눈대상포진이 병발된 경미한 얼굴의 화상

한정규,김유진,김선구 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.6

Purpose: Many conditions can mimic the presentation of burns. Herpes zoster is one of them. The characteristic features of herpes zoster such as vesicles, pustular lesions and crusts can also be found in burns. Herpes zoster ophthalmicus is a disease caused by recurrent infection of varicella - zoster virus in the ophthalmic division of the trigeminal nerve. This virus frequently affects nasociliary branch and serious ocular complications can occur. Thus, early diagnosis and proper treatment of this disease is important to prevent further ocular manifestations. We report a man who sustained minor facial burn injury that was complicated with herpes zoster ophthalmicus. Methods: A 66 – year - old man visited emergency room with multiple whitish vesicles with serous discharge on right forehead, right medial canthal area and nose. At first he was thought to have a secondary infection of facial burn injury. The vesicles on his face began to form crusts on the next day. Since his skin lesion was located on the ophthalmic division of trigeminal nerve, we also suspected herpes zoster ophthalmicus. He was referred to dermatologist and ophthalmologist. Results: We used antiviral agent (Acyclovir) and NSAIDs for treatment. The patient had no ocular complications. His skin lesion was almost healed after 1 month and remained scars. We treated a patient with minor facial burn complicated with herpes zoster ophthalmicus with antiviral agent. Conclusion: In this work, we describe a case of old patient with herpetic infection and emphasize the need for careful examination to diagnose accurately.

안면부 대상포진에 대한 15년간의 후향적 연구: 단일 기관에서의 경험

서중헌 ( Joong Heon Suh ),이수경 ( Soo Kyung Lee ),이운하 ( Un Ha Lee ),김명신 ( Myoung Shin Kim ) 대한피부과학회 2019 大韓皮膚科學會誌 Vol.57 No.5

Background: Many studies about herpes zoster exist in the Korean dermatologic literature. However, few studies have reported about facial herpes zoster and its complications. Objective: The purpose of this study was to investigate the epidemiology, clinical features, and complications of facial herpes zoster. Methods: We analyzed the medical records of 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized patients into 8 groups based on the dermatomal distribution of herpetic lesions. We investigated the correlations between clinical features, prognosis, and complications. Results: The most common site of involvement of facial herpes zoster was the ophthalmic branch of the trigeminal nerve (59.2%). Herpes zoster involving the ophthalmic and the maxillary branches of the trigeminal nerves showed a significantly higher incidence rate of herpes zoster ophthalmicus than that observed with herpes zoster involving only the ophthalmic branch (odds ratio 7.373). Age and periorbital swelling were significantly correlated with herpes zoster ophthalmicus (p<0.001). Facial palsy was significantly correlated with otalgia and cutaneous ear involvement (p<0.001). Postherpetic neuralgia (PHN) occurred in 41% of patients with facial herpes zoster. Patients who received antiviral treatment within 3 days showed lower rates of PHN (35.8%) than patients who received treatment after 4 days (45.4%) (p=0.002). Conclusion: Facial herpes zoster is associated with several neurological complications. Variables including age, periorbital swelling, otalgia, and cutaneous ear involvement are useful predictors of complications and prognosis. Early institution of antiviral treatment and appropriate interdepartmental consultations are required for better treatment outcomes. (Korean J Dermatol 2019;57(5):235∼242)

Facial herpes zoster: a 15-year retrospective singlecenter study

( Joong Heon Suh ),( Joong Ho Kim ),( Jae Ho Lee ),( Ho Young Kim ),( Soo Kyung Lee ),( Un Ha Lee ),( Myoung Shin Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: Few studies have reported about facial herpes zoster and its complications in the Korean dermatologic literature. Objectives: The purpose of this study was to investigate epidemiology, clinical features, and complications of facial herpes zoster. Methods: We analyzed 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized them into 8 groups based on dermatomes. We investigated the correlations between clinical features, prognosis, and complications. Results: The most common site of involvement of facial herpes zoster was the ophthalmic branch (59.2%). Herpes zoster involving the ophthalmic and maxillary branches showed a significantly higher incidence rate of herpes zoster ophthalmicus than that involving only the ophthalmic branch (odds ratio 7.373). Age and periorbital swelling were significantly correlated with herpes zoster ophthalmicus (p<0.001). Facial palsy was significantly correlated with otalgia and cutaneous ear involvement (p <0.001). Patients who received antiviral treatment within 3 days showed lower rates of postherpetic neuralgia (35.8%) than patients who received treatment after 4 days (45.4%) (p=0.002). Conclusion: Facial herpes zoster is associated with several complications. Age, periorbital swelling, otalgia, and cutaneous ear involvement are useful predictors of complications and prognosis. Early institution of antiviral treatment is required for better outcomes.

