▲Intercostal nerve blockade. (Photo courtesy/Xu Youjun)
Text/Xu Youjun
Chickenpox, a common problem among children in the past, has greatly reduced the proportion of outbreaks after the popularization of vaccines. However, symptoms such as rashes, blisters, and skin pains on adults are often heard. As long as you have ever been infected with chickenpox virus, when the body’s immunity is weakened, the “inactivated” chickenpox virus that originally hid in the ganglion will be induced. It will produce blisters and severe pain along the affected nerves, often in the form of bands or flakes, so it is called herpes zoster, also commonly known as skin snakes.
After the epidemic, Ms. Wang worked overtime day and night to improve her performance, and also took care of housework. She was under great pressure. Recently, I felt pain in the right waist and abdomen, and blisters and rashes appeared. I thought it was pimples at first, but after applying the ointment, it hurts more, and the area will expand after scratching. After being diagnosed with herpes zoster by a dermatologist, although antiviral drugs and anti-inflammatory painkillers were started, the pain did not ease with the skin snake disappearing after a few weeks. For the area of postherpetic neuralgia, a professional doctor performed corresponding intercostal nerve block under ultrasound positioning (as shown in the picture), and the pain finally disappeared.
Risk factors for skin snakes include: high stress, low immunity, and elderly people. Oral and topical antiviral drugs are generally effective, and most of the rashes and blisters that appear can be cured in about 2-4 weeks. However, during the attack, the nerves damaged by the chickenpox virus will cause severe pain, and there may be needles and burning sensations. Sometimes light touch and wind can also induce pain. The pain of most patients will also be relieved with the disappearance of the rash, but in some cases, the pain may last for several months to several years, making the patient miserable.
For neuralgia after herpes zoster, oral medicine, vitamin B, transcutaneous electrical nerve stimulation, laser and other rehabilitation treatments can be used for treatment. If the effect is not good and the pain is still severe, you can consider performing several nerve blockades according to the attack area, such as the intercostal nerve or the trigeminal nerve in the face, and usually achieve good relief.
In addition, skin snakes are not immune for life and relapses are common. To reduce the incidence of herpes zoster and neuralgia, the most important thing is to enhance immunity, proper rest, exercise, and a balanced diet.
(The author is concurrently the attending physician of the North Nursing Branch of National Taiwan University Hospital and the director of the Shun Hsin Rehabilitation Clinic)
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