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{ 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

Anamnesis
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.

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSIT

Contact History: Patients 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 UNIVERSIT

Vital Signs:
Blood Pressure
: 130/90mmHg
Respiration Rate : 24kali/menit
Heart Rate
: 70 kali/menit
Temperature
: 36,7c
Consousness
: Compos Mentis

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSIT

Dermatology Status
Regio: Regio truncus anterior et
posterior dextra, regio brachialis
dextra
Clinical Lession: vesikel
berkelompok dengan dasar eritem,
bulla

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSIT

Before Treatment

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSIT

After Treatment

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSIT

Dermatologist Therapy

Acyclovire 5 x 800mg ( 7 hari )


Salisil talk

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSIT

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 UNIVERSIT

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 UNIVERSIT

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 UNIVERSIT

PATHOGENESIS

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSIT

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 UNIVERSIT

DIAGNOSIS

History taking

Physical examination

Laboratory examination

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSIT

EXAMINATION

Tzank smear
histopathological
culture
PCR
serological

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSIT

DIFFERENTIAL DIAGNOSIS
Herpes simpleks
Vesicles
burn sensation
Pain
itchy

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSIT

Allergic Contact
Dermatitis

Vesicles
erosion
In chronic lesion: dry,
lichenification, papul

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSIT

MANAGEMENT
Anti-Viral

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

Immunocompromised

Mild compromised Famciclovir 3 x 500 mg --7-10 days


with HIV-1

Valacyclovir 3 x 1000 mg -- 7-10 days

infection

Acyclovir 5 x 800 mg -- 7-10 days


Acyclovir 10 mg/kgBB IV every 8 hours for 8-10 days

Severe compromise Foscarnet 40 mg/kgBB IV every 8 hours

Acyclovir resistance

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSIT

PROGNOSIS

Dubia ad Bonam
If treated early, post herpetic neuralgia can be avoided

DERMATOVENEREOLOGY DEPARTMENT OF MEDICAL FACULTY HASANUDDIN UNIVERSIT

Thank you