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Mædica - a Journal of Clinical Medicine

MAEDICA – a Journal of Clinical Medicine
2015; 10(3): 276-279

C ASE REPORT

Treatment of Postherpetic
Neuralgia Using Narrow Band
Ultraviolet B Radiation (UVB)
Piotr BRZEZINSKIa; Ewelina CYWINSKAa,b; Anca CHIRIACc,d
a
Department of Dermatology, 6th Military Support Unit, Ustka, Poland
b
“Trychoderm” Private Clinic, Slupsk, Poland
c
Department of Dermato-Physiology, Apollonia University, Iasi, Romania
d
Institute of Macromolecular Chemistry, Apollonia University, “Petru Poni” Nicolina
Medical Center, Iasi, Romania

ABSTRACT
Postherpetic neuralgia (PHN) is a common complication of herpes zoster, frequently unresponsive to
most available treatment. The disease is especially difficult to manage in elderly people and has a great
impact on the quality of life of patients.
Narrow band ultraviolet B radiation may play a role in the prevention and treatment of PHN.
Present paper describes a case of a 59 year-old female patient, diagnosed with ophthalmic herpes zoster
and postherpetic neuralgia, with positive results using narrow UVB.

Keywords: herpes zoster; postherpetic neuralgia; narrow UVB; complications

INTRODUCTION vates. At a certain moment, when the host
resistance drops below a critical level, VZV re-

H
erpes zoster (HZ) or shingles is a activates and virus replication starts. VZV
neurocutaneous disease caused spreads down the sensory nerve causing neuri-
by reactivation of latent varicel- tis and extends around the sensory nerve into
la-zoster virus (VZV) (1). VZV is a the skin inducing dermatomal zoster skin le-
deoxyribonucleic acid (DNA) vi- sions.
rus that belongs to the human alpha-herpes vi- Frequently reported complications include:
ruses, together with herpes simplex viruses bacterial infections and consequent scars for
(HSV) type I and type II.VZV is the causal agent skin, conjunctivitis, episcleritis/scleritis, uveitis,
of chickenpox (varicella) especially in children keratitis, iridocyclitis for eyes, and encephalitis,
and herpes zoster in elderly and immunocom- meningitis, granulomatous arteritis, segmental
promised individuals. paresis affect the central nervous system (3).
The prevalence of herpes zoster infection is Zoster pain is classified in acute pain and
reported to be between 0.3–0.5% (2). postherpetic neuralgia (PHN). The actual defi-
After the initial phase of varicella, VZV re- nition of PHN is: pain that persists for more
mains dormant in the sensory ganglia for a la- than three months after the onset of herpes
tency period (months-years) before it reacti- zoster (4).

Address for correspondence:
Piotr Brzezinski, Department of Dermatology, 6th Military Support Unit, Ledowo 1N, 76-270 Ustka, Poland.
E-mail: brzezoo77@yahoo.com

Article received on the 23rd of February 2015. Article accepted on the 15th of June 2015.

276 Maedica A Journal of Clinical Medicine, Volume 10 No.3 2015

burn or itch- ing. zoster. including HZ (6). beside bacte- rial superinfection (7).21 J/cm2. tients. in the absence lower risk of PHN in women. diseases.3 sessions per week. performed at the the ones over 60 (11). Volume 10 No. then the (12). es of herpes zoster (HZ) and even higher (50– VRS was also used for close follow-up of the 60%) among elderly or immunosuppressed pa. Three months prior to consul. after 14 sessions 1 and at the been used in order to attempt treating several end of cure: 0. not in men ac- of any adverse reactions reported by the pa- tient. chronic debilitating was established. such as persistent erythema. unbearable and extremely incapacitating pain. PHN in the age group below 60 compared to up to a total of 20 sessions. VRS was scored before the FIGURE 1. but does not cause sleeplessness 3=severe pain that causes sleeplessness 4=very severe. patient at 2 months follow-up. to be a chronic neuropathic pain that involves mic zoster and treated with acyclovir (800 mg aberrant somatosensory processing in the pe- five times /day for 10 days). The patient was subjectively evaluated re- garding the pain index and degree of improve- ment once weekly. the onset of herpes zoster (8). a severe acute phase of HZ (10). Nowadays. ripheral and/or central nervous system (1). Known risk factors for PHN include: ad- A diagnosis of postherpetic neuralgia (PHN) vanced age. dence in patients after traumatic brain injury The starting dose was 0. Postherpetic neuralgia (PHN) is considered tation. female gender.  CASE REPORT DISCUSSION A 56-year-old female patient was addressed to the Department of Dermatology for ery- thematous plaques distributed over left upper A bout 20-25% of cases of HZ develop PHN as a secondary complication. phototherapy is a The score remained 0 one month after the valuable therapeutic method used in nume. hemifacial area. The dermatological examination revealed PHN can also be defined as the pain lasting erythematous skin lesions accompanied by in. Maedica A Journal of Clinical Medicine. TREATMENT OF POSTHERPETIC NEURALGIA USING NARROW BAND ULTRAVIOLET B RADIATION (UVB) PHN has been reported in 9-45% of all cas. dose was increased by one increment every HZ vaccination has been reported with a session to a point of 20 sessions. One report The patient admitted an increasing intensity of claims that 15 % of HZ cases have PHN 2 years pain during the weeks that followed the herpes after the zoster rash (9). for more than 1-3 months or even years after tense pain on the left upper hemifacial area. immunocompromised condition. treatment and at the end of nbUVB sessions. the patient was diagnosed with ophthal. Trychoderm Clinic in Slupsk. tient was recommended: nbUVB (narrow band Patients with HZ have a lower incidence of UVB-311-Dermalight) . For a long time solar ultraviolet (UV) radia. 1=mild pain that does not interfere with daily activities 2=moderate pain that interferes with daily activities. and A special therapeutic approach to the pa.  two month.3 2015 277 . skin diseases. Erythematous lesions on the forehead in a 56 year old female patient during treatment with UVB narrow. Poland under PHN has been recently found in higher inci- strictly medical surveillance. tion (heliotherapy) and phototherapy have after 7 sessions 2. At the end of third session the score was 3. The patient was graded with regard to her pain severity using a 4-point Verbal Rating Scale (VRS): 0=no pain. therapy ceased and remained at that level for rous skin diseases (5). Before treatment the score was 4.

