Stankus S J, Dlugopolski M, Packer D
Eisenhower Army Medical Center, Fort Gordon, Georgia 30905, USA.
Am Fam Physician. 2000 Apr 15;61(8):2437-44, 2447-8.
Herpes zoster (commonly referred to as "shingles") and postherpetic neuralgia result from reactivation of the varicella-zoster virus acquired during the primary varicella infection, or chickenpox. Whereas varicella is generally a disease of childhood, herpes zoster and post-herpetic neuralgia become more common with increasing age. Factors that decrease immune function, such as human immunodeficiency virus infection, chemotherapy, malignancies and chronic corticosteroid use, may also increase the risk of developing herpes zoster. Reactivation of latent varicella-zoster virus from dorsal root ganglia is responsible for the classic dermatomal rash and pain that occur with herpes zoster. Burning pain typically precedes the rash by several days and can persist for several months after the rash resolves. With postherpetic neuralgia, a complication of herpes zoster, pain may persist well after resolution of the rash and can be highly debilitating. Herpes zoster is usually treated with orally administered acyclovir. Other antiviral medications include famciclovir and valacyclovir. The antiviral medications are most effective when started within 72 hours after the onset of the rash. The addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia. Ocular involvement in herpes zoster can lead to rare but serious complications and generally merits referral to an ophthalmologist. Patients with postherpetic neuralgia may require narcotics for adequate pain control. Tricyclic antidepressants or anticonvulsants, often given in low dosages, may help to control neuropathic pain. Capsaicin, lidocaine patches and nerve blocks can also be used in selected patients.
带状疱疹（通常称为“缠腰龙”）和带状疱疹后神经痛是由初次感染水痘（即水痘 - 带状疱疹病毒感染）时获得的水痘 - 带状疱疹病毒再激活引起的。水痘一般是儿童期疾病，而带状疱疹和带状疱疹后神经痛的发病率随年龄增长而增加。降低免疫功能的因素，如人类免疫缺陷病毒感染、化疗、恶性肿瘤和长期使用糖皮质激素，也可能增加患带状疱疹的风险。潜伏在背根神经节的水痘 - 带状疱疹病毒再激活是带状疱疹出现典型的皮节皮疹和疼痛的原因。灼痛通常在皮疹出现前几天出现，并可在皮疹消退后持续数月。带状疱疹后神经痛是带状疱疹的一种并发症，皮疹消退后疼痛可能会持续很长时间，且会使人极度虚弱。带状疱疹通常用口服阿昔洛韦治疗。其他抗病毒药物包括泛昔洛韦和伐昔洛韦。抗病毒药物在皮疹出现后72小时内开始使用时最为有效。加用口服糖皮质激素在减轻带状疱疹疼痛和降低带状疱疹后神经痛发病率方面可能有一定益处。眼部带状疱疹可导致罕见但严重的并发症，通常需要转诊给眼科医生。带状疱疹后神经痛患者可能需要使用麻醉药品来充分控制疼痛。三环类抗抑郁药或抗惊厥药，通常低剂量使用，可能有助于控制神经性疼痛。辣椒素、利多卡因贴剂和神经阻滞也可用于特定患者。
