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*Only for medical professionals to read for reference.
PHN treatment is combined treatment and comprehensive treatment
.
Herpes zoster is an infectious skin disease caused by reactivation of varicella-zoster virus (VZV), which is latent in the posterior root ganglia or cranial ganglia of the spinal cord for a long time, and its skin lesions are distributed in clusters.
, Erythema and blisters distributed along the nerves, accompanied by obvious neuralgia
.
It is currently believed that pain is a painful experience in sensory, emotional, cognitive, and social dimensions related to potential tissue damage after tissue injury
.
At the Annual Meeting of Dermatologists of the Chinese Medical Doctor Association and the National Aesthetic Dermatology Conference (CDA 2021), Professor Wang Yu, deputy director of the Department of Dermatology, Affiliated Hospital of Guizhou Medical University, gave the title of "Comprehensive Treatment of Neuralgia After Herpes Zoster" and combined Own clinical work experience and the latest literature reports, from the classification, diagnosis, etiology, pathogenesis and treatment of herpes zoster neuralgia (PHN), etc.
, have carried out a comprehensive and detailed introduction
.
013 kinds of herpes zoster neuralgia, what is the difference in the time of appearance? Professor Wang Yu first divided herpes zoster neuralgia into three types: 1) Acute herpes zoster neuralgia, which occurs within one month after the appearance of the rash
.
2) Subacute herpes zoster neuralgia, the pain lasts for about 1 to 3 months
.
3) Neuralgia after herpes zoster: pain that still occurs more than 90 days after the occurrence of herpes zoster
.
Among them, PHN is a complex neuropathological state, because varicella-zoster infection directly leads to inflammation of the peripheral nerves, which in turn causes pain in patients
.
When it occurs in the spinal cord, the cells are attacked by viruses, triggering an inflammatory response, and eventually leading to the activation of the C-type receptor area, resulting in post-neuralgia
.
024 criteria, teach you to diagnose PHN Professor Wang Yu mentioned that the diagnosis of PHN involves the following points: 1) Pain is located in a clear neuroanatomical area
.
2) The medical history suggests that there is related damage or disease in the peripheral or central sensory system
.
3) At least one auxiliary examination confirms that the pain meets the neuroanatomical scope
.
4) At least one auxiliary examination confirmed the existence of related damage or disease
.
The judgment method is-positive neuropathic pain: meets the above 1~4 criteria; very likely neuropathic pain: meets the above 1, 2, 3, or 4 criteria; possible neuropathic pain: meets the above first 1 And 2 standards, but lack of supporting inspection evidence
.
03 These 6 major risk factors appear, be alert to the occurrence of PHN Professor Wang Yu summarized the 6 risk factors of PHN, they are: 1) Pain score: The higher the score, the greater the risk factor for PHN, especially when >6 points
.
2) The more complicated underlying diseases (such as diabetes, kidney disease, fever, hypertension, etc.
), the greater the risk of PHN
.
3) immunocompromised / immunosuppressed state: human immunodeficiency virus (HIV) infection, lymphoma (patients in the last two years), high-dose oral glucocorticoids such as a patient
.
4) The skin lesions are located on the head, face and trunk, and the risk of PHN is higher
.
5) The older the age, the higher the risk of PHN
.
6) Receiving antiviral treatment can reduce the risk and severity of PHN
.
04How to use drugs rationally to prevent PHN? Professor Wang Yu mentioned that timely and effective antiviral treatments, especially those administered within 72 hours of the appearance of the rash, can prevent PHN
.
In addition, appropriate use of corticosteroids when necessary is also helpful.
For example, for patients with trigeminal nerve involvement and a wide range of skin lesions, if contraindications are excluded, oral hormone (usually prednisone) 1 mg/kg daily for 7 days , And then gradually reduce the amount
.
At the same time, it is necessary to treat symptomatic analgesia at different levels, and choose different types of drugs according to the degree of pain of the patient
.
Patients with mild to moderate pain are treated with non-steroidal anti-inflammatory drugs; moderate to severe pain is treated with opioid analgesics
.
When the above-mentioned drugs cannot control the pain symptoms, consider using calcium channel inhibitors such as gabapentin and pregabalin or tricyclic antidepressants and hormone drugs
.
05How to grade treatment for PHN? Figure 1 The treatment of PHN (from an online speech) Professor Wang Yu pointed out that PHN treatment is a combination treatment and comprehensive treatment, and the efficacy and safety risks need to be evaluated.
