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Research Article | DOI: https://doi.org/10.31579/2690-4861/388
Department of Otolaryngology, 988th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China, Zhengzhou 450042, Henan.
*Corresponding Author: Li Yi, Department of Otolaryngology, 988th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China, Zhengzhou 450042, Henan.
Citation: Li Yi, Wen Xiaomei, Yue Wei, Zhang Yage, Hu Haolei, Xing Peimei, et al, (2024), The Clinical Effect of External Application of Scorzonera Glabra Herpes Ointment on the Treatment of Herpes Zoster in the Ear, International Journal of Clinical Case Reports and Reviews, 16(3); DOI:10.31579/2690-4861/388
Copyright: © 2024, Li Yi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 22 January 2024 | Accepted: 19 February 2024 | Published: 29 February 2024
Keywords: herpes zoster; scorzonera glabra herpes ointment; acyclovir ointment; pure tone electrical audiometry; visual simulation scoring method
Objective to Exploring the effect of external application of scorzonera glabra Herpes Ointment on the treatment of Herpes zoster of the ear (HZE). Methods Select 100 HZE patients who met the inclusion criteria and were treated at the 988th Hospital of the Chinese People's Liberation Army Joint Logistics Support Force from January 2021 to June 2023. Divide into a treatment group and a control group using a random number table method, with 50 cases in each group. The treatment group was treated with external application of crow onion herpes ointment, while the control group was treated with external application of acyclovir ointment. After 10 days of treatment, the therapeutic effect was evaluated, and the HZE comprehensive symptom and sign efficacy score and visual analogue scale (VAS) were observed and compared between the two groups on the 10th day. The time for erythema reduction, blister stop, nodulation, and detachment were observed throughout the treatment process; Compare the difference in air conduction and air bone conduction between two groups before and after treatment (1 month after treatment); Observe and compare the incidence of postherpetic neuralgia (PHN) between two groups one month after treatment. Results The difference between the two groups was statistically significant (P<0.05), and the clinical effect of the treatment group was significantly better than that of the control group. Compared with the control group, the total score of HZE symptoms and signs in the treatment group was lower, and the difference was statistically significant (P<0.05). The comparison of air conductance between the treatment group and the control group before and after treatment (1 month after treatment) showed that the average air conductance was (35.5 ± 4.5), (35.9 ± 4.7), (15.6 ± 2.2), and (21.0 ± 3.1) dBHL, respectively; The air bone conduction differences were (10.1 ± 2.7), (10.5 ± 2.8), (5.1 ± 0.3), and (10.0 ± 2.4) dBHL, respectively. The differences in air conduction between the two groups before and after treatment (1 month after treatment) were statistically significant (P<0.05); The difference in air bone conduction between the two groups before and after treatment (1 month after treatment) was statistically significant (P<0.05); However, there was no statistically significant difference in air bone conduction difference between the control group before and after treatment (P>0.05). The incidence of PHN in the treatment group was lower than that in the control group, and the difference was statistically significant (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05).
Conclusion
The external application of scorzonera glabra Herpes Ointment has a significant effect on treating HZE, and can shorten the course of the disease, improve hearing, restore the function of the auditory nerve, and effectively prevent PHN.
The herpes zoster virus in the ear often invades the geniculate ganglia of the auditory and facial nerves, causing severe discomfort such as ear pain, deafness, and postherpetic neuralgia (PHN) [1-3]. Early active treatment of herpes zoster and peripheral neuropathic pain in the ear [4-6] can protect hearing and reduce the incidence of PHN [7]. At present, Western medicine mainly relies on antiviral drugs such as acyclovir orally or externally for the treatment of HZE, but the effect is not satisfactory. Traditional Chinese medicine treatment for HZE has the characteristics of good efficacy, short duration, and no toxic side effects. Especially in recent years, we have achieved good clinical results in the treatment of HZE with the internal preparation of scorzonera glabra herpes ointment applied externally. The specific situation is reported as follows.
1.1 General information
Select 100 HZE patients who met the inclusion criteria and were treated at the 988th Hospital of the Chinese People's Liberation Army Joint Logistics Support Force from January 2021 to June 2023. Divide into a treatment group and a control group using a random number table method, with 50 cases in each group. There was no statistically significant difference in the course, gender, age, and degree of pain between the two groups (P>0.05), indicating comparability. See Table 1. This study was approved by the Medical Ethics Committee of our hospital (SP20001 V2.0).
