Postherpetic Neuralgia Clinical Presentation

Updated: Mar 06, 2018
  • Author: W Alvin McElveen, MD; Chief Editor: Robert A Egan, MD  more...
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Presentation

History

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  • A painful vesicular eruption in a dermatomal distribution is typical of herpes zoster (HZ).

  • With resolution of the eruption, pain that continues for 3 months or more is defined as postherpetic neuralgia (PHN).

  • Pain is intense and may be described as burning, stabbing, or gnawing.

  • HZ can reactivate subclinically with pain in a dermatomal distribution without rash. [4] This condition is known as zoster sine herpete and may be more complicated, affecting multiple levels of the nervous system and causing multiple cranial neuropathies, polyneuritis, myelitis, or aseptic meningitis. [5]

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Physical

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  • Area of previous HZ may show evidence of cutaneous scarring.

  • Sensation may be altered over involved areas, in the form of either hypersensitivity or decreased sensation.

  • Allodynia is pain produced by a non-noxious stimulus, such as a light touch by a brush, and may be present over the involved area.

  • Changes in autonomic function such as increased sweating over the involved area may be seen.

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Causes

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  • Risk factors for development of PHN include the following:

    • Advancing age

    • Site of HZ involvement

      • Lower risk - Jaw, neck, sacral, and lumbar

      • Moderate risk - Thoracic

      • Highest risk - Trigeminal (especially ophthalmic division), brachial plexus

    • Severe prodromal pain (with HZ)

    • Severe rash

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