Ophthalmoplegia in herpes zoster ophthalmicus

( Min Woo Park ),( Jun Suk Hong ),( Moo Kyu Suh ),( Jong Im Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Ocular complication of herpes zoster ophthalmicus are the most dangerous sequelae of herpes zoster, because patients can lose their sight or vision caused by ocular nerve damage and ocular pathology. The manifestation of ptosis, restricted eye movement caused by oculomotor nerve paralysis in herpes zoster ophthalmicus is rarely seen and repoted in the Korean dermatologic literature. We report a case of oculomotor nerve paralysis in herpes zoster ophthalmicus. A 59-year-old man presented with acute pain on the right head and grouped vesicles on the right forehead, periorbital area for 3 days. There were no abnormal findings other than cutaneous lesions. Biopsy was performed on the right forehead and the biopsy specimen showed intraepidermal vesicle and ballooning degeneration with lymphocyte infiltration in epidermis and upper dermis. On immunohistochemical study, the specimen was positive for VZV. He was treated with intravenous acyclovir 2000mg daily for 4 days. After 4 days, ptosis and impairment of gaze except lateral movement appeared. Magnetic resonance imaging of the brain showed no abnormality. After oculomotor nerve palsy was diagnosed, the patient was treated with acyclovir with intravenous prednisolone 1000mg daily for 5 days. After 1 week, the ptosis and oculomotor palsy was improved.

안부대상포진 환자에서 보인 동공이상 3예

한정빈,김태기,진경현 대한안과학회 2013 대한안과학회지 Vol.54 No.9

Purpose: We report the occurrence of pupil abnormality in 3 patients with herpes zoster ophthalmicus. Case summary: Three patients diagnosed with herpes zoster ophthalmicus developed pupil abnormality. (Case 1) A 37-year-old male diagnosed 1 month prior with anterior uveitis secondary to herpes zoster ophthalmicus presented with peripheral corneal erosions, inflammatory cells in the anterior chamber, diffuse iris atrophy, almost fully-dilated pupils, and loss of pupil light reflex in the right eye. (Case 2) A 72-year-old male presented with vesicles on the right side of the face, and dendritic corneal ulcer, and inflammatory cells in the anterior chamber on initial examinations. After 5 days without treatment by his choice, decreased vision, decreased pupil light reflex, and ovoid-shaped pupils developed. (Case 3) A 63-year-old female presented with left ocular pain, vesicles around the left eye, dendritic corneal ulcer, inflammatory cells in the anterior chamber, and isocoric pupils with normal pupil light reflexes. However, in her left eye, the pupillary ruff was partially lost and the pupil was larger than the right pupil after the start of a 3-week treatment regimen. The pupil in Case 2 returned to normal after 1 month, but in cases 1 and 3, no improvements of pupil abnormalities were observed during the follow-up period. Conclusions: Herein we presented 3 patients that were diagnosed with herpes zoster ophthalmicus and subsequently developed pupil abnormalities. In the cases of pupil abnormalities, checking for a history of herpes zoster ophthalmicus is necessary to make a differential diagnosis.

The Effects of 830 nm Light-Emitting Diode Therapy on Acute Herpes Zoster Ophthalmicus: A Pilot Study

( Kui Young Park ),( Tae Young Han ),( In Su Kim ),( In Kwon Yeo ),( Beom Joon Kim ),( Myeung Nam Kim ) 대한피부과학회 2013 Annals of Dermatology Vol.25 No.2

Skin lesions and pain are the most distinctive features of herpes zoster. Light-emitting diode (LED) therapy is an effective treatment known for its wound-healing effects. Objective: To determine whether the LED treatment affects wound healing and acute pain in acute herpes zoster ophthalmicus. Methods: We recruited 28 consecutive Korean patients with acute herpes zoster ophthalmicus for the study. In the control group (group A), 14 subjects received oral famcyclovir. In the experimental group (group B), 14 subjects received oral famcyclovir and 830 nm LED phototherapy on days 0, 4, 7, and 10. In order to estimate the time for wound healing, we measured the duration from the vesicle formation to when the lesion crust fell off. The visual analogue scale (VAS) was used for the estimation of pain on days 4, 7, 10, and 14. Results: The mean time required for wound healing was 13.14±2.34 days in group B and 15.92±2.55 days in group A (p=0.006). From day 4, the mean VAS score showed a greater improvement in group B, compared with group A. A marginal but not statistically significant difference in the VAS scores was observed between the two groups (p=0.095). Conclusion: LED treatment for acute herpes zoster ophthalmicus leads to faster wound healing and a lower pain score.

