OBJECTIVE: To compare the clinical efficacy between the combined therapy of fire needling and cupping, and western medication on herpes zoster of acute stage, as well as the effects on Th17 and Treg cells and inflammatory factors, i.e. IL-10 and IL-17 in the peripheral blood. METHODS: Eighty patients with herpes zoster of acute stage were randomly divided into a combined therapy (fire needling plus cupping) group and a western medication group, 40 cases in each one. In the combined therapy group, the pricking and scattering techniques with fire needle were used at ashi points and Jiaji (EX-B 2) corresponding to the affected spinal segments; afterwards, cupping therapy was delivered. The combined treatment was given once daily. In the western medication group, valaciclovir hydrochloride tablet and vitamin B₁ tablet were administered orally. The duration of treatment in each group was 10 days. Before each treatment from day 1 to day 10 and on day 11 , the score of symptoms and physical signs was observed in the two groups separately. Before each treatment from day 1 to day 10 and on day 11, 30, 60, the score of visual analogue scale (VAS) and skin lesion indexes were observed in the two groups. On day 60, the incidence of postherpetic neuralgia was recorded in the two groups. The levels of Th17 and Treg cells, Th17/Treg ratio in the peripheral blood, as well as serum levels of IL-10 and IL-17 were detected before and after treatment in the two groups. The clinical efficacy was compared between the two groups. RESULTS: From day 6 to day 10 during treatment and on day 11, the scores of symptoms and physical signs in the combined therapy group were lower than those of the western medication group (P<0.05, P<0.01). On day 3, day 6 to day 10 during treatment and day 11, day 30, VAS scores in the combined therapy group were lower than those of the western medication group (P<0.05, P<0.01). On day 60, the incidence of postherpetic neuralgia in the combined therapy group was lower compared with that in the western medication group (P<0.05). The blister arresting time and scabbing time in the combined therapy group were shorter than those of the western medication group (P<0.05). After treatment, the level of Th17, and Th17/Treg ratio in the peripheral blood, as well as the serum levels of IL-10 and IL-17 were all lower in comparison with those in the western medication group (P<0.05). The curative and remarkably effective rate was 82.5% (33/40) in the combined therapy group, higher than 62.5% (25/40) in the western medication group (P<0.05). CONCLUSION The early application of fire needling combined with cupping therapy can effectively treat herpes zoster of acute stage, relieve pain, and reduce the incidence of postherpetic neuralgia, which may be related to reducing the levels of Th17 and Treg cells, and Th17/Treg ratio in the peripheral blood, as well as the serum levels of IL-10 and IL-17 so that the cellular immune balance is modulated.
Humans ; Neuralgia, Postherpetic ; Acupuncture Therapy/methods* ; Interleukin-10 ; Interleukin-17 ; T-Lymphocytes, Regulatory ; Cupping Therapy ; Th17 Cells ; Herpes Zoster/therapy* ; Treatment Outcome ; Tablets

OBJECTIVE: To investigate herpes zoster reactivation induced by arsenic in patients with acute promyelocytic leukemia (APL). METHODS: The clinical data of 212 patients with APL treated in the Department of Hematology of the First Affiliated Hospital of Xi'an Jiaotong University from 2008 to 2019 were retrospectively analyzed to observe the activation of varicella zoster virus induced by arsenic. Kaplan-Meier analysis, chi-square test, and boxplot were used to analyze and describe the cumulative dose of arsenic and the time from the beginning of arsenic treatment to the occurrence of herpes zoster. RESULTS: Excluding early death cases and early automatic discharge cases, 17 cases developed herpes zoster reactivation in 175 patients with APL treated with arsenic, and the cumulative median dose of arsenic was 6.2(2-12) mg/kg. Precise risk of reactivation of herpes zoster with 10 months in APL patients treated by arsenic was 9.7%. CONCLUSION Arsenic treatment can induce high reactivation rate of herpes zoster virus.
Arsenic ; Herpes Zoster/epidemiology* ; Herpesvirus 3, Human ; Humans ; Leukemia, Promyelocytic, Acute/drug therapy* ; Retrospective Studies

