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Preherpetic neuralgia.

D H Gilden1, A N Dueland, R Cohrs

  • 1Department of Neurology, University of Colorado School of Medicine, Denver.

Neurology
|August 1, 1991
PubMed
Summary
This summary is machine-generated.

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Pain preceding the rash in patients with herpes zoster (shingles) can occur weeks or months before the characteristic rash. This unrecognized preherpetic neuralgia can be severe and indicate potential complications.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Dermatology

Background:

  • Herpes zoster, commonly known as shingles, is typically characterized by a painful rash.
  • Prodromal pain preceding the rash is often brief and localized to the affected dermatome.

Observation:

  • This study identified six patients experiencing significant pain for 7 to over 100 days before the onset of the zoster rash.
  • The pain was described as severe, burning, and radicular, occurring in dermatomes both with and without the eventual rash.
  • Two patients developed severe neurological complications, including zoster paresis and fatal encephalitis, while on long-term low-dose steroids.

Findings:

  • Preherpetic neuralgia, a prolonged pain phase before rash onset, is an underrecognized clinical presentation of herpes zoster.

Related Experiment Videos

  • The severity and location of pre-rash pain can vary, and it may occur in patients with or without underlying conditions.
  • Risk factors such as long-term corticosteroid use, prior metastatic carcinoma, and brachial neuritis may be associated with complicated zoster presentations.

    • Implications:

    • Clinicians should consider herpes zoster in patients presenting with unexplained, severe, localized pain, even in the absence of a rash.
    • Early recognition of preherpetic neuralgia may allow for timely intervention and potentially mitigate the risk of neurological complications.
    • Further research is warranted to understand the pathophysiology and identify predictive markers for prolonged prodromal pain in herpes zoster.