1.2 Diagnostic criteria
According to the "Clinical Diagnosis and Treatment Guidelines - Dermatology and Sexually Transmitted Diseases", the diagnosis of HZE is based on the fact that the rash is caused by a single ear, with visible blisters on the auricle, external ear canal, and tympanic membrane surface, as well as band like erythema and clustered herpes, accompanied by peripheral nerve pain.
1.3 Inclusion criteria
① Meets HZE diagnostic criteria; ② The appearance time of the skin lesion is less than 3 days, and no medication or method has been used before the visit; ③ Age 13y-60y; ④ The principle of voluntariness, understanding and reasoning, and signing an informed consent form.
1.4 Exclusion criteria
① Individuals who are allergic to acyclovir; ② Long term suffering from severe cardiovascular and cerebrovascular diseases and difficulty in controlling blood sugar; ③ Pregnant or lactating women; ④ Long term use of corticosteroids or immunosuppressants.
1.5 Dosage method
The treatment group applied graffiti scallion herpes ointment (The 988th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China.batch number: 20200310, specification: 30g/box) on the affected area, with a thickness of about 0.1mm, 5 times a day, covered with sterile gauze for 3 hours before removal. The control group applied acyclovir ointment externally to the affected area [Jiangsu Yongda Pharmaceutical Co., Ltd., National Medical Standard H19993851, specification: 10g, 300mg (3%)], with a thickness of approximately 0.1mm, 5 times a day. All patients were treated continuously for 10 days. At the same time, both groups were treated with methylprednisolone injection (Pfizer Pharmaceuticals, National Medical Standard HJ20170197, specification: 40mg) 500mg+0.9% physiological saline 250ml pulse therapy, intravenous infusion, and discontinuation for 3 consecutive days.
Table 1 Comparison of baseline data between two groups
1.6 Observation of therapeutic effects
1.6.1 Observation indicators: Observe and record the patient's symptoms and signs before treatment and on the 10th day after treatment. Evaluate the degree of pain using the Visual Analog Score (VAS) method (see Table 2). The specific method is to draw a horizontal line (10cm in length) on the paper, with the two ends of the line being 0 and 10 respectively, where 0 represents painlessness; 10 represents severe pain; The pain gradually intensifies from 0 to 10. Patients can mark their pain levels online based on their own feelings. The average value of mild pain is (2.57 ± 1.04); The average value of moderate pain is (5.18 ± 1.41); The average value of severe pain is (8.41 ± 1.35). Significant effect, that is, the patient's
pain symptoms completely disappear, and the VAS score decreases by more than 70%; Effective, that is, after treatment, the patient's neurological pain symptoms have improved, and the VAS score has decreased by 45% -70%; Invalid, meaning that the patient's neuralgia symptoms have not improved after treatment, and the VAS score has decreased by less than 45%. The total effective rate is the sum of apparent efficiency and effective rate. Observe and record the time for erythema reduction, blister arrest, scab formation, scab removal, and adverse reactions in two groups. Follow up of PHN occurrence one month after the healing of herpes zoster in the ear.
Table 2 Visual Simulation Rating Scale
1.6.2 Evaluation criteria for efficacy refer to the efficacy evaluation criteria formulated in the 2023 version of the Diagnosis and Efficacy Criteria for Traditional Chinese Medicine Diseases [8]. Cure: The rash subsides, clinical signs disappear, and there are no painful sequelae. Improvement: The rash has subsided by about 30%, and the pain has significantly decreased. Not cured: The rash has subsided by less than 30% and there is still pain.
