대상포진 수막뇌염의 역학 및 임상 양상

김종규 ( Jong Kyu Kim ),이예선 ( Yea Son Lee ),나찬호 ( Chan Ho Na ),김민성 ( Min Sung Kim ),신봉석 ( Bong Seok Shin ) 대한피부과학회 2016 大韓皮膚科學會誌 Vol.54 No.10

Background: Many studies about herpes zoster are available in Korean dermatological literature. However, only a few of them reported herpes zoster meningoencephalitis. Objective: The aim of this study was to determine the epidemiology and clinical features of herpes-zoster meningoencephalitis compared with herpes zoster without meningoencephalitis. Methods: We examined the medical records of 3,154 patients with herpes zoster, who had visited our hospital from January 2008 to March 2016. Among them, 159 patients underwent cerebrospinal fluid analysis. Fifty-one patients who were diagnosed with herpes zoster meningoencephalitis and the 3,103 patients who were without meningoencephalitis were subjected to examinations to assess the incidence rates, the age distribution, the ganglion distribution, severity of acute pain, postherpetic neuralgia, serum VZV IgM and IgG, the clinical aspects, the underlying diseases, and the presence of complications. Results: The rate of herpes zoster meningoencephalitis was 1.61%, with a mean age of 53.95 years, and the female-to-male patient ratio was 1.68. The trigeminal nerve was the most frequently involved dermatome (53.7%), with the ophthalmic branch (V1) involved at a rate of 68.96% among them. The serum VZV IgM was significantly higher in herpes zoster meningoencephalitis compared with herpes zoster without meningoencephalitis. Dizziness, mental change, palsy, and myalgia with nausea/vomiting showed high predictive values. All the patients were treated with acyclovir for 10∼14 days, and 1 of them expired (1.96%). Conclusion: The results of this study demonstrated that herpes-zoster meningoencephalitis was associated with high serum levels of VZV IgM compared with herpes zoster without meningoencephalitis. When a patient with herpes zoster has symptoms of headache and nausea/vomiting with dizziness, mental status change, palsy, or myalgia, herpes-zoster meningoencephalitis should be considered. (Korean J Dermatol 2016;54(10):788∼795)

파종 대상포진의 역학 및 임상양상

김효진 ( Hyojin Kim ),강정난 ( Jeong Nan Kang ),설정은 ( Jeong Nan Kang ),서종근 ( Jong Keun Seo ),성호석 ( Ho Suk Sung ) 대한피부과학회 2013 대한피부과학회지 Vol.51 No.7

Background: There have been several studies about herpes zoster in the Korean dermatological literatures. However, there are few studies reported on disseminated herpes zoster. Objective: The aim of this study is to determine the epidemiology and clinical features of the disseminated herpes zoster as compared with herpes zoster. Methods: The authors retrospectively reviewed the medical records on 14 cases of disseminated herpes zoster and 402 cases of herpes zoster at the Department of Dermatology Busan Paik hospital during the 3 years from 2010 to 2012, and if necessary, telephone interviews were executed. Results: The rate of new disseminated herpes zoster outpatients at our dermatology clinic was 0.11% with the mean age of 67.7 years and the males to females ratio was 2.5. The most frequent involved dermatome was the lumbar (42.9%) area. The rate of patients with underlying diseases or immunosuppression, the rates of postherpetic neuralgia and the frequency of narcotic analgesics uses were significantly higher in disseminated herpes zoster as compared with herpes zoster. The patient treatment satisfaction was significantly higher in herpes zoster as compared with disseminated herpes zoster. Conclusion: These results demonstrated that the disseminated herpes zoster is associated with higher rates of underlying diseases, immunosuppression, frequent incidences of postherpetic neuralgia, more uses of narcotic analgesics and lower patient treatment satisfactions as compared with herpes zoster. (Korean J Dermatol 2013; 51(7):507∼512)

