The clinical course of herpes zoster: A prospective study in primary care

The clinical course of herpes zoster: A prospective study in primary care

The clinical course of herpes zoster: A prospective study in primary care
Results The mean age of 164 patients with herpes zoster seen at our dermatology clinic between January 1994 and December 1995 was 48.8 years, with a sex ratio of 1: 1. End points were gained for all (100%) after 12 months follow up. The occurrence of four cases of herpes zoster simultaneously, among apparently healthy young adults in contact in the same occupation, evoked some interest. Ninety patients with HZ who did not sho w clinical motor weakness except 4 patients with Ramsay-Hunt syndrome were studied prospectively for 2 years using EMG which is generally known to be very sensitive method for detection of motor involvement. Most patients belonged to the age group 70-80 years, accounting for about 35% of all patients, followed by the age group 60-70 years (24.6% of cases). Majority (39%) of cases were seen in the 21-30 year age group. The commonest segment affected was thoracic (42.4%) followed by cranial (28.2%) and cervical (12.1%).

In contrast pain was experienced by 19% and 8% of patients 60 years of age and older at 3 and 12 months respectively. The most common manifestation of HZO was dermatitis, followed by keratitis and conjunctivitis. Potential immuno-modulating conditions (diabetes mellitus, cancer, HIV-infection, steroid treatment) were present in 24 patients (5%), 4 (1%) of whom were diagnosed with a malignancy within 6 months of contracting HZ. No cases of congenital varicella syndrome or zoster in infancy occurred in this group. These findings will contribute to optimal use of the HZ vaccine and testing of new therapies that might prevent PHN. Malignancy is seldom associated with zoster rash in the primary care setting. The use of routine computerised medical records increases the possibility of collecting epidemiological information on the clinical course of a disease.

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