외안근 마비를 동반한 안부대상포진 1예

이중호,정보영 동국대학교 의학연구소 2008 東國醫學 Vol.15 No.1

We report one rare case of a patient who developed external ophthalmolplegia and diplopia during treatment for herpes zoster ophthalmicus. Antiviral agent and systemic steroid were orally administered for complications of the herpes zoster ophthalmicus because there was no specific inflammatory sign on the MRI. The amount of diplopia was gradually decreased at 3 weeks after the onset of the treatment and then the patient did not complain about diplopia. Her ocular position was nearly orthophoric at 2 months. The herpes zoster ophthalmicus complicated with external ophthamoplegia should be timely treated with antiviral agent and systemic steroid. 안부대상포진 환자에서 외안근 마비와 복시가 동반된 드문 증례를 경험하여 보고하고자 한다. 안부대상포진으로 치료를 받고 있던 환자에게 안압의 상승이나 출혈과 같은 합병증 없이 외안근의 마비와 복시가 동반되었다. 3, 4, 6번 신경마비와 관련하여 자기공명영상 촬영을 했으나 특이한 염증소견을 발견할 수 없어 안부대상포진에서 동반되는 합병증으로 생각하고 항바이러스제 및 전신 스테로이드를 경구 투여하면서 경과 관찰하였다. 치료 3주 후부터 서서히 복시의 양이 줄어들었으며 치료 2개월째에 복시 증상이 소실되고 안구위치도 정위로 회복되었다. 안부대상포진 환자를 진료할 때 안과적 임상 양상을 숙지하고 적절한 시기에 항바이러스제 및 스테로이드로 안과적 치료를 하는 것이 중요하다.

안부 대상포진의 임상양상

정유리,장윤희,김대희,양홍석,Yoo-Ri Chung,MD,Yoon-Hee Chang,MD,Dae Hee Kim,MD,Hong Seok Yang,MD 대한안과학회 2010 대한안과학회지 Vol.51 No.2

Purpose: To analyze ocular manifestations of herpes zoster ophthalmicus and evaluate risk factors and complications affecting visual acuity. Methods: Ocular, cutaneous, and systemic findings were analyzed retrospectively from the medical records of 81 patients, admitted between 1994 and 2007, to the dermatology department of our hospital for the management of herpes zoster ophthalmicus. Results: Herpes zoster ophthalmicus was manifested as eyelid eruption (93%), conjunctivitis (80%), keratitis (67%), iridocyclitis (36%), secondary glaucoma (20%), or extraocular muscle palsy (1%). Some patients had accompanying systemic illnesses, including malignancy, hepatitis, diabetes mellitus, chronic obstructive pulmonary disease, tuberculosis, and cerebrovascular disease. Patients with decreased vision during the follow-up period were statistically more likely to have presented with keratitis (p=0.032). However, 86% of these patients recovered vision over a 6-month period. Conclusions: Patients presenting with keratitis upon initial evaluation are at risk for decreased vision and require appropriate ophthalmic evaluation and management. J Korean Ophthalmol Soc 2010;51(2):164-168

