Herpes zoster episodes commence with a prodromal period of about 4 days with symptoms including pain and malaise. Such men often have a lymphopenia. Severe acute pain is more likely in older females and those with a prodrome or severe rash. Studies on the relative in vitro susceptibility of varicella-zoster virus and herpes simplex virus types 1 and 2 to acyclovir suggested that varicella-zoster virus is two- to eightfold less susceptible to the drug. © 2013 Elsevier Inc. Spontaneous burning pain is also common in these cases. As the prodrome of herpes zoster, neurological symptoms procede with a probability of about 60%.
The prodrome indicates early viral damage of affected sensory ganglion. This web just only a search engine media, not a storage or cloud server from the file. Severe acute pain probably enhances central sensitization and excitotoxic damage in the dorsal horn. Results: The study of HZ conducted in 123 cases showed that out of 123 cases 58% were below 40 years & 42 % were above 40 years. It mainly affects adults as the age group of 31-40 years has maximum number of cases (35=28.5%). Sex ratio favours slight female predominance (M:F=1.12:1). Majority of cases (83%) had no provoking factors but in remaining (17%) common provoking factors were malignancy and PTB in 4 cases, HIV infection in 3 cases, chronic use of oral steroids for other diseases, DM, post operative period in 2 cases in each group, depression under treatment & renal disease each were present in 1 case.
76 cases (62%) had prodromal dermatomal pain but constitutional symptoms like nausea, vomiting, arthralgia, insomnia, headache, loss of appetite etc. were also present in 9 cases (7.3%) in prodromal period ranging from 1-3 days. Almost all the cases had segmental neuralgia over the respective dermatome except in 3 cases among which one had DM while other 2 cases presented very early. In 36% cases rashes & pain occurred concurrently. More than half (11=55%) cases of trigeminal nerve had ophthalmic division involvement. Almost 80% of the cases had distribution of eruptions according to dermatome but in remaining 20% (24 cases) lesions were also present beyond the parental dermatome among which 8 cases had involvement of more than one adjacent dermatome, 15 cases had vesicles (ranging from 4-16) distant from the primary dermatome. Only one case who was HIV sufferer presented with more than 20 vesicles distant from primary dermatome (disseminated herpes zoster).
58 cases had lesions on right side while remaining 65 had on left side. PHN occurred in 23 cases out of which 10 were male & 13 were female. PHN was characterized as deep continuous pain in 5 cases, episodic shooting pain in 12 cases, burning & itching in 3 cases & 3 cases reported it as sensation of crawling insects. 14 cases out of 23 (60.87%) were in the age group of more than 50 years. According to dermatome involved in HZ who developed PHN most common dermatome was ophthalmic in which PHN occurred in 45.45% cases. In our study cases of HZ came to the department within the range of 1-12 days after the eruption of rashes. Out of 52 cases who received antiviral treatment within 72 hours, 9 (17.30%) developed PHN & in other 71 cases who didn’t receive antiviral treatment, 14 (19.71%) developed PHN.
Benbernou A et al reported prodromal pain in 74% cases in their study(21) while in our study this data is 62%. But the prevalence of other constitutional symptoms were low during the prodormal period. Similar to study by Katz et al (23) in our study pain was the one of the main complaint at the time of presentation and almost all the cases presented with it. This acute pain has its own morbidity and it is also associated with increased risk of development of PHN (24). Though the severity of pain may vary but those who developed PHN had severe pain at the time of presentation. Main risk factor for PHN is increasing age as PHN is relatively uncommon below the age of 50 years. It may develop in 20% of those between 60 to 65 years of age and in greater than 30% of those older than 80 years.(25) Individuals older than 60 years account for 50 percent of these cases.(26) In our study 61% of PHN cases are more than 50 years of age & in 50-70 years of age 40% cases had PHN while in more than 70 years of age all the four cases had PHN.
These figures are relatively higher from other studies which may be due to lesser number of cases. Conclusion: HZ is a common clinical diagnosis in dermatology clinic. PHN is most common complication of HZ which is more common in elderly people and also occurs more in association with female sex, presence of prodrome, severe acute pain & more severe rash. Involvement of ophthalmic division of trigeminal nerve may be associated with increased chances of PHN but antiviral treatment is not associated with decreased chances of PHN. Some of our findings are supported by some previous studies while some other studies didn’t support it which indicates requirement of more studies with large number of cases. 1. Jeffrey I.
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