Severity of skin lesions of herpes zoster at the worst phase rather than age and involved region most influences the duration of acute herpetic pain

Higa, Kazuo; Mori, Mayumi; Hirata, Kazuhiko; Hori, Koichiro; Manabe, Haruhiko; Dan, Kenjiro

doi:10.1016/s0304-3959(96)03229-0

Cited by 36 publications

(22 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Pain is more frequent and severe in older patients and can have devastating impacts; patients feel anxious and miserable, have disturbed sleep and cannot work normally or enjoy life [10, 12, 15, 18, 20, 25, 30]. Besides age, the severity and duration of acute herpetic pain correlates with the degree of prodromal pain, the severity of skin lesions, trigeminal/ophthalmic involvement, anxiety or depression, and comorbid disease [23, 32, 33, 97–100]. …”

Section: Clinicopathologymentioning

confidence: 99%

Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

et al. 2017

View full text Add to dashboard Cite

BackgroundHerpes zoster (HZ) is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable patients. Although widely recommended, vaccination against HZ is not routine; barriers in Asia-Pacific include long-standing neglect of adult immunisation and sparse local data. To address knowledge gaps, raise awareness, and disseminate best practice, we reviewed recent data and guidelines on HZ from the Asia-Pacific region.MethodsWe searched PubMed, Scopus, and World Health Organization databases for articles about HZ published from 1994 to 2014 by authors from Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. We selected articles about epidemiology, burden, complications, comorbidities, management, prevention, and recommendations/guidelines. Internet searches retrieved additional HZ immunisation guidelines.ResultsFrom 4007 retrieved articles, we screened-out 1501 duplicates and excluded 1264 extraneous articles, leaving 1242 unique articles. We found guidelines on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, and Thailand.HZ epidemiology in Asia-Pacific is similar to elsewhere; incidence rises with age and peaks at around 70 years – lifetime risk is approximately one-third. Average incidence of 3–10/1000 person-years is rising at around 5% per year. The principal risk factors are immunosenescence and immunosuppression. HZ almost always causes pain, and post-herpetic neuralgia is its most common complication. Half or more of hospitalised HZ patients have post-herpetic neuralgia, secondary infections, or inflammatory sequelae that are occasionally fatal. These disease burdens severely diminish patients’ quality of life and incur heavy healthcare utilisation.ConclusionsSeveral countries have abundant data on HZ, but others, especially in South-East Asia, very few. However, Asia-Pacific countries generally lack data on HZ vaccine safety, efficacy and cost-effectiveness. Physicians treating HZ and its complications in Asia-Pacific face familiar challenges but, with a vast aged population, Asia bears a unique and growing burden of disease. Given the strong rationale for prevention, most adult immunisation guidelines include HZ vaccine, yet it remains underused. We urge all stakeholders to give higher priority to adult immunisation in general and HZ in particular.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2198-y) contains supplementary material, which is available to authorized users.

show abstract

Section: Clinicopathologymentioning

confidence: 99%

Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

et al. 2017

View full text Add to dashboard Cite

show abstract

“…2,11 Studies by independent groups of investigators have now established that greater acute pain severity, 12,13 greater rash severity, 14,15 and the presence of a painful prodrome preceding the rash 16,17 are additional risk factors for PHN. 2,11 Studies by independent groups of investigators have now established that greater acute pain severity, 12,13 greater rash severity, 14,15 and the presence of a painful prodrome preceding the rash 16,17 are additional risk factors for PHN.…”

mentioning

confidence: 99%

Risk factors for postherpetic neuralgia in patients with herpes zoster

et al. 2004

View full text Add to dashboard Cite

The independent contributions to the prediction of PHN made by older age, female sex, presence of a prodrome, greater rash severity, and greater acute pain severity suggest that these risk factors reflect different mechanisms that each contribute to the development of PHN. Subacute herpetic neuralgia that does not progress to PHN may reflect peripheral tissue damage and inflammation caused by a particularly severe or widespread rash.

