德国皮肤病协会带状疱疹临床指南

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1、JournalofClinicalVirology26(2003)277/289德国皮肤病协会带状疱疹临床指南【Abstract】Varicellazostervirus(VZV)causesvaricella(chickenpox),remainsdormantindorsalrootandcranialnervegangliaandcanbereactivatedasaconsequenceofdecliningVZV-specificcellularimmunityleadingtoherpesz

2、oster(shingles).Patientsolderthan50yearsofageaffectedbyherpeszostermaysufferasignificantdecreaseofqualityoflife.Thesepatientsandimmunocompromisedindividualsareatincreasedrisksforseverecomplications,involvingtheeye,theperipheralandthecentralnervoussystem(

3、prolongedpain,postherpeticneuralgia).Suchcomplicationsoccurwithandwithoutcutaneoussymptoms.TheGermanDermatologySociety(DDG)hasreleasedguidelinesinordertoguaranteeupdatedmanagementtoanyoneaffectedbyherpeszoster.Diagnosisisprimarilyclinical.Thegoldstandard

4、oflaboratorydiagnosiscomprisesPCRanddirectidentificationofVZVincellcultures.DetectionofIgM-andIgA-antiVZVantibodiesmaybehelpfulinimmunocompromisedpatients.Therapyhasbecomeveryeffectiveinthelastyears.Systemicantiviraltherapyisabletoshortenthehealingprocess

5、ofacuteherpeszoster,topreventortoalleviatepainandotheracuteandchroniccomplications,particularly,whengivenwithin48htoamaximumof72hafteronsetoftherash.Systemicantiviraltherapyisurgentlyindicatedinpatientsbeyondtheageof50yearsandinpatientsatanyagewithherpes

6、zosterintheheadandneckarea,especiallyinpatientswithzosterophthalmicus.Furtherurgentindicationsaresevereherpeszosteronthetrunkandontheextremities,herpeszosterinimmunosuppressedpatientsandinpatientswithsevereatopicdermatitisandsevereekzema.Onlyrelativeindi

7、cationsforantiviraltherapyexistinpatientsyoungerthan50yearswithzosteronthetrunkandontheextremities.InGermanyacyclovir,valacyclovir,famciclovirandbrivudinareapprovedforthesystemicantiviraltreatmentofherpeszoster.Thesecompoundsareallwelltoleratedbythepatie

8、ntsanddonotdifferwithregardtoefficacyandsafety.Brivudinhasamarkedlyhigheranti-VZVpotencythanoralacyclovir,valacyclovirandfamciclovirandthusoffersasimplerdosingregimen.Itmustbegivenonlyoncedailyduring7daysincomparisontothree