The herpetic eruption within the skin is characterised by groups of tiny vesicles on an inflammatory basis. Similar vesicles may occur on the cornea and lead to scarring, opacity and even blindness. Once the acute phase of the disease has subsided, the vesicles are replaced by punctate scars irregularly dispersed on a background of shiny, hyperemic, atrophic skin. Diagnosis. Herpes zoster of the trigeminal nerve typically occurs in people of middle age or older. Most ordinarily it affects the ophthalmic division of the nerve, although alternative branches may be involved. The first symptom of the disease is severe, burning pain within the concerned space which is followed during a few days by the characteristic cutaneous eruption. The term “postherpetic neuralgia” is used to denote the pain persisting once the acute attack has subsided. If your lips could speak, they’d ask for Aloe Lips! It’s typically described as constant, burning and aching in quality. Sharp, stabbing pain may be superimposed on the constant pain.

The quality of the pain bears a shut resemblance to causalgia resulting from injury of peripheral nerves. Objective examination can disclose the characteristic scarring of the skin and cornea. Sensory examination of the involved space can demonstrate hypalgesia and hypesthesia with a superimposed hyperpathia. Treatment. Cortisone and ACTH are considered to be the drugs of choice within the treatment of herpes zoster within the acute phase. Immune globulin in doses of twenty cc. intramuscularly daily for four days has been recommended.44 The treatment of postherpetic neuralgia has been disappointing from each the medical and surgical standpoints. Additionally to the employment of sedatives and analgesics, medical regimens have included the employment of histamine, smallpox vaccination, posterior pituitary extract, radiant energy, deep x-ray therapy, varied native ap- plications, and vitamins in massive doses. A program of specific treatment has not been established.

The surgical methods that have been employed in tries to alleviate postherpetic pain embody alcohol injection of the peripheral branches of the trigeminal nerve or of the gasserian ganglion, retrogasserian neurotomy, trigeminal tractotomy, quintothalamic tractotomy, mesencephalic tractotomy, mesen-cephalotomy, resection of the postcentral sensory cortex subserving the face, cervicodorsal sympathectomy, cutaneous denervation and undercutting, and prefrontal lobotomy. None of these methods has been consistently effective in relieving pain. I have usually been approached and asked that every one important question–how to find a job. Interruption of the sensory fibers of the trigeminal nerve can typically abolish the sharp, stabbing pain but can not affect the constant, burning, aching pain within the background. Prefrontal lobotomy has been the most effective operation in relieving postherpetic pain; but, the impairment of upper intellectual function resulting from this procedure seems too high a value to justify its use in most patients. Sugar and Bucy55 have reported a case that illustrates how deeply a neurosurgeon will be concerned in an attempt to alleviate postherpetic neuralgia. Their patient had burning pain involving the first and second divisions of the trigeminal nerve.