皮膚性病學(xué)課件：帶狀皰疹（英文版）

HerpesZosterDefinition

HerpeszosteriscausedbyVaricella-Zostervirus(VZV),classicallyoccursunilaterallywithinthedistributionofasensorynerve,beingcharacterizedbyclusteredvesiclesandconsiderableneuralgia.PathogenandPathogenesis

Pathogen

Varicella-Zostervirus(VZV)ischaracterizedbyneurotropismanddermatotropism.Pathogenesis

VZVcausesvaricellainchildhood,andestablisheslatencyinsensorygangliaaftertheprimaryinfection.VZVmayreplicatelaterinlife,takingadvantage

ofthedeclineinimmunefunction,travelingdownthesensorynerveintotheskin,showingneuralgiaandclusteredvesicles.Theincidenceofherpeszosterincreaseswithadvancingageanddeclineinimmunefunction.Otherthanimmunosuppressionandage,thefactorsinvolvedinreactivationareunknown.ClinicalmanifestationsProdrome:

headacheandfeverhyperaesthesiapainintheaffectedarea.FeaturesoflesionsTheeruptioninitiallypresentsaspapulesandplaquesoferythemainthedermatome.Overafewdays,cropsofclusteredredpapulesforminadiscontinuousbandandquicklyevolvetoclearvesiclessurroundedbyerythema.Theeruptionmayhavefewlesionsorreachtotalconfluenceinthedermatome.Lesionsmaybecomehemorrhagic,necrotic,orbullous.

Thevesiclesslowlybecomepustulars,andrupturetoformcrusts,whichseparateintwotofourweeks,oftenwithscarring.Theregionallymphnodesareenlargedandtender.

Thetotaldurationoftheeruptiondependsonthreefactors:patientage;severityoferuption;presenceofunderlyingimmunosuppression.Distribution

cranialorspinalsensorynerve.thethoracic(55%)thecranial(20%),withthetrigeminalnervebeingthemostcommonsinglenerveinvolved.thelumbar(15%)thesacral(5%)Neuralgia

Thenatureofpainassociatedwithherpeszostervaries,butthreebasictypesofpainhavebeendescribed.theconstant,monotonous,usuallyburingordeep,achingpain;theshooting,lancinatingpain;thetriggeredpain.Thepainseverityisrelatedtotheagetheaffectedareatheextentoftheskinlesions.

HyperaesthiaTheskinintheaffectedareamaybehypersensitive,normallyInnocuousstimulation,suchasclothingtouchingtheskin,mayproducepain.

Incompleteherpeszoster

Therearemanyonlyneuralgiaandpapuloidlesionsbutwithnoblisters.

ComplicationsPostherpeticneuralgia(PHN)

Thepainpersistsaftertheskinlesionshavehealed,withthesamequalityasthatofacutezosterpain.Thetendencytohavepersistantpainisagedependent.OphthalmicZoster

Ocularinvolvementismostcommonlyintheformofuveitisandkeratitis.Lesscommonbutseverecomplicationsincludeglaucoma,opticneuritis,encephalitis,hemiplegiaandacuteretinalnecrosis.DisseminatedHerpesZosterAgeneralizedvaricelliformeruptionaccompanyingthesegmentaleruption.Ithasbeendefinedasmorethan20lesionsoutsidetheaffecteddermatome.Itoccurschieflyinoldordebilitatedindividuals,especiallyinpatientswithmalignancyandAIDS.RamsayHuntsyndromeResultsfrominvolvementofthefacialandauditorynervesbytheVZV.Herpeticinflammationofthegeniculateganglionisfelttobethecauseofthissyndrome.Thepresentingfeaturesinclude:herpesauricularis,facialparalysis,andauditorysymptoms.VZV.Herpeticinflammationofthegeniculateganglionisfelttobethecauseofthissyndrome.Thepresentingfeaturesinclude:herpesauricularis,facialparalysis,andauditorysymptoms.DiagnosisandMisdiagnosis

DiagnosisTypicallesions:cropsofclusteredvesiclessurroundedbyerythema,forminginadiscontinuousband,withenlargedregionallymphnodes.Thedistributionofasignaldorsalnerveroot.ObviousneuralgiaMisdiagnosis:

