HERPES ZOSTER Herpes zoster (Gtirtelrose, belt-ro.3e) is an affeetion which often appears accompanied with light febrile manifestations and is character ized by herpetic vesicles on hyperemic ground which arc arranged according to some system.
Clinical Picture.—In infancy, and even in the earliest days of life, under slight prodromal manifestations (elevation of temperatum, itching and burning of the skin), eruptions of groups of small nodules occur whieh change into vesicles and generally follow the track of a nerve. The nodules or vesicles usually appear in the region of an inter co.stal nerve (hence the name belt-rose), there are spasmodic recurrences for a few days until the median line has been reachetl; only rarely is the latter over-reached either in front or behind. Usually the eruptions remain unilateral. According to its appearance we distinguish herpes pectoralis, herpes facialis, herpes frontalis, etc. The shoulders and extremities are but rarely involved in children.
Herpes zoster is a comparatively infrequent affection among children in Germany. Comby counts one case in a thousand; person ally I have only seen two eases in my children's policlinic. It is very rare under two years of age, rarer still under four years, after that it occurs more frequently. It is a surprising fact that twice as many girls are affected as boys. On the other hand Bateman has found a preponderance of young people between twelve and fifteen years suffer ing from this complaint. Crocker found 75 per cent. under twenty years, Evans ob.served that half his cases of herpes zoster occurred in children under fourteen years. Whence this frequency arises (race, climate, etc.), is not yet cleared up.
The complaints in children are the slighter, the younger the It is only after they have reached the age of ten (Comby) that the pain becomes. more pronounced. Neuralgia, so trying in the adult, seems to be entirely absent. On the other hand there is often slight glandular enlargement and light keratitis (Millon). Besides, photophobia (von Gewaert) and facial paralysis (von Epstein) have been described. The fever rarely exceeds 3S° C. (100° F.) maximum 40° C. (104° F.) and lasts no longer than five to six (lays.
origin is unknown. We know that shingles appear epidemically (fall and spring), also that toxic substances (arsenic, carbon oxide gas, pywmic processes, typhoid, etc.) may produce herpes zoster. Central causes (injuries to the gray substance) may occasion zoster (Head, Babes, etc.). According to Barensprung nervous distur bances may be the cause which in their turn are occasioned by the penetration of infectious agents into the peripheral nerve terminations or into the intervertebral and spinal ganglia.
In how far family transmission (Klarnann, lillon) or local tuber culosis may be responsible for zoster, is still subject to demonstration.
The diagnosis is easy, and the prognosis favorable, as the cases run a light course and relapses in children are infrequent.
treatment consists, similarly to simple herpes, in the protection of the skin and the preservation of the cystic cover by means of salves, pastes and bandages. In these cases, too, Unna's unguent. caseini (P.G.) is of value.