대상포진과 대상포진 수막염의 임상 및 혈청학적 검사에 대한 비교 분석

나찬호 ( Chan Ho Na ),정병훈 ( Byung Hoon Jeong ),김민성 ( Min Sung Kim ),신봉석 ( Bong Seok Shin ),최훈 ( Hoon Choi ) 대한피부과학회 2023 대한피부과학회지 Vol.61 No.10

Background: Herpes zoster is a viral infection caused by reactivation of the varicella-zoster virus (VZV). VZV can also cause infection of the central nervous system, such as meningitis. There are relatively few studies investigating the clinical features and serological findings differentiating herpes zoster and zoster meningitis. Objective: To compare clinical features and serological findings of zoster meningitis and herpes zoster without meningitis. Methods: We retrospectively analyzed the medical records of 473 patients with herpes zoster or zoster meningitis admitted in our hospital between May 2017 to June 2022. We investigated the patients’ underlying comorbidities, clinical features and laboratory findings including fever, headache, nausea/vomiting, dizziness, meningeal irritation sign, dermatomal distribution, skin inflammation severity, initial pain numeric rating scale (NRS) at the initial visit, serum VZV immunoglobulin M (IgM) and G (IgG) titer, serum VZV polymerase chain reaction (PCR) and cerebrospinal fluid (CSF) analysis. Results: Overall, 410 patients with herpes zoster and 63 patients with zoster meningitis were included. No significant differences in age, serum VZV IgM, VZV PCR and skin inflammation severity were found between groups. Initial pain NRS was higher significantly in zoster meningitis group (herpes zoster group: 4.8±2.1, zoster meningitis group: 5.7±2.2) (p=0.003) and mean VZV IgG was lower in zoster meningitis group (herpes zoster group: 2,506±1,345.8, zoster meningitis group: 1,712±1,796.3 mIU/mL) (p=0.028). Conclusion: No typical symptoms of meningitis are found in case of trigeminal nerve involvement. Moreover, if there is severe initial pain or low levels of serum VZV IgG are detected, further evaluations such as CSF tapping may be necessary to differentiate zoster meningitis from herpes zoster. (Korean J Dermatol 2023;61(10):612∼619)

안면부 대상포진에 대한 15년간의 후향적 연구: 단일 기관에서의 경험

서중헌 ( Joong Heon Suh ),이수경 ( Soo Kyung Lee ),이운하 ( Un Ha Lee ),김명신 ( Myoung Shin Kim ) 대한피부과학회 2019 大韓皮膚科學會誌 Vol.57 No.5

Background: Many studies about herpes zoster exist in the Korean dermatologic literature. However, few studies have reported about facial herpes zoster and its complications. Objective: The purpose of this study was to investigate the epidemiology, clinical features, and complications of facial herpes zoster. Methods: We analyzed the medical records of 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized patients into 8 groups based on the dermatomal distribution of herpetic lesions. We investigated the correlations between clinical features, prognosis, and complications. Results: The most common site of involvement of facial herpes zoster was the ophthalmic branch of the trigeminal nerve (59.2%). Herpes zoster involving the ophthalmic and the maxillary branches of the trigeminal nerves showed a significantly higher incidence rate of herpes zoster ophthalmicus than that observed with herpes zoster involving only the ophthalmic branch (odds ratio 7.373). Age and periorbital swelling were significantly correlated with herpes zoster ophthalmicus (p<0.001). Facial palsy was significantly correlated with otalgia and cutaneous ear involvement (p<0.001). Postherpetic neuralgia (PHN) occurred in 41% of patients with facial herpes zoster. Patients who received antiviral treatment within 3 days showed lower rates of PHN (35.8%) than patients who received treatment after 4 days (45.4%) (p=0.002). Conclusion: Facial herpes zoster is associated with several neurological complications. Variables including age, periorbital swelling, otalgia, and cutaneous ear involvement are useful predictors of complications and prognosis. Early institution of antiviral treatment and appropriate interdepartmental consultations are required for better treatment outcomes. (Korean J Dermatol 2019;57(5):235∼242)

