Jalali Mir Hadi Aziz, Ansarin Habib, Soltani-Arabshahi Razieh
Department of Dermatology, Hazrat-e Rasool University Hospital, Iran University of Medical Sciences, Tehran, Iran.
Photodermatol Photoimmunol Photomed. 2006 Oct;22(5):232-7. doi: 10.1111/j.1600-0781.2006.00236.x.
Postherpetic neuralgia (PHN) is one of the common complications of herpes zoster infection, particularly in the elderly. Current therapeutic measures are only partially effective in the affected patients. As inflammatory mediators released by different cells play an important role in the pathogenesis of this neuropathic pain and with regard to the immunomodulatory effects of ultraviolet B (UVB) spectrum, we presumed that UVB phototherapy might be effective in the prevention of PHN.
This study was performed in two phases. Phase I was a prospective open controlled trial. Twenty-five patients with severe pain in the first 7 days of zoster rash were divided into two groups: the prevention group (n=12) received oral acyclovir (800 mg five times a day for 10 days) plus broad-band UVB to the affected dermatomes, starting with 20 mJ/cm(2) and gradually increasing the dose by 10 mJ/cm(2) each session to a maximum dose of 100 mJ/cm(2). Treatment sessions were repeated three times a week until pain relief or to a maximum of 15 sessions. The control group (n=13), who had disease characteristics similar to the prevention group, received only oral acyclovir with the same dose. All patients reported their severity of pain on a verbal rating scale (VRS, score 0-4) before treatment and at 1 and 3 months' follow-up. In phase II of the study, five patients with established PHN (more than 3 months after rash onset) received UVB with the above-mentioned protocol.
A total of 17 patients older than 40 (10 females, seven males; mean age, 65.5 years; range: 47-82 years) who had intractable pain due to zoster infection received UVB in two phases of the study. In patients who received phototherapy in the first 7 days of rash, 58.33% and 83.33% were completely pain free at 1-and 3-month follow-up, respectively. The corresponding figure in the control group was significantly lower (38.46% at 1 month and 53.85% at 3 months). The severity of pain was also lower in the phototherapy group than the control group (mean VRS 2.50 vs. 3.28 at 3 months). None of the patients who were treated more than 3 months after rash onset (established PHN) experienced significant (more than 50%) pain relief.
UVB phototherapy in the acute stage of zoster rash might reduce the incidence and severity of PHN. Treatment after 3 months does not seem to have a significant beneficial effect.
带状疱疹后神经痛（PHN）是带状疱疹感染的常见并发症之一，在老年人中尤为常见。目前的治疗措施对受影响的患者仅部分有效。由于不同细胞释放的炎症介质在这种神经性疼痛的发病机制中起重要作用，并且考虑到紫外线B（UVB）光谱的免疫调节作用，我们推测UVB光疗可能对预防PHN有效。
本研究分两个阶段进行。第一阶段是一项前瞻性开放对照试验。25例在带状疱疹皮疹出现的前7天有严重疼痛的患者被分为两组：预防组（n = 12）接受口服阿昔洛韦（800mg，每日5次，共10天）加对受影响皮节进行宽带UVB照射，起始剂量为20mJ/cm²，每次逐渐增加剂量10mJ/cm²，最大剂量为100mJ/cm²。每周重复治疗3次，直至疼痛缓解或最多治疗15次。对照组（n = 13），其疾病特征与预防组相似，仅接受相同剂量的口服阿昔洛韦。所有患者在治疗前以及随访1个月和3个月时用视觉模拟评分法（VRS，评分0 - 4）报告疼痛严重程度。在研究的第二阶段，5例已确诊为PHN（皮疹出现后超过3个月）的患者按照上述方案接受UVB治疗。
共有17例年龄超过40岁（10例女性，7例男性；平均年龄65.5岁；范围：47 - 82岁）因带状疱疹感染而患有顽固性疼痛的患者在研究的两个阶段接受了UVB治疗。在皮疹出现的前7天接受光疗的患者中，分别有58.33%和83.33%在随访1个月和3个月时完全无痛。对照组的相应数字明显较低（1个月时为38.46%，3个月时为53.85%）。光疗组的疼痛严重程度也低于对照组（3个月时平均VRS为2.50，而对照组为3.28）。在皮疹出现后超过3个月接受治疗（已确诊为PHN）的患者中，没有一例疼痛缓解超过50%。
带状疱疹皮疹急性期的UVB光疗可能降低PHN的发生率和严重程度。皮疹出现3个月后进行治疗似乎没有显著的有益效果。
