TEACHING BANGSAL 1

Herpes Zooster

GROUP MEMBERS
Dian Utami C 111 09 134 Arsyi 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

PATIENT IDENTITY
Name

Gender
Age Marital

status Religion Address Job Addmission date Medical record no

: Mrs. Bayang Dg Nganga : Female : 82 years old : Marriage : Moeslim : Salaka, Takalar : Housewife : 29 / 01 / 2013 : 591482

HISTORY TAKING
Main

Complaint: wound on the left side of upper

nose.
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.

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

PHYSICAL EXAMINATION
Anemic

(-), icterus (-), cyanoses (-) Cor/ Pulmonal : Normal Abdomen : Normal, peristaltic (+) Extremities : Edema (-) Lymph nodes : Enlargement (-)

Regio facialis

DERMATO-VENEROLOGY STATUS
Region

: superior nasalis sinistra Efflorescency : granulated tissue and crusta Region : anterior nasalis sinistra Efflorescency : crusta and skuama Region : Orbitalis (palpebra superior) sinistra Efflorescency : oedem and erithema

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 are normal. Hypertension history (+).

DIAGNOSIS
Herpes

Zoozter Facialis

DISCUSSION
Herpes

Zoster is an acute dermatomal infection associated 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 of age; 5% of cases in children <15 years.

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.

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.

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.

CONSTITUTIONAL SYMPTOMS
Prodromal stage and active vesiculation: flulike symptoms such as headache, malaise, fever. Chronic stages: depression is very common in individuals with PHN.

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.

 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

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.

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)contact dermatitis, erysipelas, bullous impetigo, necrotizing fasciitis.

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

o o

Severe herpes zoster on the trunk and on the limb Herpes zoster in immunodeficient patients 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

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

SYMPTOMATIC THERAPY

1)
2)

3)

Analgesic : Ibuprofen Mefenamic acid Anti Pruritus : Antihistamine

RECOMMENDED EXAMINATION
Tzank

examination polynuclear of datia cell

THANK YOU