Goh C L, Khoo L
Institute of Dermatology, National Skin Center, Singapore.
Int J Dermatol. 1997 Sep;36(9):667-72. doi: 10.1046/j.1365-4362.1997.00241.x.
This is a retrospective study of the epidemiology and morbidity of herpes zoster and the risk factors for herpes zoster morbidity in Singapore.
The mean age of 164 patients with herpes zoster seen at our dermatology clinic between January 1994 and December 1995 was 48.8 years, with a sex ratio of 1:1. The common presenting symptoms were pain (90%), feelings of helplessness and depression (20%), and flu-like symptoms (12%). The commonest prodromes were pain (41%), itching (27%), and paresthesia (12%). Prodromal pain was more frequently experienced by patients aged more than 50 years (42%) than by patients aged less than 30 years (25%). The thoracic (45%) and cervical (23%) dermatomes were the most commonly affected in all age groups. There was no statistically significant difference in the frequency of dermatomal distribution among the different age groups and between the sexes. Pain was experienced by almost all (95%) patients during the course of their disease. It tended to be more severe in older patients. Burning (26%), stabbing (15%), and shooting (15%) pain were the most common types experienced. Post-herpetic neuralgia was significantly more common in older patients. The prevalence of post-herpetic neuralgia decreased over time in all age groups. A higher proportion of older patients (more than 50 years of age) (20%) suffered from post-herpetic neuralgia compared with younger patients (less than 30 years of age) (7%) (not significant). Patients in all age groups considered acute pain (46%) and persistent pain (25%) to be their most unbearable symptoms during the course of herpes zoster. The most significant problems caused by herpes zoster pain were insomnia (25%), misery (feeling helpless and depressed) (20%), limitation of movement (9%), and inability to continue work (8%). Insomnia was significantly more commonly experienced by patients more than 50 years of age (36%) than those less than 30 years of age (P = 0.026). Few patients (9%) consulted their general practitioner (GP) during the prodrome or on the day of appearance of skin eruptions. Most patients (45%) consulted their GP within the first 3 days of the onset of skin eruptions; 33% sought treatment more than 3 days after the appearance of zoster symptoms. Only 30% of patients were willing to pay more than S$200 for antiviral therapy. Most (43%) were only prepared to pay for antiviral treatment if it cost less than S$200. The most important features the patients wished to derive from antiviral therapy were a shortening of the duration of skin lesions (55%) and a reduction in the severity of pain (acute and chronic) (30%).
Our study indicated that older patients (aged more than 50 years) were at a higher risk of developing post-herpetic neuralgia. They were also more likely to suffer morbidity, e.g. insomnia. There is a need to educate patients at risk to identify the prodrome and skin eruptions of herpes zoster so that early antiviral therapy can be considered.
这是一项关于新加坡带状疱疹的流行病学、发病率及带状疱疹发病风险因素的回顾性研究。
1994年1月至1995年12月期间在我们皮肤科诊所就诊的164例带状疱疹患者的平均年龄为48.8岁，男女比例为1:1。常见的临床表现为疼痛（90%）、无助感和抑郁（20%）以及流感样症状（12%）。最常见的前驱症状为疼痛（41%）、瘙痒（27%）和感觉异常（12%）。50岁以上患者（42%）比30岁以下患者（25%）更常出现前驱疼痛。所有年龄组中，胸段（45%）和颈段（23%）皮节最常受累。不同年龄组和性别之间皮节分布频率无统计学显著差异。几乎所有（95%）患者在病程中都经历过疼痛。老年患者的疼痛往往更严重。灼痛（26%）、刺痛（15%）和射痛（15%）是最常见的疼痛类型。带状疱疹后神经痛在老年患者中明显更常见。所有年龄组中，带状疱疹后神经痛的患病率随时间下降。与年轻患者（30岁以下）（7%）相比，老年患者（50岁以上）（20%）患带状疱疹后神经痛的比例更高（无显著性差异）。所有年龄组的患者都认为急性疼痛（46%）和持续性疼痛（25%）是带状疱疹病程中最难以忍受的症状。带状疱疹疼痛引起的最严重问题是失眠（25%）、痛苦（无助感和抑郁）（20%）、活动受限（9%）和无法继续工作（8%）。50岁以上患者（36%）比30岁以下患者更常出现失眠（P = 0.026）。很少有患者（9%）在前驱期或皮疹出现当天咨询全科医生（GP）。大多数患者（45%）在皮疹出现后的前3天内咨询全科医生；33%的患者在带状疱疹症状出现3天后才寻求治疗。只有30%的患者愿意支付超过200新元用于抗病毒治疗。大多数（43%）患者仅愿意在抗病毒治疗费用低于200新元时支付费用。患者希望从抗病毒治疗中获得的最重要特征是缩短皮损持续时间（55%）和减轻疼痛严重程度（急性和慢性）（30%）。
我们的研究表明，老年患者（50岁以上）发生带状疱疹后神经痛的风险更高。他们也更有可能出现如失眠等发病情况。有必要对有风险的患者进行教育，使其能够识别带状疱疹的前驱症状和皮疹，以便考虑早期抗病毒治疗。
