SGD VI

KETUA: PUTRI MENTARI SITANGGANG

SEKRETARIS: ADINDA AYU TEMASHIERA
CINDY PRAJNA METTA
ADI FRANSISKUS NABABAN
FITRI NIRWANA SINAGA
SILVIA AUDINA
AMIE TAHIR RAJAGUKGUK
BELLA LUCINTA RILLOVA
ANIS MASRUROH
DINA ROSLIYANI
JERIKSAR PARTONA NAINGGOLAN
MAYA SARRY TARIGAN
RESTU IMANESYA
ASRI NOOR
FERDINAN PANGESTU
DYAH LESTARI

Scenario
An Acehnese 47-year-old man was consulted from the department
of pulmonary disease to Royal Prima Hospital Medans skin clinic
with complaints of the appearance of nodules and fluid-contained
small vesicles from the area around stomach to his right-below-back
since 2 days before and also accompanied with pain that cause
sleeping disorder on him. About 2 days before the appearance of
the skin lesion, the patient got fever and weakness, skin around
those area seemed hot and puncture-like felt. He was given the
paracetamol by the doctor but the pain stand still. The patient had
smallpox when he was young. The patient once was an inpatient
from the department of pulmonary disease and diagnosed with
mediastinum tumor. According to the dermatologists examination a
group of vesicles above the reddish skin on the dextral abdominal
region to dextral posterior lumbar region was found. What happened
to the patient and what medication should be given to him?

Clarification of term
Skinlesions:
a superficial growth or patch of the skin that
does not resemble the area surrounding it.
Mediastinum:
a median septum or partition between the sternum in
front and the vertebral column behind, containing the
heart.
Erythematous:
Redness of the skin caused by dilatation and congestion
of the capillaries, often a sign of inflammation or
infection.

Vesicle :
a small bladder or sac containing liquid.
a small circumscribed elevation of the epidermis
containing a serous fluid; a small blister.
Dermatology :
the medical specialty concerned with the diagno-sis and treatment of skin diseases.

Problem determination
An Acehnese 47-year-old man was came
to hospital with complaints:
the appearance of nodules and fluid-contained
small vesicles from the area around stomach to
his right-below-back since 2 days before.
Skin lesions
Fever
Skin around those area seemed hot
The patient was diagnosed with mediastinum
tumor before

Analysis
1. Skin infection.
2. Infections caused by viruses.
3. Patients once diagnosed with
mediastinum tumor which is
cause a low immunity system.

Conclusions
Based on existing symptoms,
patient patients diagnosed with
herpes zoster

Learning Objective
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.

Skin diseases caused by viruses

Definition of herpes zoster
Epidemiology of herpes zoster
Etiology of herpes zoster
Pathophysiology of herpes zoster
Clinical symptoms
Physical examination
Supporting examination
Diagnosis
Differential diagnosis
Management of herpes zoster
Prevention of herpes zoster
Complication of herpes zoster
Prognosis

LO. 1
Types of skin diseases caused by viruses
1.
2.
3.
4.
5.
6.

Herpes simpleks
Herpes zoster
Varicella
Variolla
Moluskum Kontagiosum
Veruka

LO. 2
THE DEFINITION OF HERPES ZOSTER

Herpes zoster which was also known as shingles

is an acute-localized skin inflammation, mostly
happened to adults, marked by unilateralradicular pain and the appearance of limited
vesicular lesion on dermatome that affected by
both spinal nerve fibers and sensory ganglion
nerve fibers. This infection happened as the
result of Varicella-Zoster Virus (VZV) reactivation
from the latent endogenous infection after the
primary infection from the virus itself.

LO. 4
ETIOLOGY OF HERPES ZOSTER
Varicella zoster virus is highly contagious.
One study showed a 75% secondary
attack rate with chickenpox in susceptible
household contacts. More than 90% of
adults have been infected although many
will not remember having it or may have
had subclinical infection.

LO. 3
Epidemiology of shingles
Hesper Herpes can appear along the years,
because it is not influenced by season, evenly
around the world, cidence of herpes zoster and
complication rates of herpes zoster increases
with age, in 68% of cases occur in people aged
50 years and older.

LO. 5
Pathophysiology Of Herpes
The causative agent for herpes
zoster
is
thevaricella
zoster
virus(VZV) a double strandedDNA
virusrelated to theherpes simplex
virus. Most individuals are infected
with this virus as children, and suffer
from an episode ofchickenpox.