1.7 Statistical methods
Statistical analysis was conducted on the obtained data using SPSS 26.0 software. Quantitative data that conform to a normal distribution are expressed as mean ± standard deviation (x soil s) using t-test. Measurement data that do not conform to a normal distribution are represented as median or quartile [M (P25, P75)], using Mann Whitney U test. Count data expressed in examples or percentages, using Χ 2 Inspection. Before and after treatment, t-tests were used for hearing (pre - and post-treatment air conduction, and pre - and post-treatment air bone conduction difference), and the results were statistically analyzed. The difference is statistically significant with P<0>
2.1 Comparison of treatment effects between two groups
After 10 days of treatment, the total effective rate of the treatment group was 98.00%, while the total effective rate of the control group was 84.00%. Both rows Χ Two tests showed that the treatment group had better therapeutic effects than the control group, and the difference was statistically significant (P<0>
| groups | n | cure | Better healed | |
| Treatment | 50 | 33(66.00) | 16(32.00) | 1(2.00) |
| Control | 50 | 26(52.00) | 16(32.00) | 8(16.00) |
| Χ2 | 5.983 | |||
| P | 0.015 |
Table 3: Comparison of treatment effects between two groups, ％）
2.2 Comparison of total scores of HZE symptoms and signs before and after treatment between two groups
After repeated measures analysis of variance, there was a statistically significant difference (P<0>
| groups | n | before | On the 10th day after treatment |
| Treatment | 50 | 21.18 ±5.89a | 4.04±1.97 a |
| Control | 50 | 20.97±5.01b | 7.76±2.12b |
| t组间/P组间 | 0.252/＞0.05 | -13.350/<0> | |
| ta/Pa | 20.574/<0> | ||
| tb/Pb | 18.642/<0> |
Table 4 Comparison of total scores of HZE symptoms and signs between two groups before and after treatment score, (x土s）
Note: Compared with before treatment in this group, P<0>
2.3 Comparison of Erythema Reduction Time, Scar Stopping Time, Scab Formation Time, and Scab Removal Time between Two Groups
The time for erythema reduction, blister arrest, scab formation, and scab removal in the treatment group was shorter than that in the control group, and the difference was statistically significant (P<0>
| groups | n | Reduce time | Stop blister time | Scabbing time | Scab shedding time |
| Treatment | 50 | 3.34±1.78 | 4.46±2.13 | 5.87±1.67 | 9.02±2.45 |
| Control | 50 | 3.98±1.87 | 5.41±2.34 | 7.67±1.84 | 12.23±3.23 |
| t | 2.420 | 2.870 | 6.686 | 7.026 | |
| P | 0.019 | 0.006 | <0> | <0> |
Table 5 Comparison of time for erythema reduction, blister arrest, scab formation, and scab removal between two groups (d,x土s）
2.4 Comparison of VAS scores between two groups before and after treatment
After repeated measurements, there was a statistically significant difference (P<0>
Groups treatment | n | before | On the 10th day after |
| Treatment | 50 | 8.64±1.84a | 2.81±0.87a |
| Control | 50 | 8.56±1.81 | 3.98±1.12 |
| tInter group/P Inter group | 0.307/＞0.05 | 9.508/<0> | |
| ta/Pa | 22.401/<0> | ||
| tb/Pb | 17.890/<0> |
Table 6 Comparison of VAS scores between two groups before and after treatment (scorex土）
Note: Compared with before treatment in this group, P<0>
2.5 Comparison of incidence rates of PHN between two groups
There was no occurrence of PHN in the treatment group, while there were 12 cases in the control group, with an incidence rate of 24.00%. The incidence of PHN in the treatment group was significantly lower than that in the control group, and the difference was statistically significant（ Χ 2 values=13.636, P<0>
2.6 Comparison of air conduction and air bone conduction differences between two groups before and after treatment (1 month after treatment)
The difference in air conduction between the two groups before and after treatment (1 month after treatment) was statistically significant (P<0>0.05). See Table 7.
| Treatment group | control group | Air conduction |
| before | 35.5±4.5 | 35.9±4.7 |
| One month after treatment | 15.6±2.2 | 21.0±3.1 |
| t | 31.265 | 22.413 |
| P | <0> | <0> |
| Air bone conduction differencebefore | 10.1±2.7 | 10.5±2.8 |
| One month after treatment | 5.1±0.3 | 10.0±2.4 |
| t | 13.093 | 1.262 |
| P | <0> | 0.219 |
Table 7 Comparison of air conduction and air bone conduction differences between two groups before and after treatment (1 month after treatment) (dBHL）
2.7 Comparison of incidence rates of adverse reactions between two groups
During the treatment period, no adverse reactions occurred in the treatment group; There were 6 cases of adverse reactions in the control group, including 4 cases of nausea, vomiting, and poor appetite, and 2 cases of abdominal pain and diarrhea. The incidence of adverse reactions was 12.00%. There is a statistically significant difference in the incidence of adverse reactions between the two groups（ Χ 2 values=6.383, P<0>
HZE is a common skin disease in clinical practice. After infection with herpes zoster virus, the virus can lurk in the posterior root of the spinal cord and cranial ganglion cells. When the body's resistance/immunity decreases, the herpes zoster virus will be reactivated, causing a series of symptoms and signs, such as burning, stabbing, and other symptoms [9]. Some patients have left behind PHN in the long term [10], often manifested as burning like, needle like pain [11-13], Seriously affecting the work and daily life of patients [14-15]. The auricle and external ear canal belong to the distribution area of the sensory branch of the facial nerve, with visible blisters on their surface, as well as band like erythema, clustered herpes, and peripheral nerve pain. The herpes zoster virus in the ear often affects other brain nerves and often causes symptoms of meningitis to a certain extent. After the herpes zoster virus invades the auditory nerve and its ganglia, it can lead to permanent deafness. Facial paralysis caused by the herpes zoster virus in the ears can be temporary, but if not treated promptly, it may also lead to permanent facial paralysis.
