Shingles-like appearance

Introduction Herpes zoster-like appearance, the main feature of which is the clustering of vesicles, which are clustered along the peripheral nerves of one side, with obvious neuralgia. The first infection is characterized by chickenpox. After the virus can be lurking in the posterior root ganglia of the spinal cord for a long time, the immune function can be weakened to induce the varicella zoster virus to re-activate, grow and reproduce, and spread herpes along the peripheral nerves and the skin. Patients with herpes zoster generally receive lifelong immunity to the virus. However, there have been repeated authors.

Cause

Human is the sole host of varicella-zoster virus. The virus enters the bloodstream through the respiratory mucosa to form viremia, which causes varicella or a recessive infection. Later, the virus can be lurking in the posterior root ganglia or cranial nerve sensory ganglia. When the body is subjected to certain stimuli (such as trauma, fatigue, malignant tumors or weakness after illness), the body's resistance is reduced, the latent virus is activated, and the blister is produced by replicating along the sensory axon down to the skin in the area dominated by the nerve. At the same time, the affected nerves have inflammation, necrosis, and neuralgia. This disease can obtain longer-lasting immunity, so it is generally not recurred.

an examination

Related inspection

Cochet and Bonnet's corneal sensory skin smear microscopy

The intercostal nerve and the area of the skin that the trigeminal nerve can control.

1. Characteristics of rash The cluster of papules and blisters appear on the basis of flushing erythema. The size of miliary to mung bean is clear. When it is severe, it may be bloody or necrotic. The unilateral distribution of the rash is characterized by a band.

2, the symptoms of self-consciousness, pain, and unbearable. Pain can occur before the appearance of a rash, manifested as hyperesthesia, and light touch induces pain. Pain often persists until the rash has completely subsided, sometimes for several months.

3, the beginning of the rash for the skin redness, followed by the cluster of clusters of mung bean-sized papules, rapidly evolved into blisters after 1-2 days, the blisters along the proximal nerve development arranged in a band shape, after a few days, the blister wall is relaxed, blister fluid It is turbid, then gradually absorbed and dried up. Temporary erythema or pigmentation is left behind.

Differential diagnosis

Differential diagnosis of herpes zoster-like appearance:

1, in the herpes zoster prodromal period and non-rash herpes zoster, sometimes easily misdiagnosed as intercostal neuralgia, pleurisy or acute abdomen, etc., should be noted.

2, the disease sometimes needs to be differentiated from herpes simplex, the latter occurs at the junction of the skin and mucous membrane, the distribution is not regular, the blister is small and easy to break, the pain is not, more common in the process of fever (especially high fever), often Easy to relapse.

3, occasionally confused with contact dermatitis, but the latter has a history of contact, rash has nothing to do with nerve distribution, consciously burning, itching, no neuralgia.

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