수두와 대상포진 환자에서 수두대상포진 바이러스에 대한 혈청 내 면역글로불린 M, G의 임상적 의의

김영균 ( Young Gyun Kim ),백준오 ( Jun Oh Paek ),김정수 ( Joung Soo Kim ),유희준 ( Hee Joon Yu ) 대한피부과학회 2015 대한피부과학회지 Vol.53 No.6

Background: The presence of serum varicella zoster virus (VZV) immunoglobulin M and G (IgM and IgG) aid diagnosis of and confirmation of immunization against varicella and herpes zoster. However, the relationship between serum VZV IgM and IgG and the clinical characteristics of VZV infection remains unclear. Objective: We evaluated quantitative changes in serum VZV IgM and IgG in accordance with the clinical features of varicella, herpes zoster, and disseminated herpes zoster compared with a normal control group. Methods: A total of 922 patients were classified into 3 groups: varicella, herpes zoster, and disseminated herpes zoster. We assessed serum VZV IgM and IgG titers in association with age, severity of skin lesions, duration of skin lesions, immune status, and neurologic complications. Results: In patients with varicella and herpes zoster, serum antibody titer varied significantly depending on age and the duration of skin lesions. A high serum VZV IgM titer was related to varicella or disseminated herpes zoster viremia. In herpes zoster, elevated antibody titers, especially VZV IgM, were associated with severe skin lesions and the presence of neurologic complications. Conclusion: Serologic data for varicella and herpes zoster varied according to clinical features. A high serum VZV IgM titer was associated with an unfavorable clinical course of herpes zoster. (Korean J Dermatol 2015;53(6):441∼ 448)

대상포진 수막뇌염의 임상적 고찰

변지원 ( Ji Won Byun ),송희진 ( Hee Jin Song ),최광성 ( Gwang Seong Choi ),신정현 ( Jeong Hyun Shin ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.4

Background: Herpes zoster meningoencephalitis is a rare neurological complication and the known risk factors include an immunocompromised status, infiltration into the trigeminal ganglion, disseminated herpes zoster and elderly patients. Serious complications may develop, including cerebral hemorrhage. Objective: As early diagnostic detection is mandatory to prevent long-term sequelae, we wanted to determine what signs and symptoms we should focus on for diagnosing zoster meningoencephalitis at an early stage. We also investigated the descriptive statistics of the patients and compared them with the patients who had non-complicated herpes zoster. Methods: We examined the medical records of 5114 herpes zoster patients who had visited our clinic from 1996 through 2009. Among them, 18 patients who were diagnosed with herpes zoster meningoencephalitis by cerebrospinal fluid tests were subject to examinations to assess the incidence rates, the age distribution, the ganglion distribution, the clinical aspects, the underlying diseases and the presence of complications. Results: The ages of the patients with herpes zoster meningoencephalitis showed that 50% of the patients were under 30 years old. Infiltration into the trigeminal ganglion and immunocompromising underlying diseases accounted for 50% and 16.7% of the total patients, respectively. In the case of disseminated herpes zoster patients, no meningoencephalitis developed. The rates of neck stiffness and fever, which are the most common symptoms of meningoencephalitis, were lower in the patients with herpes zoster meningoencephalitis (33.3% and 11.1%, respectively). However, headaches accompanied with nausea or vomiting showed high sensitivity (88.9%), and a high positive predictive value (69.6%) (p<0.001). All the patients were treated with acyclovir for 10∼14 days, and cerebral hemorrhage occurred in 1 of them (5.5%) after treatment. Conclusion: When a patient with herpes zoster has symptoms of headache and nausea or vomiting then herpes zoster meningoencephalitis should be considered even if neck stiffness and fever are not present. (Korean J Dermatol 2011;49(4):328∼333)

