Lim Delwyn Zhi Jie, Tey Hong Liang, Salada Brenda Mae Alferez, Oon Jolene Ee Ling, Seah Ee-Jin Darren, Chandran Nisha Suyien, Pan Jiun Yit
National Skin Centre, Singapore 308205, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 637371, Singapore.
Pathogens. 2024 Jul 17;13(7):596. doi: 10.3390/pathogens13070596.
Herpes zoster is caused by the reactivation of latent varicella infection within the sensory ganglia, caused by the varicella-zoster virus (VZV). The disease is classically characterized by a painful unilateral vesicular eruption. Complications of the disease include herpes zoster ophthalmicus, Ramsay Hunt syndrome, acute retinal necrosis, and post-herpetic neuralgia. In this paper, we discuss the epidemiology, pathogenesis, clinical features, diagnosis, management, and vaccination strategies of herpes zoster and post-herpetic neuralgia.
This paper was developed with input from specialists from Singapore's public sectors-dermatologists, family physicians, and infectious diseases specialists.
The diagnosis of herpes zoster is clinical and can be aided with laboratory investigations. Early initiation of antivirals, within 72 h of onset, can reduce the severity and duration of the condition and decrease the intensity of pain. In patients with a high risk of post-herpetic neuralgia, early initiation of anticonvulsants or tricyclic antidepressants can be considered. Herpes zoster is highly preventable, with the advent of the recombinant zoster vaccine (RZV) providing an overall vaccine efficacy of 97.2%. Procedures such as epidural blocks and subcutaneous or intracutaneous injections of local anesthetics and steroids can be considered for patients with a high risk of post-herpetic neuralgia to reduce its incidence.
This article serves as a guideline for clinicians in the diagnosis, investigations, management, and prevention of herpes zoster. With the majority of adults in Singapore currently at risk of developing herpes zoster due to varicella immunization being only introduced in 2020, it is important for clinicians to recognize and manage herpes zoster appropriately.
带状疱疹是由水痘-带状疱疹病毒（VZV）引起的感觉神经节内潜伏性水痘感染重新激活所致。该病的典型特征是单侧疼痛性水疱疹。其并发症包括眼部带状疱疹、拉姆齐·亨特综合征、急性视网膜坏死和带状疱疹后神经痛。在本文中，我们讨论了带状疱疹和带状疱疹后神经痛的流行病学、发病机制、临床特征、诊断、管理及疫苗接种策略。
本文是在新加坡公共部门的专家——皮肤科医生、家庭医生和传染病专家的参与下撰写的。
带状疱疹的诊断依靠临床判断，实验室检查可辅助诊断。在发病72小时内尽早开始使用抗病毒药物，可减轻病情的严重程度和持续时间，并减轻疼痛强度。对于有带状疱疹后神经痛高风险的患者，可考虑尽早开始使用抗惊厥药或三环类抗抑郁药。随着重组带状疱疹疫苗（RZV）的出现，带状疱疹具有高度可预防性，其总体疫苗效力为97.2%。对于有带状疱疹后神经痛高风险的患者，可考虑采用硬膜外阻滞以及局部麻醉药和类固醇的皮下或皮内注射等方法来降低其发病率。
本文为临床医生诊断、检查、管理和预防带状疱疹提供了指导方针。由于新加坡大多数成年人目前因2020年才开始接种水痘疫苗而有患带状疱疹的风险，临床医生正确识别和管理带状疱疹非常重要。
