% (13 of 21 patients) at week 24, 69% (9 of 13 patients) at week 48% and 71% (5 of 7 patients) at week 72 in the adalimumab-only group, compared with 56% (5 of 9 patients) at week 16, 50% (4 of 8 patients) at week 24, 80% (4 of 5 patients) at week 48% and 67% (2 of 3 patients) at week 72 in the combined group. Of the 39 patients, 15 (38%) achieved a PASI of 0 at some point in their treatment. Adalimumab was well tolerated; 38% of patients experienced side-effects, which were generally mild.
Conclusion.  Adalimumab was effective in a group of patients with psoriasis refractory to other systemic therapies, including biological treatments, and was well tolerated.     

Serum interleukin-6 levels are increased in post-herpetic neuralgia: a single-center retrospective study

BackgroundStudies have shown that the overall incidence rate of herpeszoster (HZ) in China is 6.64 cases per 1000 people, despite such harms brought by postherpetic neuralgia (PHN), the mechanism of the disease remains unclear in China. Currently, effective biomarkers to predict PHN remain unavailable, which makes it difficult to prevent and successfully treat PHN.ObjectiveThe aim of the study was to determine the serum interleukin-6 level in PHN.MethodsThe serum levels of interleukin 6 (IL-6) were measured by multi-antibody sandwich ELISA. The likert scale was used to represent the degree of neuralgia in the patients. Patients with PHN were divided into a mild PHN group and a severe PHN group according to the Likert scale. ROC curve was performed for evaluating the diagnostic efficiency of IL6 for PHN. The correlation between the IL6 level and the Likert scale before and after treatment with gabapentin and mecobalamin was analyzed.ResultsIL6 levels in PHN patients resulted higher compared to volunteers. Patients in the severe PHN group had a higher serum IL6 level than in the mild PHN group. The Likert scale score was related to the serum IL6 levels and the frequency of IL6 levels above the cutoff value (4.95 pg/mL) in PNH groups before and after treatment (p < 0.05).Study limitationsPain is subjective. Some mental states, such as anxiety and depression, greatly influence an individual’s perception of pain, and pain tolerance can vary between people. Therefore, pain scores can be affected by different individual factors.ConclusionsThe serum IL6 levels may be used as a biochemical indicator of the severity of PNH.     

Effectiveness and safety of lidocaine patch 5% to treat herpes zoster acute neuralgia and to prevent postherpetic neuralgia

Herpes zoster is often associated to acute neuralgia and postherpetic neuralgia (PHN). Their therapeutic management is still challenging: among therapeutic options, lidocaine patch 5% was rarely used in acute neuralgia on lesional skin, and its efficacy to prevent PHN was never studied. The efficacy and tolerability of lidocaine patch 5% was evaluated in 38 patients with acute neuralgia (19) and PHN (19). Pain intensity was investigated using DN4 questionnaire and NRS‐11 scale at baseline and at week 2, 4, and 8. The use of rescue therapy was also evaluated. A significant reduction of DN4 and NRS‐11 was observed already at W2, with further improvement at W4 and W8. A complete response to treatment (DN4 and NRS‐11 = 0) at week 8 was higher in patients with acute neuralgia (63.2%) than PHN (31.6%). Rescue therapy gradually decreased in acute neuralgia patients from week 2 (57.9%) to week 8 (10.5%), with only two patients needing neuroleptics. In PHN patients rescue therapy remained stable (68.4%). According to our results, lidocaine patch 5% applied on lesional skin was well tolerated and ensured a rapid pain relief in acute neuralgia; if early used, it prevented PHN in almost all patients.     

308-nm Excimer Laser for the Treatment of Alopecia Areata in Children

Abstract:  Alopecia areata (AA) is a common skin disease which is characterized by nonscarring localized or diffused hair loss. In this study we assessed the efficacy of 308-nm Excimer laser in the treatment of alopecia areata in children. A total of 9 children with 30 recalcitrant patches alopecia areata and two children with alopecia areata totalis were enrolled in this study which included seven male and four female patients, aged between 4 and 14 years and the durations of their disease were between 7 and 25 months. All of these patients had more than one lesion of alopecia areata and at least one of them was left as a control for comparison. The lesions were treated with the 308-nm Excimer laser twice a week for a period of 12 weeks. Regrowth of hair was observed in 18 (60%) alopecia patches in the scalp, while there was no response in the control patches and over the extremities. Only four patients with scalp lesions showed a recurrence of alopecia after 6 months post laser therapy. So, 308-nm Excimer laser is considered an effective safe therapeutic option for patchy alopecia areata in children.     

Two courses of rituximab (anti-CD20 monoclonal antibody) for recalcitrant pemphigus vulgaris

Background Pemphigus vulgaris (PV) is a severe autoimmune blistering disease involving the skin and mucous membranes. The response to therapy varies greatly amongst patients and treatment may be challenging. Rituximab is a chimeric monoclonal antibody that selectively targets cell surface antigen CD20, thus depleting mature B cells in vivo. Methods We report the results of rituximab treatment in two patients with severe PV. In both patients, high‐dose oral prednisolone and adjuvant therapy with intravenous immunoglobulins and mycophenolate mofetil failed to control disease activity. Consequently, the patients were treated with two courses of four weekly intravenous infusions of rituximab (375 mg/m²) with a 6‐month interval. Results Clinical improvement was already noticeable 3–6 weeks after the first infusion. After the second course, complete remission was achieved. Oral prednisolone was reduced and treatment with mycophenolate mofetil was continued. The patients remained in full remission 6 months after the last rituximab infusion. Conclusion These cases suggest that two courses rather than a single course of rituximab may be a preferable mode of treatment. Rituximab should be considered as a promising treatment option for recalcitrant PV.