눈대상포진 환자의 임상양상 및 위험인자 분석

문치영,정문선 대한안과학회 2017 대한안과학회지 Vol.58 No.12

Purpose: To evaluate the clinical characteristics and risk factors of severe manifestation of herpes zoster ophthalmicus. Methods: We conducted a retrospective analysis using medical records from 106 patients diagnosed with herpes zoster ophthalmicus from January 2012 to June 2015. Patients were classified according to the type and frequency of ophthalmologic manifestations. Patients with conjunctivitis, punctate keratitis, and pseudodendritic keratitis were classified into the mild group, whereas patients with deep stromal keratitis, endothelitis, scleritis, glaucoma, and extraocular muscle paralysis were classified into the severe group. The age, sex, severity, location of skin lesions, delayed time to treatment, the presence of Hutchinson's sign, and associated systemic diseases were compared between the groups. In addition, we investigated changes in vision, intraocular pressure, treatment duration, recurrence and the prevalence of postherpetic neuralgia. Results: The incidence of conjunctivitis (47.2%), punctate keratitis (42.5%), pseudodendritic keratitis (12.2%), deep stromal keratitis (12.2%), endothelitis (15.1%), scleritis (18.9%), glaucoma (14.2%), and extraocular muscle (EOM) paralysis (4.7%) were observed in these patients. The group with mild disease included 70 cases with conjunctivitis, punctate keratitis and pseudodendritic keratitis. The severe group included 36 cases with deep stromal keratitis, endothelitis, scleritis, glaucoma and EOM palsy. Disease most often occurred in the distribution of the first branch of the trigeminal nerve, with no differences in the age or sex of patients in both groups. Severe manifestations were more common when a greater extent of the skin was involved, when Hutchinson’s sign was present, or when treatment was significantly delayed. There were no significant differences between the two groups in recurrence or the presence of postherpetic neuralgia. Conclusion: Long-term treatment for herpes zoster opthalmicus is more likely to be required if severe manifestation of disease exists, such as widespread skin involvement, Hutchinson's sign, or a delay to the initiation of antiviral treatment. More active observation and treatment are required in such cases. 목적: 눈대상포진 환자 중 심한 안증상이 동반된 경우의 임상양상과 위험인자에 대하여 알아보고자 한다. 대상과 방법: 2012년 1월부터 2015년 6월까지 눈대상포진으로 진단된 106명을 대상으로 의무기록을 이용한 후향적 분석을 시행하였다. 눈대상포진 환자들의 안증상의 종류와 빈도를 확인하고, 결막염, 점상각막염, 가성수지각막염 소견을 보이는 환자를 경증군, 심층기질각막염, 각막내피염, 공막염, 녹내장, 외안근마비를 보이는 환자를 중증군으로 나누었다. 두 군에서 나이, 성별, 피부 병변의 정도와 위치, 증상 발생부터 치료 시작까지의 시간, Hutchinson’s 징후 여부 그리고 동반된 전신질환들에 대해 비교하였다. 또한 두 군의 치료 후 시력, 안압의 변화와 치료기간, 재발 및 포진 후 신경통 발생에 대해 조사하였다. 결과: 전체 106명의 환자의 안증상은 결막염(47.2%), 점상각막염(42.5%), 가성수지상각막염(12.2%), 심층기질각막염(12.2%), 각막내피염(15.1%), 공막염(18.9%), 이차성 녹내장(14.2%), 외안근 마비(4.7%)의 빈도로 관찰되었다. 경증군은 결막염, 점상각막염, 가성수지상각막염을 진단 받은 70명 70안이, 중증군에는 심층기질각막염, 각막내피염, 공막염, 녹내장, 외안근 마비를 진단 받은 36명 36안이 포함되었다. 두 군을 비교하였을 때 가장 많이 침범한 뇌신경분지는 삼차신경의 첫 번째 분지로 동일하게 나타났으며, 연령이나 성별에서는 차이가 없었다. 피부병변의 범위가 넓고 심한 경우(p<0.01), Hutchinson 징후가 있는 경우(p=0.01) 그리고 치료 시작까지 지연된 시간이 긴 경우(p=0.02) 중증군에 속하는 안증상이 더 흔하였다. 재발과 포진 후 신경통의 발생은 두 군에서 유의한 차이가 없었다(p=0.16). 결론: 눈대상포진 환자에서 피부병변이 넓고 심하거나 Hutchinson' 징후가 있고 항바이러스제 치료가 지연된 경우에는 장기간 치료가 필요하며 후유증 발생 가능성이 높은 심한 안증상이 발생할 가능성이 높으므로 적극적인 관찰과 치료가 필요할 것으로 생각된다.

안부대상포진에서 발생한 시신경염 2예

김종연,안민,이동욱.Jong Youn Kim. M.D.. Min Ahn. M.D.. Dong Wook Lee. M.D. 대한안과학회 2008 대한안과학회지 Vol.49 No.6

Purpose: We report the treatment and prognosis of two patients who experienced pain in their face associated with skin lesions and acute decreased visual acuity and were diagnosed with optic neuritis caused by the herpes zoster virus. Case summary: Two patients were diagnosed with herpes zoster ophthalmicus after experiencing an acute decrease in visual acuity and were sent to our clinic for examination. On ophthalmic evaluation, the results were positive for relative afferent pupillary defect (RAPD) and showed abnormal VEP levels. On MRI T1, one case showed a high signal along the optic nerve sheath. Both patients with optic neuritis were treated with Acyclovir (Zovirax®, GlaxoSmithKline, U.K.), which is an antiviral drug, at a dose of 10 mg/kg every 8 hours for 5 days, and a combination of prednisolone at a dose of 250 mg every 6 hours. After general therapy, they took Acyclovir (250 mg) orally 3 times daily for 14 days, with steroids (40 mg), and decreased the dosage after two weeks. We saw no improvement of visual acuity in either case, which still showed RAPD. Conclusions: Optic neuritis secondary to herpes zoster ophthalmicus rarely occurs, but it is difficult to treat and has a poor prognosis. We should keep in mind that optic neuritis can occur in patients who were diagnosed with herpes zoster ophthalmicus. J Korean Ophthalmol Soc 49(6):1028-1032, 2008