Postherpetic Neuralgia Clinical Presentation

Updated: Sep 18, 2023
  • Author: W Alvin McElveen, MD; Chief Editor: Robert A Egan, MD  more...
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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. [1]  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. [2]




Area of previous herpez zoster (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.



Risk factors for development of postherpetic neuralgia (PHN) include the following:

  • Advancing age

  • Site of herpes zoster (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