erythematous papules coalesce into plaques. Vesicles and blisters were also seen. The lesion was on left side only and did not extend to the right side.
L3 involvement – it involves two separate areas: 1. lower back area. 2. inner thigh. Note that the skin lesion is not continuous. ( L3 – 脊神經腰3之皮區)
【病例簡介】
41歲女士, 因痛性皮疹一個多星期來我診所就診. 最初患者感覺(左下)腰痛,随後在一片紅斑的基礎上發生一些丘疹和小水疱.皮疹由左下腰逐漸擴散至左側臀部、左大腿內側及後方、以及左膝中部.
當左下腰痛性皮疹發生後不久,患者往看跌打醫生.跌打醫生按腰扭傷治療.幾日後皮疹擴散至大腿,跌打醫生意識到並非單純的腰扭傷,於是轉介給我.
皮膚科檢查發現皮疹位於 脊神經 腰3之皮區(見上圖),在一片紅斑的基礎上發生丘疹和小水疱, 皮疹非常疼痛. 據此,帶狀疱疹的臨床診斷很容易確定. 我給她口服Acyclovir,兩日後患者症狀改善,治療一星期後患者痊癒.患者並無疱疹後神經痛(帶狀疱疹的皮疹癒後遺留下持續性的疼病稱為疱疹後神經痛).
Case presentation:
This 41 year old lady came to see me for her left buttock painful rash which has lasted for more than one weeks. It started as left lower back pain and then some papules and vesicles appeared upon an erythematous back ground. The rash went down from her left lower back to her left buttock then spread to her left inner thigh (also back of left thigh). The rash continued to go down to the medial aspect of her left knee.
Soon after the appearance of the painful rash on her left lower back, she went to see a traditional Chinese bone setter and was treated as sprained back. A few days later, the rash spread to the thigh and the traditional Chinese medicine practitioner thought it was not a simple sprained back case and he referred her to see me.
On dermatological examination, she was found to have skin rash distributed in the L3 dermatome. There were papules and vesicles on an erythematous base. The lesions were very painful.
A clinical diagnosis of herpes zoster was esily made. Oral acyclovir was given and the symptoms improved in two days time. After one week of oral medication, patient had recovered from the illness.
She did not suffer from post herpetic neuralgia (persistent pain after recovery from the illness).
一、咩係帶狀皰疹？
帶狀皰疹（俗稱「皮蛇」或者「飛蛇」）同水痘一樣，都係由水痘帶狀皰疹病毒（Varicella Zoster Virus）引起。第一次感染呢隻病毒就會出水痘，有時仲會影響腦部。之後病毒會長期潛伏喺脊椎神經根入面。當身體抵抗力下降，病毒就會再度活躍，沿住神經走到皮膚，令到皮膚出紅疹。紅疹通常只會喺身體一邊出現，好多時係胸口、軀幹或者面部。大部分人一生只會發病一次，但亦有可能多次復發。
二、帶狀皰疹會唔會傳染？
如果身體入面冇潛伏嘅水痘帶狀皰疹病毒（即係未出過水痘），就唔會直接患上帶狀皰疹。不過，帶狀皰疹患者有機會將病毒傳染畀未感染過嘅人，令佢哋第一次感染時出水痘。
三、帶狀皰疹有咩徵狀？
- 初期通常係受影響神經範圍出現痛楚，因為病毒沿住神經復發，令神經發炎。痛楚程度因人而異，有人覺得輕微，有人痛到受唔住。
- 幾日之後，身體或者面部一邊會出紅疹同水泡。
- 一星期內，紅疹同水泡會陸續再出，痛楚加劇。
- 之後水泡會慢慢結痂，紅腫消退。由出紅疹開始計，整個過程通常要三至四星期。
- 雖然全身任何部位都有機會出皰疹，但胸口、腰部同面部最常見。
- 如果生喺眼睛附近要特別小心，因為可能會永久傷害眼睛，需要眼科醫生處理。
四、治療同護理要注意嘅地方：
- 一般接受適當治療後，兩至五星期內會痊癒，但免疫力差嘅人（例如愛滋病患者）可能要更耐時間。
- 抗病毒藥物愈早食愈有效，最好喺出疹三日內開始。早期用藥可以減少新水泡生出，亦有助減輕痛楚同縮短「皰疹後神經痛」嘅時間。
- 止痛藥可以舒緩神經痛；嚴重或者影響到眼睛嘅患者，醫生可能會用類固醇配合抗病毒藥。
- 如果有皰疹後神經痛，除咗止痛藥，仲可以加抗抑鬱藥，甚至考慮做神經阻斷術。
- 皮膚傷口要由醫護人員處理，唔好自己掂紅疹或者整破水泡，更唔好亂搽萬金油、小護士或者草藥膏，否則容易感染同留疤。要有足夠休息同均衡飲食，避免酒精同辛辣刺激食物。
- 著寬鬆衫，減少磨擦水泡同減輕痛楚。
五、可能嘅併發症：
雖然大部分人一個月內會痊癒，但有啲人會出現併發症：
- 皰疹後神經痛：係最常見嘅併發症，痛楚可以持續幾星期、幾個月甚至幾年，年紀愈大愈容易出現。
- 繼發性細菌感染：皮膚容易受細菌感染，令傷口難以痊癒同留疤。
- 眼部併發症：病毒可能影響眼睛，引起結膜炎、角膜炎、葡萄膜炎，嚴重可致青光眼甚至失明。
- 神經併發症：較少見，但可能導致肌肉無力或者腦膜炎。
- 膀胱功能問題：有時會出現小便困難或者便秘。