대상포진의 임상적 고찰과 Acyclovir 치료

이하린 ( Ha Rin Lee ),이민재 ( Min Jae Lee ),함정희 ( Jeong Hee Hahm ) 대한피부과학회 1995 대한피부과학회지 Vol.33 No.4

Background : Herpes zoster is an acute localized infection caused by varicella-zoster virus and characterized by unilateral pain and vesicular eruptions along the sensory dermatomes. Objective : The purpoe of this study was to elucidate the clinical features of herpes zoster and estimate the current theeap utic effect of Aeyclovir on herpes zoster. Method : We studied 517 cases of herpes zoster by retrospective method comparing annual incidence, age and monthly vacations, predilection site, associated conditions, complication and disease progress according toicylovir treatmentat at the department of dermatology, Ewha Womans University Hospital over 4 years(1990-1993). Results : 1. The average annual incidence during the 4 years was 0.2%, being on the increase recently. There was no significant, mannual, seasonal and monthly variation and the majority of cases occurred mast frequently were the fifth decade. 2. The dermatomal involvement of herpes zoster were most frequently on the thoracic dermatome (54.7%), followed by cervical, ophthalmic branch of trigeminal nerve, lumbar, sacral, maxillary branch of trigeminal nerve and mandibular branch of trigeminal nerve. The frequencies of associ ated conditions in herpcsioster, in descending order, were diabetes mellitus, hypertension, infectious disease, gastritis urgastric ulcer, malignant neoplasm, cardiovascular disease and postoperative condition. 3. The duration of treatment in herpes zoster was 3.8 weeks and significantly shortened in acyclovir-using group(p<0.05). The duration of treatment was significantly prolonged in associated disease (p <0.01). 4. Postherpetic neuralgil was the most common complication(11.2%), followed by ophthalmic complications, varicelliform erptions, secondary bacterial infections, meningoencephalitis, recurrent herpes zoster, keloid fomation, urinary retention, ptosis and hypopigmentation. Postherpetic neu ralgia increased with age and was observed most frequently in the ophthalmic branch of trigerninal nerve. Conclusion . The annwal incidence of herpes zoster shows a tendency to increase recently but there was no significant monthly or seasonal variation. The most common anatomical distribution was on the thoracic dematome. Herpes zoster was commonly associated with systemic disorders and the treatment durat,ion was prolonged in associated diseases. Acyclovir has a significant effect in shortening the treatment duration. Postherpetic neuralgia was the most common complication of herpes zoster and was observed most frequently in the ophthalmic branch of trigeminal nerve. (Kor J Dermatol 1995;33(4): 661-668)

Clinical Diagnosis of Herpes Zoster Presenting as Odontogenic Pain

Yang, Seong-Hak,Jung, Dong-Ho,Lee, Hae-Doo,Lee, Yoon,Chang, Hoon-Sang,Min, Kyung-San 大韓齒科保存學會 2008 Restorative Dentistry & Endodontics Vol.33 No.5

Herpes zoster는 varicella zoster 바이러스에 의해 발생하는 급성 바이러스성 감염질환으로 삼차신경의 분지들을 침범할 수 있다. 치성동통과 유사한 증상을 보이는 43세 남자 환자가 내원하였으며 임상 및 방사선 검사 후에도 명확한 원인 발견할 수 없었다. 피부과의사에 의해 삼차신경의 세 번째 분지에 발생한 herpes zoster로 진단되었고 항바이러스 치료를 시행하였다. 2개월 뒤,환자의 피부 병소 및 동통은 대부분 사라졌으나 반흔조직은 다소 남아있었다. 진단과정 중 임상가는 구강안면부 동통이 herpes zoster와 연관될 수 있다는 가능성을 숙지하여야 할 것이다. Herpes zoster, an acute viral infection produced by the varicella zoster virus, may affect any of the trigeminal branches. This case report presents a patient with symptoms mimicking odontogenic pain. No obvious cause of the symptoms could be found based on clinical and radiographic examinations. After a dermatologist made a diagnosis of herpes zoster involving the third trigeminal branch, the patient was given antiviral therapy. Two months later, the facial lesions and pain had almost disappeared, and residual pigmented scars were present. During the diagnostic process, clinicians should keep in mind the possibility that orofacial pain might be related to herpes zoster.