The clinical experience of He's three-clear method by stages for herpes zoster on the head and face is summarized. The strong-clear method (blood-letting therapy) combined with mild-clear method (acupuncture with filiform needle) are applied for the acute pain period and subacute pain period of herpes zoster on the head and face. For acute pain period, the bleeding volume should be large (more than 10 mL), and treatment is given once every other day; for the subacute pain period, the bleeding volume should be 5-10 mL, and treatment is given 2-3 times a week. In the chronic pain period, the fire needle of the warm-clear method combined with mild-clear method (acupuncture with filiform needle) are applied for the syndrome of qi-stagnation and blood-stasis, while the warm acupuncture of the warm-clear method combined with mild-clear method (acupuncture with filiform needle) ware applied for the syndrome of qi-deficiency yin-injury blood-stasis.
Acupuncture Therapy ; Acute Pain ; Bloodletting ; Herpes Zoster/therapy* ; Humans ; Hyperplasia ; Needles

OBJECTIVE: To explore and analyze the risk factors of herpes zoster in patients with multiple myeloma (MM) during the chemotherapy with bortezomib. METHODS: Clinical data of 85 MM patients treated with bontizomib from January 2015 to January 2019 were selected and divided into case group and control group accroding to the occurred of herpes zoster. The clinical characteristic, treatment outcome and related factor of herpes zoster were retrospective analyzed. RESULTS: Twenty of the 85 patients with MM treated with bortezomib developed herpes zoster occurred (23.5%). Single-factor analysis showed that age≥65 years, lymphocytopenia occurred before treatment, neutropenia occurred before treatment, ECOG score≥2, application of cyclophosphamide, absence of preventive antiviral therapy were associated with the genesis of herpes zoster (P＜0.05). Multivariate logistic regression analysis showed that lymphocytopenia occurred before treatment, the application of cyclophosphamide and the absence of preventive antiviral therapy were the independent risk factors for herpes zoster (P＜0.05). CONCLUSION The incidence of herpes zoster is high in the multiple myeloma patients treated with bortezomib. Lymphocytopenia occurred before treatment, the application of cyclophosphamide, and the absence of prophylactic antiviral therapy are the important risk factors for herpes zoster, for which the clinicians should attach great importance.
Boronic Acids ; Bortezomib ; Herpes Zoster/epidemiology* ; Humans ; Multiple Myeloma/drug therapy* ; Patients ; Pyrazines ; Retrospective Studies ; Risk Factors

PURPOSE: Despite the successful use of tyrosine kinase inhibitors (TKIs) in cancer patients, their effect on herpes zoster development has not been studied. The aim of this study was to evaluate and compare the effects of epidermal growth factor receptor (EGFR) TKI and cytotoxic chemotherapy on the risk of herpes zoster development in non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS: We conducted a medical review of all eligible NSCLC patients in Seoul National University hospital between 2002 and 2015. We classified patients based on whether they previously underwent EGFR TKI therapy into either the TKI group or the cytotoxic group. We compared the incidence rates of herpes zoster during TKI therapy and cytotoxic chemotherapy. Additionally, the longitudinal risk of herpes zoster from TKIs was analyzed using the incidence rate ratio (IRR) of the TKI group to the cytotoxic group and the log-rank test of the Kaplan-Meier method. RESULTS: Of the 2,981 NSCLC patients, 54 patients (1.54%) developed herpes zoster. In the TKI group (2,002 patients), the IRR of herpes zoster during TKI therapy compared to that during cytotoxic chemotherapy was 1.05 (95% confidence interval [CI], 0.53 to 2.09). The IRR of the TKI group compared to the cytotoxic group was 1.33 (95% CI, 0.64 to 2.76). The Kaplan-Meier cumulative risk of both groups was not significantly different. CONCLUSION: Our results show that the incidence rate of herpes zoster in the TKI group was not statistically different from the incidence in the cytotoxic group during and after chemotherapy in NSCLC patients.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy* ; Erlotinib Hydrochloride ; Herpes Zoster* ; Humans ; Incidence ; Methods ; Protein-Tyrosine Kinases* ; Receptor, Epidermal Growth Factor ; Seoul ; Tyrosine*

