{HERPES ZOOSTER

• Name : Tn. Syarifuddin• Sex : Male• Age : 64th years old• Address : Makassar• Status : Married• Religion : Islam• Diagnosis : Herpes Zooster

Cervicothoracalis (C4-C6, T1-T8)

CASE STUDY

CHIEF COMPLAINT: PAIN ON THE UPPER RIGHT ARM

ANAMNESIS TERPIMPIN: A patient come to the hospital with a chief complain of a pain sensation on his body since 3 days he came to the hospital. He felt the pain on his upper right arm and spread to his chest and back. The pain felt like a stabbing sensation take place through out the whole day. The pain is felt for three days and then red spots appeared on the upper right arm, spread to his chest and back. The red spots then turn to vesicles when he was being treated at the hospital.

Anamnesis

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

Contact History: Patient’s son had the same signs an symptoms but it goes away by itself.

Treatment History: Before this, the patient went to a clinic and was given some treatment but there were no changes.

Other Medical History: Asthma (+)

History of Allergy: No

History with the same desease: No

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

Blood Pressure : 130/90mmHgRespiration Rate : 24kali/menitHeart Rate : 70 kali/menitTemperature : 36,7cConsousness : Compos Mentis

Vital Signs:

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

Regio: Regio truncus anterior et posterior dextra, regio brachialis dextra

Clinical Lession: vesikel berkelompok dengan dasar eritem, bulla

Dermatology Status

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

Before Treatment

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

After Treatment

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

Acyclovire 5 x 800mg ( 7 hari ) Salisil talk

Dermatologist Therapy

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

Herpes Zoster is an infection by Varicella zoster virus (VZV) that attacks the skin and mucosa, this infection is the reactivation of the virus that occurs as the reactivation of VZV after primary infection.

WHAT IS HERPES ZOSTER ?

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

20% in adults and 50% in people with decreased immune systems.

Spread same as varicella Reactivation of the virus occurs

after a person gets varicella Sometimes it lasts subclinical

varicella Transmission of the virus is the

aerogen from the varicella patients

EPIDEMIOLOGY

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

Varicella-zoster virus is a member of the herpes virus family

VZV contais capsid that isokahedral shaped surrounded by lipid envelope that covers the genome of a virus, where the genome contains linear molecule of double-stranded DNA (deoxyribonucleic acid).

The diameter is 150-200 nm and has a molecular weight about 80 million.

ETIOLOGY

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

PATHOGENESIS

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

{ {Signs and Symptoms

Headache Photophobia Malaise Unbearable itching Pain (varying

severity) Aching Burning Stabbing Shock-like Provoked by trivial

stimuli Altered sensitivity to

touch

LESION

Usually limited to 1 or 2 adjacent, unilateral dermatomes1,2

“Grape-like” lesions clustered on an erythematous base1,2

Lesions usually heal within 4 weeks1

SIGN AND SYMPTOMS OF PRODROMALAND ACUTE

ZOSTER: DERMATOMAL DISTRIBUTION

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

• History taking

• Physical examination

• Laboratory examination

DIAGNOSIS

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

• Tzank smear• histopathological• culture• PCR• serological

EXAMINATION

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

Herpes simpleks

Vesicles

burn sensation

Pain

itchy

DIFFERENTIAL DIAGNOSIS

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

• Allergic Contact Dermatitis

Vesicles erosion In chronic lesion: dry, lichenification, papul

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

Anti-ViralMANAGEMENT

Normal• Age <50 year• Age> 50 years

and accompanied by lesions of herpes zoster in the ophthalmic

Simptomatic therapy or

Famciclovir 3 x 500 mg --7 days

Valacyclovir 3 x 1000 mg -- 7 days

Acyclovir 5 x 800 mg -- 7 days

Immunocompromi

sed

• Mild

compromised

with HIV-1

infection

• Severe

compromise

• Acyclovir

resistance

Famciclovir 3 x 500 mg --7-10 days

Valacyclovir 3 x 1000 mg -- 7-10 days

Acyclovir 5 x 800 mg -- 7-10 days

Acyclovir 10 mg/kgBB IV every 8 hours for

8-10 days

Foscarnet 40 mg/kgBB IV every 8 hours

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSITY

• Dubia ad Bonam

PROGNOSIS

If treated early, post herpetic neuralgia can be avoided

Thank you