HERPES ZOSTER OPHTALMICUS EXACERBATED BY TOPICAL …
Transcript of HERPES ZOSTER OPHTALMICUS EXACERBATED BY TOPICAL …
HERPES ZOSTER OPHTALMICUS
EXACERBATED BY
TOPICAL USE OF HERBAL MEDICINE
Sudarsa P, Rusyati LM, Adiguna MS
Dermatovenereology Departement
Medical Faculty of Udayana University /Sanglah General Hospital Bali
CASE REPORT
INTRODUCTION
Herpes zoster (HZ) is still a common problem worldwide estimated 10-20% of the population will experience at least once episode
In Bali, herbal and traditional medication frequently used as first aid especially in dermatology problem
A case of herpes zoster opthalmicus
(HZO) exacerbated by topical use of
herbal medication
CASE PRESENTATION
Balinese male, 38 years old, came to Sanglah
Hospital with chief complaint of painful eruption on
right face
• Pain in forehead and around right eye
• Redness and blister
• Light fever, malaise
• Runny eye and swollen on right eye
+7 days before admission
• Went to traditional healer gave herbal medicine
• Skin lesion worsen, painful erosion afterward
• Burning sensation
2 days before admission
• Past medical history and medication history
history of chickenpox (+) at teenage age
other systemic disease was denied
From traditional healer “Balian” herbal medicine consist mixture of ginger, sandalwood oil, and dapdap leaves should be put on to the skin
• Social history
he is a policeman, last educational background in police academy
married with 2 children, sexual multipartner was denied
Physical Examination
Present state within
normal limit
Right frontalis and
periorbital region
multiple erosion,
covered by thick
black crust.
Right nasal
region multiple
grouped vesicles,
round shape, tense-
walled, filled with
seropurulent fluid
Right eye
examination:
palpebrae edema
with discharge and
crusts (+)
Conjunctival injection
(+)
Cornea clear & intact
Dermatological
State:
Laboratory Result
Gram Staining
• Leucocytes (+) 5-10/fv
• Gram positive cocci (+)
• Bacillcoccus (+)
Tzank Smear
• Multinucleated giant cell
(+)
• Leucocytes 13,2 K/uL (4.1-10.9)
neu 9,4
lym 2,6
mono 1,0
eos 0,1
• Hemoglobin 14,2 g/dL (12,0-
16,0)
• Hct 42,9 L% (36,0-46,0)
• Platelet 166 K/uL (150-440)
Complete Blood Count
Diagnosis and Treatment
• Herpes zoster opthalmicus dextra with irritant contact dermatitis and secondary infection
• Valacyclovir 3x1000 mg for 7 days, cefadroxil 2x500 mg, parasetamol 4x500 mg, neurotropic vitamin and open dressing with natrium chloride
Dermatology Departement
• Blepharoconjungtivitis oculi dextra ec herpes zoster
• Ofloxacin ED 6 x 1 drops OD, eye toilet every day
Opthalmology Department
Follow up Day 5th Subjective:
Pain was decreased, no new lesion, old lesion became dry,
can open right eye, no fever and malaise
Objective:
Present and general state within normal
Dermatologic State:
• Right frontalis and periorbital region multiple erosion,
most became dry, some still covered by thick crust.
• Right nasal region multiple erosion, round shape,
surrounded by hyperpigmented macule
Patient was discharge from hospital, continuing valacyclovir 3x1000mg until day 7, open dressing with natrium chloride, and
topical antibiotic fusidic acid twice daily
DISCUSSION
A neurodermal disease caused by reactivation of dormant varicella-zoster
virus radicular pain with grouped eruption of
vesicular lesion, unilateral along dermatome
Sporadic 10-20% of population
Can affect all ages, risk increased above 60 years
old
Herpes zoster opthalmicus 10-20% of all HZ cases with risk of complication esp to the
eyes
Risk factors age, immunosuppression such as HIV, transplant patient,
malignancy, use of corticosteroid,
chemotherapy, diabetes, stress
HERPES ZOSTER
Traditional medication is a common practice in
Indonesia, esp Bali
Most people went to “Balian” to seek
medication
Indonesia rich with natural sources
ingredients of herbal medicine
A lot of ongoing study focus on natural/herbal
substance for medication
Ginger
• One of the most common herbs used in traditional medicine
• Thought to have properties of antioxidant, anti-inflammatory, antinausea and anticancer
Sandalwood
• Mostly in the form of distilled oil
• Believed to have biological activity as an anti-inflammatory, antimicrobial, and antiproliverative agent
Dapdap leaves (Erythrina variegate)
• The extracts from the leaves reported to have anti-inflammatory, analgetic, antibacterial and antihelminthic activity
Herpes zoster lesion resulting in disrupted skin
barrier prone to exposure of exogenous
substances and also infection
Although herbal medication might have beneficial
impact and effectiveness,
inappropriate preparation and usage of herbal
medication in impaired skin barrier function
worsening of underlying skin disease as in this
case
CONCLUSSION
The use of traditional herbal medicine, although
sometimes can be helpful, but if not used
appropriately can cause deterioration in
disrupted skin barrier condition
THANK YOU