Skin and soft tissue infections

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Herpes zoster

Case report:

A 72 year old woman with long-standing diabetes mellitus history and a - treated middle steroid doses - chronic bronchitis comes into practice and complains of a circumscribed, some band-shaped arranged, which occurred in the lower right lateral thoracic region reddening of the skin with formation of small groups like arranged nodules. These lesions are gone hand in hand with considerable pain and partly the nodules have been converted into small papules with pellucid vesicles. Out are also low-grade fever occurred and the pain had significantly increased in intensity.

Comment:

The inspection of the lesions shows the fairly typical changes of herpes zoster in a relatively early stage with restriction on a Hautdermatom. A diagnostic fuse is not necessary for the typical clinical disease findings. Because of the immunological risk factors of the patient with advanced age, diabetes mellitus and steroid treatment should be carried out for preventing disseminated path targeted therapy.

Therapy:

The basic treatment consists initially in the administration of symptomatic topical medications (for example, Anaesthesul lotion) and the Regulation of analgesics [e.g. Paracetamol (BEN U RON et al)]. - The specific therapy should be mitAciclovir orally (Zovirax among others) at a dose of 5 x 800 mg (children 20 mg / kg) daily. As an alternative with improved absorption, thereby saving dose geltenFamciclovir (FAMVIR) in a dose of 3 x 250 mg daily, or valacyclovir (VALTREX) in a dose of 3 x 1000 mg daily. In young and immunocompetent patients the costly antiviral therapy is not absolutely necessary, because the routine treatment of uncomplicated herpes zoster is not recommended. Only at a very early initiation of treatment may be a slightly shortened course of the skin manifestations are expected. The incidence postherpetic neuralgia was however not significantly reduced in all studies. An exception exists for face localization of zoster, here antiviral therapy is to avoid ophthalmological complications getting indexed.

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