The clinical experience of professor is introduced in treatment of herpes zoster and post-neuralgia with herbal thread moxibustion of medicine combined with acupuncture. Professor divides the pathological process of herpes zoster into pre-herpes stage, herpes stage and post-herpes stage. At pre-herpes stage, in pathogenesis of medicine, the deficiency of antipathogenic , invasion of pathogens, retarded and blood circulation in dragon and fire pathways are involved. Clearing heat, detoxification, promoting circulation in the pathways and dispersing and blood are considered in treatment. The herbal thread moxibustion is provided at " point" and " point" and seize "the head and tail of snake", and 3 needles are used at each of ends of skin leison. At herpes stage, toxin stagnation in dragon and fire pathways, stagnation on skin and muscle, and blood disturbance and dysfunction of three kinds of are considered in pathogenesis. The treatment focuses on removing pathogens and toxin, assisted with regulating and blood circulation, removing herpeses and promoting wound healing. The herbal thread moxibustion is used at " point", " point" and the two ends of skin lesion. The local row-like puncture is provided at skin lesion according to the intercostals nerve distribution. At post-herpes stage, the retention of pathogens and stagnation of blood in dragon and fire pathways are considered in pathogenesis. The treatment focuses on activating blood circulation, removing stasis and eliminating the pathogen residuals. " point", " point" and the two ends of skin lesion are selected in herbal thread moxibustion, or sweeping and dragging techniques of acupuncture are adopted. The timely application of herbal thread moxibustion controls the development of herpes zoster and prevents from post-neuralgia.
Acupuncture Therapy ; Clinical Protocols ; Herpes Zoster ; Humans ; Mind-Body Therapies ; Moxibustion

OBJECTIVE: To compare the efficacy difference between thumb-tack acupuncture with surrounding needling method plus medication and medication alone for herpes zoster (HZ) of stagnated heat in liver meridian type. METHODS: According to random number table method, 60 patients with HZ of stagnated heat in liver meridian type were randomly divided into an observation group and a control group, 30 cases in each one. All the patients were treated with oral valaciclovir hydrochloride dispersible tablets (0.3 g per time, twice per day), mecobalamin tablets (0.5 mg per time, three times a day) and vitamin B (10 mg per time, three times a day) for 15 days. In addition, the patients in the observation group were treated with thumb-tack acupuncture at area 1 cm outside the herpes, with an interval of 3 cm between thumb-tack needles. The thumb-tack acupuncture was given once every 3 days, retained for 48 h, with an interval of 1 day between treatments, and totally 5 treatments were given. The index of herpetic evaluation (stopping time of herpes, scarring time, decrustation time), visual analogue scale (VAS), serum immune-related factors (IgG, IgM, IgA) and serum inflammatory factors (IL-4, IL-17, TNF-α, TGF-β1) were observed before and after treatment in the two groups. RESULTS: After treatment, the stopping time of herpes, scarring time, decrustation time in the observation group were shorter than those in the control group (all <0.05). Compared before treatment, the VAS score in the two groups were reduced after treatment (both <0.05), and no significant difference was observed between the two groups (>0.05), but the difference before and after treatment in the observation group was superior to that in the control group (<0.05). Compared before treatment, the levels of serum immune-related factors IgG, IgM, IgA were increased in the two groups after treatment (all <0.05), and the levels in the observation group after treatment were higher than those in the control group (all <0.05). Compared before treatment, the levels of serum inflammatory factors IL-4, IL-17, TNF-α, TGF-β1 were reduced in the two groups after treatment (all <0.05), and the levels in the observation group after treatment were lower than those in the control group (all <0.05). CONCLUSION The thumb-tack acupuncture with surrounding needling method plus medication have the advantages of rapid onset and analgesic effect for HZ of stagnated heat in liver meridian type, which could also improve serum immune-related factors and reduce inflammatory reaction.
Acupuncture Therapy ; Herpes Zoster ; therapy ; Hot Temperature ; Humans ; Liver ; Meridians ; Thumb ; Treatment Outcome

OBJECTIVE: Rheumatoid arthritis (RA) patients suffer from an increased risk of herpes zoster (HZ) partially due to immunosuppressant medications. This study investigated HZ in RA patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs), as compared with conventional DMARDs (cDMARDs). METHODS: This retrospective case series study assembled record information of 277 RA patients who received bDMARDs after failure of at least one cDMARDs at Seoul National University Hospital between August 2003 and February 2015. Following capture of baseline information and identification of HZ episodes, crude HZ incidence rates per 100 patient-years (95% confidence intervals) were calculated. RESULTS: For 718 treatment courses, 277 (38.6%) comprised cDMARDs, 66 (9.2%) infliximab, 175 (24.4%) etanercept, 95 (13.2%) adalimumab, 9 (1.3%) golimumab, 41 (5.7%) rituximab, 31 (4.3%) abatacept, and 24 (3.3%) tocilizumab. There were 37 HZ episodes, 16 during cDMARD treatment courses, and 21 accompanying bDMARDs, two with infliximab, eight with etanercept, five with adalimumab, and three each with rituximab and abatacept. The crude HZ incidence rate per 100 patient-years was 2.4 (1.4∼3.9) for cDMARDs, 2.2 (0.3∼7.9) for infliximab, 1.8 (0.8∼3.6) for etanercept, 3.7 (1.2∼8.4) for adalimumab, 3.9 (0.8∼11.0) for rituximab, and 8.5 (1.8∼23.1) for abatacept. CONCLUSION: We conclude that bDMARDs do not always increase the risk of HZs in RA patients, although HZ rates vary for different bDMARDs.
Abatacept ; Adalimumab ; Antirheumatic Agents ; Arthritis, Rheumatoid* ; Biological Therapy ; Etanercept ; Herpes Zoster* ; Humans ; Incidence ; Infliximab ; Retrospective Studies ; Rituximab ; Seoul