Painususllyprecedestheeruptionby3or4days,sometimesitmaybemisdiagnosedtootherdiseases,dependingondifferentpart.AppendicitisCholecystitisAnginapectorisTreatmentBedrestAntivirivaltherapy:acyclovir(ACV)0.25timesdailyvalacyclovir(VCV)1.03timesdailyfamciclovir(FCV)0.53timesdailyfor7days

Inophthalmiczoster,disseminatedzoster,RamysayHuntSyndrome,patientsfailinginoraltherapy,intravenousACVshouldbeused.10mg/kg.Inimmunosuppressedpatients,intravenousACVshouldbealsousedbecauseoftheincreasedriskofdissemination.VitaminB:helptorelieftheinflammationoftheinvolvednerveandreliefthepain.TTFD25mgtidVitB120.5mgimqdAnalgesic:aspirinindomethacinnebumetone,NerveblocksImprovingimmunefunction:transferfactor(TF)Systemiccorticosteroidtherapy:prednisone10mgtidPhysicaltherapyTopicaltherapy:5%sclInconclusion:DefinitionPathogenPathogenesisClinicalmanifestationsComplicationsDiagnosisandmisdiagnosisTreatmentDefinition

HerpeszosteriscausedbyVZV,classicallyoccursunilaterallywithinthedistributionofasensorynerve,withthefeaturesofclusteredvesiclesandneuralgia.Pathogen

Varicella-Zostervirus(VZV)ischaracterizedbyneurotropismanddermatotropism.Pathogenesis

VZVcausesvaricellainchildhood.VZVestablisheslatencyinsensoryganglia.VZVmayreplicatetakingadvantageofthedeclineinimmunefunction,travelingdownthesensorynerveintotheskin,showingneuralgiaandclusteredvesicles.ClinicalmanifestationsProdromeTypicallesionsDistributionNeuralgiaIncompleteherpeszosterComplicationsPostherpeticneuralgia(PHN)OphthalmicZosterDisseminatedHerpesZosterRamsayHuntsyndromeDiagnosisandMisdiagnosisTreatmentAntivirivaltherapyBedrestVitaminBAnalgesicNerveblocksImprovingimmunefunctionSystemiccorticosteroidtherapyPhysicaltherapyTopicaltherapy

定義

帶狀皰疹是一種由水痘－帶狀皰疹病毒引起的以沿神經(jīng)分布的群集的皰疹及神經(jīng)痛為主要特征的病毒性皮膚病。

帶狀皰疹病因和發(fā)病機(jī)理病原體：水痘－帶狀皰疹病毒

Varicella-Zostervirus

水痘－帶狀皰疹病毒具有嗜神經(jīng)和嗜皮膚（neurotropismanddermatotropism）的特性。

常見誘因：大劑量應(yīng)用皮質(zhì)類固醇激素、放療、化療、應(yīng)用免疫抑制劑、過度疲勞、創(chuàng)傷、燒傷、器官移植、惡性腫瘤等。臨床表現(xiàn)

前驅(qū)癥狀

皮膚感覺過敏或神經(jīng)痛、全身不適、低熱、食欲不振等

皮疹特點(diǎn)沿神經(jīng)單側(cè)分布，紅斑基礎(chǔ)上的簇集性水皰,可有丘疹、大皰、血皰、壞死等損害。

局部淋巴結(jié)可腫大、壓痛

皮疹分布特點(diǎn)及好發(fā)部位：皮疹沿某一周圍神經(jīng)單側(cè)分布好發(fā)于肋間神經(jīng)、三叉神經(jīng)第一支分布區(qū)。神經(jīng)痛

為本病特征之一，與皮疹不成比例，可很劇烈，可為燒灼樣、刀割樣、針刺樣等。部分患者有后遺神經(jīng)痛

病程：2-4周頓挫性帶狀皰疹：僅有紅斑、丘疹，無典型水皰大皰性帶狀皰疹:皮損嚴(yán)重，形成大皰出血性帶狀皰疹：皰內(nèi)容物為血性壞疽性帶狀皰疹：老年或營養(yǎng)不良患者，皮損壞死，愈后留有瘢痕播撒性帶狀皰疹

年老體弱、或患惡性淋巴瘤等病的患者，在局部發(fā)疹后數(shù)日內(nèi)，全身發(fā)生皮疹、伴高熱、可并發(fā)腦、