The immune system eventually

eliminates the virus from most
locations, but it remains dormant
(latent) in thegangliaadjacent to the
spinal cord (called thedorsal root
ganglion) or the ganglion semi lunare
(ganglion Gasseri) in the base of the
skull.

LO. 6
Clinical Symptoms

Symptoms
typically
include
prodromal sensory phenomena along
1 or more skin dermatomes lasting 110 days (average, 48 hours), which
usually are noted as pain or, less
commonly, itching or paresthesias.

LO. 7
Physical Examination

1. Inspection and palpation were found:

. Temperature (febrile)
. Rubor and tumors can also be seen
. Presence or absence of induration and
enlargement kelenjarregional fluctuations
and generalized
2. Observation and identification of facial skin
lesions note the location, distribution,
composition type, and then examine the
color of other body parts

2. Observation and
identification of facial skin
lesions note the location,
distribution, composition
type, and then examine the
color of other body parts

LO. 8
Supporting Examination

1.
2.
3.
4.
5.
6.

Viral (virus) culture

Detection antigen
Serologic
PCR (polymerase chain reaction)
Tzanck Smear
Direct Fluorescent Assay (DFA)

LO . 9
DIAGNOSIS OF HERPES ZOSTER
The diagnosis of herpes zoster is usually
clinical, with laboratory tests reserved for
more atypical cases. The ideal specimen
is a swab from the base of burst new
vesicles in viral transport medium.

This can be processed for direct

fluorescent antibody testing (12 hour
turnaround time), DNA testing by PCR
(turnaround time of one day, but more
sensitive especially in older lesions) and
viral culture (takes 12 weeks and is less
sensitive than PCR).

LO. 10
THE DIFFERENTIAL DIAGNOSIS OF HERPES
ZOSTER

1.
2.
3.
4.

Herpes Simplek
Varicella
Impentigo vesicobulosa
In the prodromal pain is often
misdiagnosed local rhematic disease with
angina pectoris
5. Contact dermatitis
6. Cellulitis

LO. 11
Management Of Herpes Zoster

Given powder calamine lotion can be given

to reduce discomfort and drain the vesicular
lesions.
Oral administration of prednisone 30 mg
daily or 48 mg daily triamcinolone will
shorten the pascaherpatik neuralgia.
Treatment with immunomodulators such as
interferon antiviral isoprinosin and can be
considered.

LO. 12
Herpes Zosters Prevention

Primary
Prevention

Secondary
Prevention

1. Active Prevention
Varicella Vaccine (Live
attentuated vaccine)

 Commonly used antiviral drugs acyclovir and its

modifications are, for example valacyclovir. Should be
given within the first 3 days since the lesion appeared.
The recommended dose of acyclovir is 5 x 800 mg a day
and 7 days whereas normally used enough valacyclovir
100 mg 3 times a day because of a higher concentration
in plasma. If new lesions still arise the drug can still be
routed and terminated after 2 days since the lesions do
not arise again.
Varicella vaccine can be given to a child or adult, and
very high ectivitas in preventing infection.

2. Passive Prevention
ZIG (Zoster Imun Globulin)
Definition
Doses
Effect
ZIP (Zoster Imun Plasma)
Definition
Doses
Effect

LO. 13
Complication Of Herpes Zoster
Although herpes zoster is rarely, if ever,
fatal in itself, it may be considered a
contributing factor to death in some
individuals who are severely debilitated.
Westenend and Hoppenbrouwers reported
fatal hemorrhagic encephalitis in an
otherwise healthy female. The condition
has
numerous
potential
nonfatal
complications, as follows

LO. 14
Prognosis Of Herpes Zoster
prognosis of this disease is good. But
for the patient with Herpes Zoster
Ophtalmic should get treatment
quickly.
Vesicles should be drained to prevent
secondary infection

FINAL CONCLUSION
An Acehnese 47-year-old man was consulted from the
department of pulmonary disease to Royal Prima Hospital
Medans skin clinic must be given:
1. Tzarack smear Tzanck Smear
2. Direct Fluorescent Assay (DFA)
3. PCR (polymerase chain reaction)
Need some medical treatment like:
. Give neurotropik medicines: vitamin B1, B6 and
vitamin B12
. Vaksin passive.