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herpes zoster

secondary from Variccella virus [chicken pox]

factor aggrevated reactivation

  1. immune suppressed : HIV

  2. trauma

  3. CA

  4. tumor of spine

  5. frontal sinus inflamme

clinical

  1. 1-3 days prior to rash has neuralgia itching and pain along dermatome

  2. group of vesicle on erythematous rash along dermatome

  3. most common at ophthalmic branch [CN 5 ] facial dermatome 

  4. trunk most common at T3-L2 body dermatome 

  5. started with pustule in fist 3-4 days then turn to scale and resolve in 7-10 days

complication

  1. herpetic neuralgia : 10-15 % of zoster case , 50% resolve in three month , 75% resolve in 1 year

  2. superficial bacterial infection

  3. keratitis [ophthalmic zoster , nasocillary branch , tip of nose ]

  4. generalize herpes zoster , immuno compromise

  5. Ramsay -Hunt syndrome : facial nerve paralysis earpain , vesicle in upper palate

treatment

  1. wet compression

  2. acyclovir 800 mg five time daily 7 days – 10 days

  3. generalized herpes zoster : acyclovir 10 mg/kg q 8 hr 7-10 days

  4. post herpetic neuralgia : NSAID, paracetamol , TCA

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