The Clinical Features And TCM Syndromes Of Herpes Zoster In Head And Face And Related Complications

Objective: By collecting the medical records of inpatients with herpes zoster occurring in the head and face in the past 2 years in the Department of Dermatology of Wuhan First Hospital,to summarize the epidemiological characteristics of herpes zoster head and face,and the clinical symptoms,signs,diagnosis points,and treatment of traditional Chinese and western medicine of related complications.To provide referrence for clinical use.Methods: By retrospective analysis during October 2018 to October 2020 dermatology hospital medical records of patients with herpes zoster,according to include and exclude criteria to select eligible patients,the general information(gender and age,cause,with basic diseases),the disease clinical datas(incidence,affected nerves,misdiagnosed cases),complication of eye disease,Ramsay Hunt syndrome(herpes zoster,multiple cranial neuropathy,clinical symptoms and signs)and the combination of Chinese and western therapy on herpes zoster,and follow-up to collect patients’ prognosis,Combined with domestic and foreign literature,the characteristics of the disease and the efficacy of different therapy were summarized.Results: A total of 220 patients with herpes zoster head and face were enrolled.(1)The trigeminal nerve was involved in 169cases(169/220,76.8%),among which the first trigeminal nerve(ocular branch)was most involved in 145 cases(145/220,65.9%),auricular herpes in 31 cases(31/220,14.1%),and cervical nerve in67 cases(67/220,30.5%).(2)Among the patients with head and facial herpes zoster,there were 104 males(47.3%)and 116 females(52.7%),with a male to female ratio of 1:1.12,more female patients than male patients.Among the 169 patients with herpes zoster trigeminal nerve,93 cases were male(55.0%)and 76 cases were female(45.0%).The male-to-female ratio was 1:0.82,and there were more male patients.(3)54 patients(24.5%)had clear predisposing factors,and most of them were fatigue-induced diseases(35/220,15.9%),followed by upper respiratory tract infection,combined with basic diseases requiring long-term oral glucocorticoids or immunosuppressant,tumor,trauma,etc.(4)159 patients(72.3%)had a history of underlying diseases.According to the system classification,the main complications were circulatory system(85/220,38.6%),endocrine system(38/220,17.2%),digestive system(40/220,18.2%),respiratory system(26/220,11.8%).Other basic diseases also included urinary system diseases,connective tissue diseases,malignant tumors,etc.61 cases(27.7%)had no previous health history of special diseases.(5)In 220 patients,111 cases(51%),pain and skin rash appear on the same day,93 cases(42%),pain appeared before the rash,the shortest interval of 1 day,the longest interval of 10 days,an average of 3.44 + /-2.16 days,and in 145 cases of ocular herpes zoster patients,75 cases(50%),pain and skin rash appears on the same day,63 cases(43%),pain appeared before the rash,9 cases(6%)appeared after a skin rash,blister pain.(6)202 cases(91.8%)were common type,15 cases(6.81%)were hemorrhagic,3 cases(1.4%)were gangrene type.(7)60 patients(27.3%)visited other departments for the first time,including ophthalmology,otolaryngology,emergency,community hospitals,neurology,traditional Chinese medicine,orthopedics,etc.(8)In ocular herpes zoster,there were 72 patients(72/145,49.7%)with ocular symptoms,58 patients(40.0%)with conjunctivitis,32 patients(22.1%)with keratitis,and 8 patients(5.5%)with uveitis.Other complications included patients with corneal ulceration,scleritis,glaucoma,cataract,and elevated intraocular pressure.Twelve patients complained of different degrees of vision loss,and 3 patients received ophthalmic treatment for more than half a year due to chronic recurrent eye complications.Conclusion :(1)The incidence of herpes zoster increases with age.(2)Herpes zoster in the head and face is most easily involved in the trigeminal nerve,especially the ocular branch,and facial nerve involvement is not uncommon.(3)Ocular herpes zoster often occurs conjunctivitis,keratitis,uveitis,and other ocular complications,inadequate treatment may cause its recurrence,resulting in visual impairment,early treatment of ocular herpes zoster related complications have a higher success rate.(4)For patients with other neurological symptoms,it is necessary to be alert to multiracial neuropathy.A comprehensive physical examination,complete examination,and timely treatment should be conducted to prevent serious complications of this common disease.(5)The possibility of herpes zoster should be considered in patients with unexplained unilateral skin pain,headache,or toothache treated in clinical departments other than dermatology.