Teaching Herpes Zoster

7/29/2019 Teaching Herpes Zoster

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TEACHING BANGSAL 1Herpes Zooster


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GROUP MEMBERS

Dian Utami C 111 09 134Arsyi Adliah Anwar C 111 09 266

Andi Utari Dwi Rahayu C 111 09 280

Eka Utami Makmur C 111 09 291

M. Awwalul Akram C 111 09 262

Ahmad Zaki C 111 09 320

Arie Rhoedyat Swardhani C 111 08 167

Ryan Kanzul Arasy C 111 08 128 Muh. Luqmanul Hakim C 111 08 765


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PATIENT IDENTITY

Name : Mrs. Bayang Dg Nganga

Gender : Female

Age : 82 years old

Marital status : Marriage

Religion : Moeslim

Address : Salaka, Takalar

Job : Housewife

Addmission date : 29 / 01 / 2013

Medical record no : 591482


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HISTORY TAKING

Main Complaint: wound on the left side of uppernose.

Brief Anamnesis : Occur since 5 day ago. Itchy

(+), swelling (+), red rash (+), nausea (+), vomit(+), epigastric pain (+), cough (-), dyspneu (-),

chest pain (-), fever (-), fever history (-),

defecation and micturition are normal.

Hypertension history (+). No family members

with the same disease.


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CURRENT STATUS

Consciousness : Compos Mentis

General Condition : Moderate

Hygiene : Moderate

Nutrition : Normal

Vital sign :

BP : 120/80 mmHg

Pulse : 80 minutes

RR : 24x/minutes

Temperature : 36,5 0C


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PHYSICAL EXAMINATION

Anemic (-), icterus (-), cyanoses (-)

Cor/ Pulmonal : Normal

Abdomen : Normal,peristaltic (+)

Extremities : Edema (-)

Lymph nodes : Enlargement (-)


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Regio facialis


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DERMATO-VENEROLOGY STATUS

Region : superior nasalis sinistra

Efflorescency : granulated tissue and

crusta

Region : anterior nasalis sinistra

Efflorescency : crusta and skuama

Region : Orbitalis (palpebra

superior) sinistraEfflorescency : oedem and erithema


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RESUME

An 82-years-old woman with main complaint

is wound on the left side of upper nose.

Occur since 5 day ago. Patient feels Itchy

(+), swelling (+), red rash (+), nausea (+),vomit (+), epigastric pain (+), cough (-),

dyspneu (-), chest pain (-), fever (-), fever

history (-), defecation and micturition arenormal. Hypertension history (+).


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DIAGNOSIS

Herpes Zoozter Facialis


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DISCUSSION

Herpes Zoster is an acute dermatomal infectionassociated with reactivation of VZV

Characterized by :

Unilateral pain

A vesicular or bullous eruption limited to a

dermatome(s) innervated by a corresponding

sensory ganglion.

Age of Onset : More than 66% are >50 years ofage; 5% of cases in children


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CLINICAL MANIFESTATIONS

Duration of Symptoms

Prodromal stage: Neuritic pain or

paresthesia precedes for 23 weeks(84% of cases).

Acute vesiculation: 35 days.

Crust formation: days to 23 weeks.


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PHN: months to years.

Chronic pain or PHN (post herpetic

neuralgia) is that persisting after the

lesions have healed or persisting 4

weeks after the onset of lesions,

regardless of degree of healing.


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SKIN SYMPTOMS

Prodromal Stage

Pain (stabbing, pricking, sharp, boring,

penetrating, lancinating, shooting),

tenderness, paresthesia (itching, tingling,burning, freezeburning) in the involved

dermatome precedes the eruption.

Allodynia: heightened sensitivity to mild

stimuli.


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CONSTITUTIONAL SYMPTOMS

Prodromal stage and active vesiculation:

flulike symptoms such as headache,

malaise, fever.

Chronic stages: depression is very commonin individuals with PHN.


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MUCOCUTANEOUS LESIONS

Papules (24 h) vesicles-bullae ( (48h)

pustules (96 h) crusts (710 days).

New lesions continue to appear for up to 1

week. Erythematous, edematous base with

superimposed clear vesicles, sometimes

hemorrhagic.


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The vesicle-bulla is oval or round, may be

umbilicated.

Vesicles erode forming crusted erosions

Necrotic and gangrenous lesions sometimes

occur.

Scarring is common after healing of HZ


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DISTRIBUTION

Unilateral, dermatomal .

Two or more contiguous dermatomes may

be involved .

Noncontiguous dermatomal zoster is rare.

Hematogenous dissemination to other skin

sites in 10% of healthy individuals.


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DIFFERENTIAL DIAGNOSIS

Prodromal Stage/Localized Pain Can

mimic

migraine, cardiac or pleural disease, an

acute abdomen, or vertebral disease.Dermatomal Eruption Zosteriform HSV

infection

phytoallergic (poison ivy, poison oak)contactdermatitis, erysipelas, bullous impetigo,

necrotizing fasciitis.


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TREATMENT

Antiviral therapy:

o Systemic Antiviral (Acyclovir,

Famcyclovir, Valacyclovir)

o Urgent indications

o Herpes zoster at any site of the body

in patients beyond the age of 50

o Herpes zoster in the head/neck area of

patient at any age


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o Severe herpes zoster on the trunk and on the

limbo Herpes zoster in immunodeficient patients

o Herpes Zoster in patient severe atopic

dermatitis and severe eczema

Relative indications:

o Herpes Zoster on the trunk or on the extremities

in patients younger than 50 years


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DOSAGE

Acyclovir : 800 mg PO four times daily

for 710 days

Valacyclovir : 1000 mg PO three times

daily for 7 days

Famcyclovir : 500 mg PO three times

daily for 7 days


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SYMPTOMATIC THERAPY

Analgesic :

1) Ibuprofen

2) Mefenamic acid

Anti Pruritus :

3) Antihistamine


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RECOMMENDED EXAMINATION

Tzank examination polynuclear of datia cell


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THANK YOU

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Teaching Herpes Zoster