BACKGROUND/AIMS: The frequencies of opportunistic diseases (ODs) vary across countries based on genetic, environmental, and social differences. The Korean HIV/AIDS cohort study was initiated in 2006 to promote research on human immunodeficiency virus (HIV) infection in Korea, and to provide a logistical network to support multicenter projects on epidemiological, clinical, and laboratory aspects of HIV infection. This study evaluated the prevalence of ODs among HIV-infected patients in the era of highly active antiretroviral therapy, and the risk factors associated with ODs. METHODS: The study enrolled 1,086 HIV-infected patients from 19 hospitals. This study examined the baseline data of the HIV/AIDS Korean cohort study at the time of enrollment from December 2006 to July 2013. RESULTS: Candidiasis was the most prevalent opportunistic infection (n = 176, 16.2%), followed by Mycobacterium tuberculosis infection (n = 120, 10.9%), Pneumocystis jirovecii pneumonia (n = 121, 11.0%), cytomegalovirus infection (n = 52, 4.7%), and herpes zoster (n = 44, 4.0%). The prevalence rates of Kaposi’s sarcoma (n = 8, 0.7%) and toxoplasmosis (n = 4, 0.4%) were very low compared with other countries. The risk factors for ODs were a low CD4 T cell count at the time of HIV diagnosis (odds ratio [OR], 1.01; p < 0.01), current smoking (OR, 2.27; p = 0.01), current alcohol use (OR, 2.57; p = 0.04), and a history of tuberculosis (OR, 5.23; p < 0.01). CONCLUSIONS: Using recent Korean nationwide data, this study demonstrated that an important predictor of ODs was a low CD4 T cell count at the time of HIV diagnosis. Tuberculosis remains one of the most important ODs in HIV-infected patients in Korea.
AIDS-Related Opportunistic Infections ; Antiretroviral Therapy, Highly Active ; Candidiasis ; Cell Count ; Cohort Studies* ; Cytomegalovirus Infections ; Diagnosis ; Herpes Zoster ; HIV ; HIV Infections ; Humans ; Korea ; Mycobacterium tuberculosis ; Opportunistic Infections ; Pneumocystis jirovecii ; Pneumonia ; Prevalence ; Risk Factors ; Sarcoma ; Smoke ; Smoking ; Toxoplasmosis ; Tuberculosis

Following anti-retroviral therapy (ART) or highly active antiretroviral therapy, there is an increased response to latent infections such as herpes zoster, which may lead to their reactivation. This is a result of improved immunity brought about by ART, also termed immune recovery syndrome. A 75-year-old male patient arrived at our institute with widespread vesicles and scabs on the right half of his face and oral cavity, suggesting the involvement of the trigeminal nerve. The patient had a history of being on ART two months earlier and a history of tooth extraction eight days prior to his arrival at our institute. The incidence of human immunodeficiency virus (HIV)-positive cases amongst herpes zoster cases is high, and these patients become susceptible to infections following ART. Therefore, regardless of the presence of risk factors, every herpes zoster patient should be tested for HIV infection, and high anti-retroviral therapy should be commenced/reinstituted as soon as possible. In addition, the treating physician should maintain a high level of vigilance for the patient during the first few months of ART, the peak incidence of immune recovery inflammatory disease.
Aged ; Antiretroviral Therapy, Highly Active ; Herpes Zoster* ; HIV ; HIV Infections ; Humans ; Incidence ; Male ; Mouth ; Risk Factors ; Tooth Extraction ; Trigeminal Nerve