the benefi- neurons) (17). Treatment of PHN is difficult because the UVB radiation reaches the epidermis and majority of cases are unresponsive to most the upper dermis. secrete immunosuppressive cytokines such as tients received nbUVB sessions. PG-E2. for a total of 15 sessions or until the pain (25). during the first 7 days of rash. especial. trates more deeply into the dermis. contributing also to improve PHN. dendritic cells.71%) and 9 (52. suppressive effects by activating keratinocytes. while UVA radiation pene- available treatment modalities. broblasts (6).TREATMENT OF POSTHERPETIC NEURALGIA USING NARROW BAND ULTRAVIOLET B RADIATION (UVB) cordingly to a very recent study. with PHN treated The exact pathogenesis of zoster pain still with nbUVB phototherapy. Sessions were repeated three zoster skin lesions. topical or intranasal UVB phototherapy can also have a positive ketamine (22).8). three times a IL-10. patients were evaluated LCs. Nabarawy enrolled in the study 17 patients UVB also suppresses antigen presentation of with distressing PHN. opioids (20).29%) and 8 shift from a Th-1 immune response to a Th-2 (47. HZ.06%) patients. TNF-. mJ/cm2 then gradually increasing the dose by ning. (nbUVB) causes local and systemic immuno- tors and by inhibiting serotonin and nor. (64. gabapentin. during the order to explain the mechanisms induced by last decades. As results more than 50% im. and even stabbing. but applied 3 months af- substance P which is a neurotransmitter) (19). • opioids analgesics( acting as mu-recep. but it is admitted to be oral acyclovir (800 mg five times a day for 10 mostly immunologically mediated (1). IL-4. at the end of therapy and response (1). sity in the epidermis and superficial dermis provement less that 50% was achieved in 11 (27). but further in. circulating and cutaneous T lymphocytes. Jalali et al. topical amitriptyline (21). topical capsaicin (affecting the phase of HZ and thus preventing or decreasing TRPV1 receptor and producing depletion of the intensity of PHN.33% of treated patients were completely grees and can affect deeply daily social activi. at the end of In present case nbUVB proved to be effec- therapy (1). cial effects observed in HZ (1. • NSAIDs. with effects Oral treatment for PHN can include: on blood vessels. clonidine. itching. ter the onset of HZ the beneficial effect is low diclofenac. with variable de. mast cells. can of 15 sessions. (8). Narrowband UVB ing sodium. An im. epinephrine reuptake) (15). VZV particles in nerve fibers (26). Ultraviolet B (UVB) phototherapy was used UVB can interact with Langerhans’s cells for the first time in two studies done by Jalali et that are believed to be involved in inducing al. • and anticonvulsants: gabapentin and The immunomodulatory effects of UVB ra- pregabalin (blocking calcium channels in diation can explain. mast cells and fi- tor agonists) (16). pain free at at one and three months follow-up. days) plus nbUVB to the affected dermatomes. A percentage of 58. localized to 10 mJ/cm2 each session to a maximum dose of the dermatomal area with preceding herpes 100 mJ/cm2. stimulates keratinocytes and mast cells to using the Verbal Rating Scale (VRS). monocytes. 83. all with unimpressive effects effect by decreasing the neuronal damage in especially on long term evolution. (24). respectively. when it was performed three 278 Maedica A Journal of Clinical Medicine. The group received remains debatable. calcium and NMDA recep. described the evolution of 12 pa- vestigations are needed (13). granulocytes. ties.8). modifies the T-cell response to persistent disappeared. Pain can be associated with times a week until pain relief or to a maximum sleep disturbance. tive in PHN.33% and be paroxysmal or continuous. fibroblasts. UVB phototherapy can suppress lidocaine by blocking voltage-gated sodium the inflammatory response during the acute channels)(18). local injections of botulinum toxin type A (23). reduce the cutaneous nerve den- after 3 months follow up. • tricyclic antidepressants (acting by block. oral steroids. at least in part. Volume 10 No.3 2015 . ly VZV-specific cell-mediated immunity (14). Many hypotheses have been launched in Topical agents have been used. for PHN: local anesthetics (topical UVB in PHN. The pa. -MSH or CGRP week. respectively (8). Langerhans cell.94%) patients. in 2008 and respectively by Nabarawy in neuritis and play a role in immune response 2011 as an attempt to treat PHN (1. starting with 20 PHN is described by the patients as bur. depressive symptoms. induces a provement was achieved in 6 (35. tients older than 40 years.

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