At the same time, the principle is to start with a relatively small dose and gradually increase the dose
.
In addition, the purpose of treatment is to improve pain, improve sleep, and improve the quality of life
.
For the treatment of pain hierarchical principle different types: 1) first-line treatment of mild pain: topical drugs such as lidocaine patch or cream, and the like capsaicin cream
.
When first-line treatment fails, systemic application of tricyclic antidepressants (amitriptyline) or calcium channel inhibitors (gabapentin, pregabalin) can be considered
.
For elderly patients or with cardiovascular and cerebrovascular diseases, you can choose second-line drug therapy, such as gabapentin and pregabalin
.
At the same time, the drug dosage should be adjusted according to the patient's kidney function
.
When second-line treatment fails, consider third-line treatment, such as nerve block therapy
.
2) For moderate to severe pain, first use systemic medications: calcium channel blockers, tricyclic antidepressants
.
Consider opioid analogs when the above treatment is ineffective, and consider nerve block therapy when it is still ineffective
.
Finally, Professor Wang Yu said that although there are many treatments and drugs for PHN, PHN is still a very difficult disease
.
In the future, more advanced treatment methods and methods are still needed to achieve better treatment effects
.
Source of this article: Medical skin channel Author of this article: Zhu Zhu Review of this article: Tang Jiaoqing Editor in charge: Mr.
Lu Li The medical community strives to be accurate and reliable when it passes the review, but does not regard the timeliness of the published content and the citations The accuracy and completeness of the information (if any) are promised and guaranteed, and the content is out of date, and the cited information may be inaccurate or incomplete
.
Relevant parties are requested to check separately when adopting or using this as a basis for decision-making
.
The medical community strives for the accuracy and reliability of its published content when it is reviewed and approved, but does not make any promises or guarantees on the timeliness of the published content, and the accuracy and completeness of the cited information (if any), and it does not assume any responsibility for this.
some content is outdated, any liability of the information may be inaccurate or incomplete, etc.
caused cited
.
Relevant parties are requested to check separately when adopting or using this as a basis for decision-making
.
Contribution/Reprint/Business Cooperation: yxjsjbx@yxj.
org.
cn
PHN treatment is combined treatment and comprehensive treatment
.
Herpes zoster is an infectious skin disease caused by reactivation of varicella-zoster virus (VZV), which is latent in the posterior root ganglia or cranial ganglia of the spinal cord for a long time, and its skin lesions are distributed in clusters.
, Erythema and blisters distributed along the nerves, accompanied by obvious neuralgia
.
It is currently believed that pain is a painful experience in sensory, emotional, cognitive, and social dimensions related to potential tissue damage after tissue injury
.
At the Annual Meeting of Dermatologists of the Chinese Medical Doctor Association and the National Aesthetic Dermatology Conference (CDA 2021), Professor Wang Yu, deputy director of the Department of Dermatology, Affiliated Hospital of Guizhou Medical University, gave the title of "Comprehensive Treatment of Neuralgia After Herpes Zoster" and combined Own clinical work experience and the latest literature reports, from the classification, diagnosis, etiology, pathogenesis and treatment of herpes zoster neuralgia (PHN), etc.
, have carried out a comprehensive and detailed introduction
.
013 kinds of herpes zoster neuralgia, what is the difference in the time of appearance? Professor Wang Yu first divided herpes zoster neuralgia into three types: 1) Acute herpes zoster neuralgia, which occurs within one month after the appearance of the rash
.
2) Subacute herpes zoster neuralgia, the pain lasts for about 1 to 3 months
.
3) Neuralgia after herpes zoster: pain that still occurs more than 90 days after the occurrence of herpes zoster
.
Among them, PHN is a complex neuropathological state, because varicella-zoster infection directly leads to inflammation of the peripheral nerves, which in turn causes pain in patients
.
When it occurs in the spinal cord, the cells are attacked by viruses, triggering an inflammatory response, and eventually leading to the activation of the C-type receptor area, resulting in post-neuralgia
.
024 criteria, teach you to diagnose PHN Professor Wang Yu mentioned that the diagnosis of PHN involves the following points: 1) Pain is located in a clear neuroanatomical area
.
2) The medical history suggests that there is related damage or disease in the peripheral or central sensory system
.
3) At least one auxiliary examination confirms that the pain meets the neuroanatomical scope
.
