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