Differential diagnosis:

1. This disease sometimes needs to be differentiated from herpes simplex. The latter usually occurs at the junction of skin and mucosa, with irregular distribution, small blisters that are easy to break and no pain. More common in the process of fever (especially high fever), it is often easy to relapse.

2. Occasionally confused with contact dermatitis, but the latter has a history of contact. The rash has nothing to do with nerve distribution, and it is burning, itching and no neuralgia.

3. In the prodromal period of herpes zoster and herpes zoster without rash, people with obvious neuralgia are easily misdiagnosed as intercostal neuralgia, pleurisy and acute appendicitis, which need to be paid attention to.

4. Herpes simplex usually has a history of multiple recurrences in the same site, but there is no such phenomenon in patients with herpes zoster who have no obvious immune deficiency. Isolation of virus from blister fluid or detection of VZV, HSV antigen or DNA is the only reliable differential diagnosis method.

Treatment:

1. drug therapy

(1) The antiviral drug can be acyclovir, valaciclovir or famciclovir.

(2) Drug treatment of neuralgia ① The main antidepressants are paroxetine, fluoxetine, fluvoxamine and sertraline. ② Anticonvulsants include carbamazepine and sodium valproate. 3 narcotic analgesics Analgesics represented by morphine. The available drugs are morphine (MS contin), oxymorphone (MS contin), oxycodone, fentanyl (Durogesic), dihydroetorphine and Gai Ke. ④ Non-narcotic analgesics include non-steroidal anti-inflammatory drugs, tramadol, aconite alkaloids and capsaicin.

2. Nerve block

When severe pain drugs are difficult to control, direct and effective sensory nerve block therapy should be considered. The choice of blocking position should depend on the lesion scope and treatment response. The general principle should be from shallow to deep, from simple to complex, from terminal to nerve trunk and nerve root.

3. Nerve injury

Radio frequency thermocoagulation is the most direct and effective treatment for nerve destruction. The treatment of nerve injury also includes stereotactic radiotherapy of medial thalamus (gamma knife or X knife), surgical treatment of spinal cord dorsal root injury in subdural cavity, pituitary injury, sympathetic trunk ganglion injury and so on.