Hemicellulose Dressing for Skin Lesions Caused by Herpes Zoster in a Patient With Leukemia—An Alternative Dressing

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Author(s): 
Julieta Chacon, RN, MS; Lydia Ferreira, MD, PhD; From the Graduate Program in Plastic Surgery and Division of Plastic Surgery, Federal University of São Paulo, Brazil

Abstract: Herpes zoster is a painful disease that can develop in immunosuppressed children. Prolonged immunosuppression in leukemia patients can substantially delay healing of herpetic lesions. The purpose of this report was to evaluate the use of hemicellulose dressings as an alternative treatment for extensive herpetic lesions in an immunosuppressed child with leukemia. The hemicellulose dressing was applied to the lesions on the second day after debridement. After 36 days, the lesions were completely healed. The hemicellulose dressing was an effective resource for promoting complete epithelial healing.



Address correspondence to:
Julieta Chacon, RN, MS
Disciplina de Cirurgia Plástica, UNIFESP
Rua Napoleão de Barros 715, 4˚ andar
CEP 04024-002 São Paulo
Brazil
Phone: 55 11 5576 4118
E-mail: julieta.chacon@uol.com.br



     The varicella-zoster virus (VZV) belongs to the herpes virus group. It causes varicella (chicken pox) and herpes zoster (shingles) as a result of viral reactivation. This virus can remain latent for years without causing any clinical symptoms.1,2 Individuals affected by VZV may not develop complete immunity against the virus, which remains latent in the ganglia. When conditions are favorable, the virus is reactivated and spreads along peripheral nerve fibers reaching the skin. 1,2 It affects men and women, and occurs more frequently in adults and the elderly. 3

     Before skin lesions appear, painful symptoms and localized paresthesias are observed simultaneously with cutaneous hyperalgesia caused by nerve inflammation.4 Cutaneous manifestations start with vesicles, which may coalesce along a nerve pathway. Crusts typically begin to form after a few days. This process is followed by epithelialization, which leaves pigmented skin patches that tend to disappear. The cutaneous manifestations are limited to one side of the body where the affected nerve is located; bilateral manifestations are rare.5–7

     The occurrence of herpes zoster may be indicative of decreased immune response. The disease will manifest in almost 15% of children with leukemia. These patients rarely experience painful conditions resulting from postherpetic neuralgia, which is difficult to treat and may persist for months or years after the cutaneous manifestations have resolved.2,4,8,9 Herpes zoster is a self-limiting disease with time to resolution of about 15 days. However, prolonged immunosuppression in patients with leukemia can substantially delay healing of herpetic lesions, leading to more severe lesions, and longer time for disease resolution—a condition that may be aggravated by the presence of infection.

     The treatment of any lesion needs to be individualized. Careful evaluation must take place with respect to indications and contraindications, efficacy, cost, and benefits before a dressing is selected. The need for or selection of treatment of lesions depends on the cause of the disease and systemic and local factors such as level of contamination and type of exudate. Since healing is a systemic and dynamic process, an effective dressing should support this process.1,10

     Topical acyclovir is commonly used to treat simple herpes zoster lesions. However, for the treatment of more extensive lesions, other coverage options that provide pain relief and prevent infections need to be considered to avoid complications during the healing process. Although we have no knowledge of the use of cellulose dressings in the treatment of herpetic lesions, this type of dressing may be beneficial in patients with herpes zoster because it provides a moist wound environment, pain relief, and an antibacterial barrier. However, secondary dressings are required and need to be changed every 42–72 hours.

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