Western medicine treatment for HZE is currently mainly antiviral therapy [16], commonly used being acyclovir. Although this drug has the effect of inhibiting virus replication, it cannot reduce the incidence of PHN [17], and acyclovir has significant side effects, often including nausea, poor appetite, dizziness, bloating, and renal function damage.
In clinical treatment of HZE, corticosteroid drugs are often used in addition to antiviral therapy. But it is usually used in the early stages of the disease, and commonly used methods such as methylprednisolone injection combined with physiological saline for 3D shock therapy have significant clinical effects. As this drug is an immunosuppressive agent and belongs to the hormone class, it has anti-inflammatory and anti-allergic effects, and can also inhibit the growth of viruses. But this medicine cannot be used for a long time. Long term use can cause metabolic disorders of fat and protein, as well as drug-induced liver damage.
scorzonera glabra herpes ointment is a traditional Chinese medicine topical ointment developed by our hospital. When applied to the affected area, it can directly act on the affected area and kill the virus without the need for liver and kidney metabolism. It can regulate the function of the organs through the meridian system and promote the recovery of herpes. The main ingredient of scorzonera glabra herpes ointment is scorzonera, which has a bitter and spicy taste, a cold nature, and has the effects of clearing heat, detoxifying, treating sores, and dispersing nodules. There are literature reports that scorzonera has antiviral, analgesic, immunomodulatory, and antidepressant effects [17-20].
After 10 days of treatment in both groups, the total effective rate of the treatment group was 98.00%, while the total effective rate of the control group was 84.00%. The treatment effect of the treatment group was better than that of the control group, and the difference was statistically significant (P<0>
The incidence of PHN between the two groups was compared, with no PHN occurring in the treatment group and 12 cases in the control group, with an incidence rate of 24.00%. The incidence of PHN in the treatment group was significantly lower than that in the control group, and the difference was statistically significant. This indicates that external application of scorzonera glabra herpes ointment can indeed alleviate or eliminate postherpetic neuralgia (PHN) in the treatment of herpes zoster in the ear.
The external application of Ya Cong Herpes Ointment to treat ear herpes zoster not only reduces symptoms but also relieves pain, which is related to an important substance contained in Ya Cong itself. Their research found that the extracts from the ground and roots of Ya Cong have anti-inflammatory and analgesic effects [22]; Some scholars have studied [19] and found that extracts C, glucosylflavones, and 7-methylisochlorohydrin have analgesic and anti-inflammatory effects. Therefore, scorzonera glabra herpes ointment can improve the symptoms and signs of HZE and alleviate the pain of patients.
Scorzonera glabra herpes ointment can not only improve the symptoms and signs of HZE, alleviate the pain of patients, but also shorten the course of the disease. Comparison of the time for erythema reduction, scar arrest, scab formation, and scab removal between the two groups showed that the treatment group had shorter time for erythema reduction, blister arrest, scab formation, and scab removal compared to the control group, and the difference was statistically significant (P<0>
Comparison of the incidence of adverse reactions between the two groups, during the treatment period, no adverse reactions occurred in the treatment group; There were 6 cases of adverse reactions in the control group, including 4 cases of nausea, vomiting, and poor appetite, and 2 cases of abdominal pain and diarrhea. The incidence of adverse reactions was 12.00%. There is a statistically significant difference in the incidence of adverse reactions between the two groups. This indicates that the incidence of adverse reactions is low when treated with external application of scorzonera glabra herpes ointment.
The difference in air conduction between the two groups before and after treatment (1 month after treatment) was statistically significant (P<0>0.05). This indicates that external application of scorzonera glabra Herpes Ointment in the treatment of ear herpes zoster can not only improve the patient's air conduction hearing, but also effectively enhance bone conduction hearing. At the same time, it also indicates that the crow onion herpes ointment can better promote the recovery of auditory nerve function.
In summary, the external application of scorzonera glabra Herpes Ointment has a significant effect on the treatment of HZE, and can shorten the course of the disease, improve hearing, and effectively prevent PHN. The clinical application has minimal toxic side effects and is worthy of clinical promotion and application.
All authors have no conflict of interest.
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