Herpes Zoster Infection Involving the Hand and Upper Extremity

Kim,  JunHyung; Eo,  SuRak; Cho,  SangHun; Lee,  SeungHo

Journal of the Korean Society for Surgery of the Hand 2010;15(1):21-26.
Published online March 1, 2010.

JunHyung Kim, SuRak Eo, SangHun Cho, SeungHo Lee

¹Department of Plastic and Reconstructive Surgery, Dongguk University Ilsan Hospital, Gyeonggi-do, Korea. sreo@duih.org
²Department of Dermatology, Dongguk University Ilsan Hospital, Gyeonggi-do, Korea.

Abstract

Purpose
Herpes zoster, or shingles is caused by reactivation of varicella zoster virus lying latent in the ganglion of the dorsal root. It is rare in hand and upper extremities. The aim of this study is to report the shingles occurred in the hand, upper extremity along the various dermatome. MATERIALS AND METHODS: Between October of 2006 and August of 2009, patients with herpes zoster infection in hand and upper extremity were reviewed. The mean age of the patients was 61.4 years, and there were four female patients, one male patient. With the appropriate diagnosis, antiviral agent such as acyclovir(Zovirax(R)), Zovirax(R) cream were applied within 72 hours of skin lesions. Analgesics and wet dressing were commonly applied for relief of acute pain. To prevent the secondary infection and postherpetic neuralgia, tricyclic antidepressants, anticonvulsants and opioids were also prescribed.

Results
Herpes zoster infection was occurred along the distribution of ulnar nerve in three cases, radial nerve in one case and medial antebrachial cutaneous nerve in one case. Four patients developed unilateral vesicular eruption with dermatomal rash in addition to severe pain. But, one patient did not show any significant signs on physical exam except dysesthesia along the ulnar nerve distribution in hand and forearm. All of the patients were relieved acute pain, skin rash within 1-2 weeks. There were no recurrence and complications during the one year follow-up period.

Conclusions
It is important that hand surgeons should not misdiagnose the possibility of herpes zoster infection even without developed skin rash. Early diagnosis, appropriate treatment can lower the risk of its complications.