4) At least one auxiliary examination confirmed the existence of related damage or disease
.
The judgment method is-positive neuropathic pain: meets the above 1~4 criteria; very likely neuropathic pain: meets the above 1, 2, 3, or 4 criteria; possible neuropathic pain: meets the above first 1 And 2 standards, but lack of supporting inspection evidence
.
03 These 6 major risk factors appear, be alert to the occurrence of PHN Professor Wang Yu summarized the 6 risk factors of PHN, they are: 1) Pain score: The higher the score, the greater the risk factor for PHN, especially when >6 points
.
2) The more complicated underlying diseases (such as diabetes, kidney disease, fever, hypertension, etc.
), the greater the risk of PHN
.
3) immunocompromised / immunosuppressed state: human immunodeficiency virus (HIV) infection, lymphoma (patients in the last two years), high-dose oral glucocorticoids such as a patient
.
4) The skin lesions are located on the head, face and trunk, and the risk of PHN is higher
.
5) The older the age, the higher the risk of PHN
.
6) Receiving antiviral treatment can reduce the risk and severity of PHN
.
04How to use drugs rationally to prevent PHN? Professor Wang Yu mentioned that timely and effective antiviral treatments, especially those administered within 72 hours of the appearance of the rash, can prevent PHN
.
In addition, appropriate use of corticosteroids when necessary is also helpful.
For example, for patients with trigeminal nerve involvement and a wide range of skin lesions, if contraindications are excluded, oral hormone (usually prednisone) 1 mg/kg daily for 7 days , And then gradually reduce the amount
.
At the same time, it is necessary to treat symptomatic analgesia at different levels, and choose different types of drugs according to the degree of pain of the patient
.
Patients with mild to moderate pain are treated with non-steroidal anti-inflammatory drugs; moderate to severe pain is treated with opioid analgesics
.
When the above-mentioned drugs cannot control the pain symptoms, consider using calcium channel inhibitors such as gabapentin and pregabalin or tricyclic antidepressants and hormone drugs
.
05How to grade treatment for PHN? Figure 1 The treatment of PHN (from an online speech) Professor Wang Yu pointed out that PHN treatment is a combination treatment and comprehensive treatment, and the efficacy and safety risks need to be evaluated.
At the same time, the principle is to start with a relatively small dose and gradually increase the dose
.
In addition, the purpose of treatment is to improve pain, improve sleep, and improve the quality of life
.
For the treatment of pain hierarchical principle different types: 1) first-line treatment of mild pain: topical drugs such as lidocaine patch or cream, and the like capsaicin cream
.
When first-line treatment fails, systemic application of tricyclic antidepressants (amitriptyline) or calcium channel inhibitors (gabapentin, pregabalin) can be considered
.
For elderly patients or with cardiovascular and cerebrovascular diseases, you can choose second-line drug therapy, such as gabapentin and pregabalin
.
At the same time, the drug dosage should be adjusted according to the patient's kidney function
.
When second-line treatment fails, consider third-line treatment, such as nerve block therapy
.
2) For moderate to severe pain, first use systemic medications: calcium channel blockers, tricyclic antidepressants
.
Consider opioid analogs when the above treatment is ineffective, and consider nerve block therapy when it is still ineffective
.
Finally, Professor Wang Yu said that although there are many treatments and drugs for PHN, PHN is still a very difficult disease
.
In the future, more advanced treatment methods and methods are still needed to achieve better treatment effects
.
Source of this article: Medical skin channel Author of this article: Zhu Zhu Review of this article: Tang Jiaoqing Editor in charge: Mr.
Lu Li The medical community strives to be accurate and reliable when it passes the review, but does not regard the timeliness of the published content and the citations The accuracy and completeness of the information (if any) are promised and guaranteed, and the content is out of date, and the cited information may be inaccurate or incomplete
.
Relevant parties are requested to check separately when adopting or using this as a basis for decision-making
.
The medical community strives for the accuracy and reliability of its published content when it is reviewed and approved, but does not make any promises or guarantees on the timeliness of the published content, and the accuracy and completeness of the cited information (if any), and it does not assume any responsibility for this.
some content is outdated, any liability of the information may be inaccurate or incomplete, etc.
caused cited
.
Relevant parties are requested to check separately when adopting or using this as a basis for decision-making
.
Contribution/Reprint/Business Cooperation: yxjsjbx@yxj.
org.
cn
