重慶醫(yī)科大學《皮膚性病學》31帶狀皰疹英文教學課件

1、,welcome,Herpes Zoster,M.D Zhou xun The First Teaching Hospital of Chongqing University of Medical Sciences,Definition Herpes zoster is caused by Varic

2、ella - Zoster virus (VZV) , classically occurs unilaterally within the distribution of a sensory nerve, being characterized by clustered vesicles and considerable neuralgia.,

3、Pathogen and Pathogenesis Pathogen Varicella-Zoster virus (VZV) is characterized by neurotropism and dermatotropism.,Pathogenesis

4、VZV ↓ the primary infection nonimmune host ↓

5、 varicella ↓ VZV establishes latency in sensory ganglia ↓ the

6、 decline in immune function VZV may replicate later ↓,Herpes zoster showing neuralgia and clustered vesicles,The incidence of he

7、rpes zoster increases with advancing age and decline in immune function. Other than immunosuppression and age, the factors involved in reactivation are unknown.,Clinical manifestationsP

8、rodrome: headache and fever hyperaesthesia pain in the affected area,Features of lesions initially presents as papules and plaques of erythema crops of clustered red papules form in

9、a discontinuous band evolve to clear vesicles surrounded by erythema,the eruption may have few lesions or reach total confluence in the dermatome lesions may becom

10、e 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 regional

11、 lymph nodes are enlarged and tender,The total duration of the eruption depends on three factors: patient age severity of eruption presence of underlying immunosuppres

12、sion,Distributioncranial or spinal sensory nerve the thoracic (55%) the cranial (20%), with the trigeminal nerve being the most common single nerve involved the lumbar (15%) the sacral

13、 (5%),Neuralgia The nature of pain associated with herpes zoster varies, but three basic types of pain have been described. the constant, monotonous, usually buring or deep, a

14、ching pain the shooting, lancinating pain the triggered pain,The pain severity is related to the age the affected area the extent of the skin lesions,Hyperaesthia The

15、skin in the affected area may be hypersensitive , normally innocuous stimuli, such as clothing touching the skin , may producepain.,Incomplete herpes zoster There are may only neural

16、gia and papuloid lesions but with no blisters.,ComplicationsPostherpetic neuralgia(PHN) The pain persists after the skin lesions have healed, with the same quality as that of acute

17、 zoster pain. The tendency to have persistant pain is age dependent.,Ophthalmic Zoster Ocular involvement is most commonly in the form of uveitis and keratitis. Less common but severe complicat

18、ions include glaucoma, optic neuritis, and acute retinal necrosis.,Disseminated Herpes Zoster a generalized varicelliform eruption accompanying the segmental eruption more than 20 lesions outside

19、 the affected dermatome occurs chiefly in old or debilitated individuals, especially in patients with malignancy and AIDS,Ramsay Hunt syndrome results from involvement of the facial and audito

20、ry nerves by the VZV herpetic inflammation of the geniculate ganglion is felt to be the cause of this syndrome the presenting features include : herpes auricularis, facial paralysis, and

21、auditory symptomsVZV. Herpetic inflammation of the geniculate ganglion is felt to be the cause of thi

22、s syndrome. The presenting features include : herpes auricularis, facial paralysis, and auditory symptoms.,Diagnosis Misdiagnosis,Diagnosistypical lesions: crops of cluster

23、ed vesicles surrounded by erythema, forming in a discontinuous band, with enlarged regional lymph nodes,the distribution of a signal dorsal nerve root obvious neuralgia,Misdiagnosis: Pai

24、n ususlly precedes the eruption by 3 or 4 days, sometimes it may be misdiagnosed to other diseases, depending on different part. appendicitis chol

25、ecystitis angina pectoris,TreatmentBed restAntivirival therapy: acyclovir (ACV) valacyclovir(VCV) famciclovir (FCV),intravenous ACV should be used in ophthalmic zoster dissemin

26、ated zoster Ramysay Hunt Syndrome patients failing in oral therapy immunosuppressed patients,Vitamin B: help to relief the inflammation of the involved nerve and relief the pain

27、 VitB12, TTFD Analgesic: aspirin indomethacin nebumetone,Nerve blocksImproving immune function transfer factor (TF)Systemic

28、 corticosteroid therapy prednisone 10mg tidPhysical therapy Topical therapy: 5% scl,In conclusion: Definition Pathogen and Pathogenesis Clinical manifestations Complicat

29、ions Diagnosis and misdiagnosis Treatment,Definition caused by VZV unilaterally with the distribution of a sensory nerve clustered vesicles and neuralgia,Pathogen Varicella-Zos

30、ter virus (VZV) is characterized by neurotropism and dermatotropism.,Pathogenesis VZV causes varicella, and establishes latency in sensory ganglia VZV may replicate later in life t

31、raveling down the sensory nerve into the skin showing neuralgia and clustered vesicles,Clinical manifestationsProdromeTypical lesionsDistributionNeuralgiaIncomplete herpes zoster,,Comp

32、lications,Postherpetic neuralgia(PHN),Ophthalmic Zoster,Disseminated Herpes Zoster,Ramsay Hunt syndrome,Diagnosis and MisdiagnosisTreatment Antivirival therapy Bed rest Vitamin B Analgesic