Facial Herpes Zoster: A 15-year Retrospective Single-Center Study / 대한피부과학회지

BACKGROUND: Many studies about herpes zoster exist in the Korean dermatologic literature. However, few studies have reported about facial herpes zoster and its complications. OBJECTIVE: The purpose of this study was to investigate the epidemiology, clinical features, and complications of facial herpes zoster. METHODS: We analyzed the medical records of 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized patients into 8 groups based on the dermatomal distribution of herpetic lesions. We investigated the correlations between clinical features, prognosis, and complications. RESULTS: We analyzed the medical records of 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized patients into 8 groups based on the dermatomal distribution of herpetic lesions. We investigated the correlations between clinical features, prognosis, and complications. Results: The most common site of involvement of facial herpes zoster was the ophthalmic branch of the trigeminal nerve (59.2%). Herpes zoster involving the ophthalmic and the maxillary branches of the trigeminal nerves showed a significantly higher incidence rate of herpes zoster ophthalmicus than that observed with herpes zoster involving only the ophthalmic branch (odds ratio 7.373). Age and periorbital swelling were significantly correlated with herpes zoster ophthalmicus (p<0.001). Facial palsy was significantly correlated with otalgia and cutaneous ear involvement (p<0.001). Postherpetic neuralgia (PHN) occurred in 41% of patients with facial herpes zoster. Patients who received antiviral treatment within 3 days showed lower rates of PHN (35.8%) than patients who received treatment after 4 days (45.4%) (p=0.002). CONCLUSION: Facial herpes zoster is associated with several neurological complications. Variables including age, periorbital swelling, otalgia, and cutaneous ear involvement are useful predictors of complications and prognosis. Early institution of antiviral treatment and appropriate interdepartmental consultations are required for better treatment outcomes.

The Clinical Characteristics of Facial Herpes Zoster in Korean Patients

PURPOSE: To investigate the clinical characteristics of Korean patients with facial herpes zoster. METHODS: The present study enrolled patients with facial involvement among the patients with herpes zoster. The percentage of involved branches of the trigeminal nerve, types and frequency of ocular complications, and changes in visual acuity depending on systemic treatment were analyzed. RESULTS: A total of 146 patients (15.9%) out of 916 patients with herpes zoster were diagnosed with facial herpes zoster. The ophthalmic branch was the most frequently involved (55.5%), and coinfection with the ophthalmic and maxillary branch was also common (31.5%). Ocular complications developed in 82 eyes (56.2%) and were most common in the group of coinfection with the ophthalmic and maxillary branch (Fisher's exact test, p=0.003). Conjunctivitis (72.0%) was the most commonly observed ocular complication, while punctate keratitis and endothelitis were also frequent. After treatment with a systemic antiviral agent, visual acuity was significantly improved (paired t test, p=0.001). CONCLUSIONS: A higher incidence of ophthalmic complications was observed in facial herpes zoster patients with a wider area of involvement, including the ophthalmic branch. There was significant improvement of visual acuity and ocular complications after systemic treatment. Therefore, systemic antiviral treatment should be considered when a broad herpes zoster skin lesion is observed.