show abstract

“…Although age and the trigeminal area affected are known to be risk factors for PHN [3,5••,6,7,24], other risk factors should be considered by clinicians who examine patients with herpes zoster that has the potential to develop into PHN. The first step in preventing a PHN process is to identify instances of the following risk factors: 1) age (> 60); 2) severity of cutaneous lesions [25]; 3) affected area (trigeminal region most aggressive and painful in our experience); 4) sensory loss in affected area [9,11,23,24]; 5) concomitant peripheral neuropathy [26], usually seen together with increase in lesion severity and sensory loss; 6) high level of pain [9], usually with extensive lesions and trigeminal area affected; and 7) presence of immunocompromised diseases such as AIDS and cancer [9,24]. If one of these risk factors is present, treatment measures must be taken to decrease both the lesion time of shingles and, most importantly, the intensity of the patient's pain.…”

Section: Preventionmentioning

confidence: 99%

Acute herpes zoster and postherpetic neuralgia

Català

Ferrándiz

1999

Current Review of Pain

View full text Add to dashboard Cite

Herpes zoster ( HZ ) is an acute unilateral and segmental inflammation of the dorsal root ganglia caused by infection with the herpes virus varicella-zoster, which also causes chickenpox. During an initial infection of chickenpox, the virus spreads through the blood to the skin and then travels up sensory nerves to the dorsal root ganglia, where a latent infection is established. The virus then lies dormant inside nerve cells near the spinal cord and the brain.It is believed that this virus multiplies as it is reactivated and that it is neutralized by antibodies remaining from initial infection. If effective antibodies are not present [1], which may be the case in older and immunocompromised patients, the virus continues to multiply in the ganglia, destroys the host neuron, and spreads from the sensory nerve to the skin, where it produces a rash and blisters, commonly known as shingles, or herpes zoster. The main problem with this illness is that the pain and discomfort it causes may become chronic. Pain in herpes zoster is very resistant to treatment and remains a source of frustration for both patients and physicians. As the average life expectancy of our population increases, the scope of herpes zoster and its more frequent complication, postherpetic neuralgia (PHN), will expand. Efforts must be made to lessen the tremendous suffering caused by this disease. IncidenceSurveys taken in developed countries suggest that the incidence of HZ ranges from 10% to 20% of the general population, but the percentage increases in patients over 65 years of age and in patients who are immunocompromised by HIV or by the cancer process [2,3]. In those countries or populations in which varicella occurs at a later age, the incidence of HZ is very low, but no data exists to estimate its prevalence.It is commonly believed that a person can develop more than one case of shingles in a lifetime, but this seldom happens because the first attack provides immunity against it. Our focus here is on the large number of patients whose pain continues after the rash has healed, starting a separate and difficult process called postherpetic neuralgia (PHN). It is difficult for several reasons to establish the period of time that elapses before the diagnosis of PHN is appropiate. These reasons include the tendency for pain to lessen after the first 3 to 4 months, the different kinds of pain involved, and the difficulty in treating both pain and patients. Consequently, a good alternative is to observe this approximately 4-month period as defining a PHN process. Prior to this defined period, acute pain of herpes zoster would be a more appropriate diagnosis than PHN [4].The incidence of PHN also increases with age. It is estimated that PHN affects few people under the age of 50, but incidence increases dramatically for patients over the age of 65 (Table 1). A recent meta-analysis indicates that the prevalence of PHN in untreated patients is 25% of that in all patients [5••].As an instance of chronic pain, PHN is treated in many pain clinics, but lit...

show abstract

Severity of skin lesions of herpes zoster at the worst phase rather than age and involved region most influences the duration of acute herpetic pain

Cited by 36 publications

References 39 publications

Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

Risk factors for postherpetic neuralgia in patients with herpes zoster

Acute herpes zoster and postherpetic neuralgia

Contact Info

Product

Resources

About