Frequency of Herpes Zoster Recurrence in Central District of Korea

( Jae Won Ha ),( Jin Yong Lee ),( Young Her ),( Chul Woo Kim ),( Sang Seok Kim ) 대한피부과학회 2017 Annals of Dermatology Vol.29 No.5

Background: Herpes zoster is characterized by unilateral grouped vesicles along the distribution of a dermatome. A global recurrence rate as low as 0.5%∼6.2% has been reported for herpes zoster. The recurrence of herpes zoster is higher in immunocompromised patients and older patients. Objective: The purpose of this study is to assess the frequency of herpes zoster recurrence and factors that can influence its recurrence. Methods: From January 2005 to December 2015, 14,343 patients with herpes zoster were enrolled in this study. The patients were diagnosed at Hallym University Medical Centers and Kangwon National University Hospital in Seoul, Gyeonggi, and Gangwon. Herpes zoster recurrence and patient characteristics were surveyed by medical record review and a telephonic survey. Results: The overall frequency of herpes zoster recurrence was 1.18%. The frequency of recurrence was higher in women than in men. It was also higher in patients aged 50∼70 years than in patients who were younger or older than this. Additionally, we assessed that the frequency of recurrence was statistically higher in patients with a compromised immune system and in patients who experienced longer lasting pain during their first episode. Conclusion: The frequency of herpes zoster recurrence is more common in women, older age, patient with longer pain duration and immunocompromised patients. (Ann Dermatol 29(5) 602∼607, 2017)

대상포진에 대한 임상적 연구: 대상포진에서 나타나는 가려움증의 임상적 특징을 중심으로

노태우 ( Tae Woo Noh ),박혜진 ( Hai Jin Park ),김성현 ( Seong Hyun Kim ),강유석 ( Yoo Seok Kang ),이운하 ( Un Ha Lee ),박현수 ( Hyun Su Park ) 대한피부과학회 2012 대한피부과학회지 Vol.50 No.7

Background: Herpes zoster is a common dermatologic disorder. However, there have been no reported studies of the characteristics of pruritus in herpes zoster in Korean literature. Objective: The purpose of this study is to investigate the epidemiological features and clinical characteristics of pruritus in herpes zoster. Methods: Retrospective study was performed by reviewing the medical records of 178 patients with herpes zoster. The analyses of age, gender, accompanying symptoms, dermatomal distribution, underlying disease, treatment and complication were performed. Results: The ratio of male to female patients was 2:3. The age distribution ranged from 1 to 87 years old. A total of 76.4% of the patients with herpes zoster experienced pruritus, and 18.4% of the patient with pruritus had pruritus that disrupted normal activities. There were no relationships between the incidence of pruritus and age of patients, gender, dermatomal distribution, and incidence of pain. As the severity of pain increased, the incidence and the severity of pruritus increased (p=0.01, p=0.01). Pruritus was improved within 3 weeks in the 74.3% of the patients with pruritus; however, 9.6% of the patients felt complaint with pruritus over 6 weeks. The duration of the pruritus extended with advancing age (p=0.01). As the severity of pruritus and pain increased, the duration of pruritus increased (p=0.025). Conclusion: Pruritus is a common symptom in herpes zoster, and this study describes the general aspects of pruritus in herpes zoster. Advancing age and the severity of the pruritus and the pain are possible risk factors of long-lasting pruritus. (Korean J Dermatol 2012;50(7):591∼598)