[Acquired reactive perforating collagenosis following herpes zoster as isotopic response?]. / Erworbene reaktive perforierende Kollagenose nach Herpes zoster als isotopische Antwort?

Reactive perforating collagenosis is a disease whose pathogenesis is still not fully understood. Histological findings are degenerated collagen bundles which are arranged in vertical direction penetrating the epidermis into a dome-shaped crater. Usually diabetes mellitus and renal failure can be found among patients with reactive perforating collagenosis. To date, there have been five cases described where the eruption of reactive perforating collagenosis followed herpes zoster infection. This could be a form of Wolf's isotopic response, a term that is used for dermatoses which arise after the healing of a preexisting dermatosis. We report the sixth case of a herpes zoster-associated reactive perforating collagenosis and discuss the current literature.

[Pricking blood therapy combined with ultraviolet irradiation for treatment of acute herpes zoster].

OBJECTIVE: To evaluate clinical therapeutic effect and the safety of pricking blood therapy combined with ultraviolet irradiation for treatment of acute herpes zoster. METHODS: One hundred and thirty cases were randomly divided into an observation group and a control group, 65 cases in each group. The observation group was treated with pricking blood therapy combined with ultraviolet irradiation. Firstly, the affected parts were heavily taped with a plum-blossom needle and then cupping. After the cup was removed, with the body surface-dividing field method, ultraviolet irradiation was given at the skin injury area and the nerve root area corresponding to paraspinal vertebra, and the control group was treated with Aciclovir and other western medicine. Seven days constituted one course. Their therapeutic effects and adverse reactions were observed. RESULTS: After treatment of 7 days, the cured rate of 76.9% and the total effective rate of 90.8% in the observation group were significantly higher than 38.5% and 66.2% in the control group, respectively (both P < 0.01); the incidence rate of post herpetic neuralgia of 3.1% in the observation group was significantly lower than 12.3% in the control group (P < 0.05); after treatment, the scores for pain, rash and sleep decreased significantly in the two groups (all P < 0.01), more significantly decreased in the observation group than in the control group (P < 0.01 or P < 0.05); the pain-relieving time, herpes-stopping time, scab-forming time and the cured time in the cured patients of the observation group were significantly shorter than those in the control group (P < 0.01 or P < 0.05). CONCLUSION: The pricking blood therapy combined with ultraviolet irradiation has rapid therapeutic effect, effectively shortens duration of illness, decreases the incidence rate of post herpetic neuralgia and it is a safe remedy for treatment of herpes zoster.

Broad-band ultraviolet B phototherapy in zoster patients may reduce the incidence and severity of postherpetic neuralgia.

BACKGROUND: 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. METHOD: 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. RESULTS: 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. CONCLUSION: 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.

Treatment of trigeminal and thoracic zoster with idoxuridine.

A double-blind random selection comparison was made of the therapeutic effects in acute herpes zoster of 40% idoxuridine (IDU) dissolved in dimethyl sulphoxide (DMSO) compared with DMSO and saline flavoured with garlic. Thoracic (80 patients) and trigeminal (42 patients) zoster were investigated separately. The patients were evaluated daily until skin healing and then at 1, 3 and 6 months by registering pain, paraesthesia and sensitivity disturbances as well as by clinical and photographic evaluation of the skin lesions. Duration of pain was positively correlated to age, to delayed healing and to elevated temperature in the acute phase of zoster. The period of pain before skin eruption was considerably longer in thoracic than in trigeminal zoster, while the latter was associated with a more severe inflammatory reaction, more neurologic sequelae, but also by a faster healing of the skin lesions. IDU was highly effective in shortening the period of pain and improving skin healing in trigeminal zoster, while no effect of IDU was observed in thoracic zoster. The reason for this difference is presently not understood.