Factors Associated with Postherpetic Neuralgia among Thai Patients with Herpes Zosterat the Dermatology Clinic, Siriraj Hospital: A Retrospective Cohort Study

Sukhum Jiamton; Pichaya Limphoka; Ya-Nin Nokdhes; Nattha Angkoolpakdeekul; Sariya Sittiwanaruk; Thanakorn Woramongkol; Wittawat Turakit

Authors

Sukhum Jiamton Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Pichaya Limphoka Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Ya-Nin Nokdhes Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Nattha Angkoolpakdeekul Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Sariya Sittiwanaruk Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Thanakorn Woramongkol Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Wittawat Turakit Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Keywords:

Characteristics, Herpes Zoster, Postherpetic neuralgia, Dermatomal distribution, Retrospective, Siriraj Hospital, Thailand

Abstract

Introduction: Herpes Zoster (HZ) is caused by the reactivation of latent varicella zoster virus in the sensory ganglia following an outbreak of chickenpox. The aim of this study was to evaluate the characteristics of HZ in Thai patients.

Objective: To describe the clinical characteristics of patients with HZ attending the outpatient dermatology clinic at Siriraj Hospital.

Materials and Methods: This retrospective cohort study included patients diagnosed with HZ at the Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand between December 2015 and December 2016. Data on patients’ characteristics, underlying diseases, clinical manifestations, affected sites, treatments, and complications were obtained from medical records.

Results: A total of 432 patients with HZ were included. The mean age was 57.7 years, with a predominance of female patients (59.0%). The most commonly affected dermatome was thoracic (35.0%). Postherpetic neuralgia (PHN) was the most frequent complication (18.8%) and was significantly associated with older age (64.2 vs. 56.8 years, P < 0.001), female gender (69.1% vs. 56.6%, P = 0.038), presence of comorbidities (75.3% vs. 60.6%, P = 0.013), and gabapentin use (60.8% vs. 37.5%, P < 0.001).

Conclusions: This study highlights the demographic and clinical characteristics of HZ among Thai patients. PHN was significantly more common in older patients, females, and those with comorbidities. The increased use of gabapentin in PHN cases reflects its role in standard clinical management. These findings may support early antiviral treatment and targeted prevention strategies in high-risk groups.

References

Thomas SL, Hall AJ. What does epidemiology tell us about risk factors for herpes zoster? Lancet Infect Dis 2004;4:26-33.

Bader MS. Herpes zoster: diagnostic, therapeutic, and preventive approaches. Postgrad Med 2013;125:78-91.

Lam AC, Chan MY, Chou HY, et al. A cross-sectional study of the knowledge, attitude, and practice of patients aged 50 years or above towards herpes zoster in an out-patient setting. Hong Kong Med J 2017;23:365-73.

Stankus SJ, Dlugopolski M, Packer D. Management of herpes zoster (shingles) and postherpetic neuralgia. Am Fam Physician 2000;61:2437-44, 47-8.

Hillebrand K, Bricout H, Schulze-Rath R, Schink T, Garbe E. Incidence of herpes zoster and its complications in Germany, 2005–2009. J Infect 2015;70:178-86.

Yang F, Yu S, Fan B, et al. The Epidemiology of Herpes Zoster and Postherpetic Neuralgia in China: Results from a Cross-Sectional Study. Pain Ther 2019;8:249-59.

Gnann JW Jr, Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med 2002;347:340-6.

Aunhachoke K, Bussaratid V, Chirachanakul P, et al. Measuring herpes zoster, zoster-associated pain, post-herpetic neuralgia-associated loss of quality of life, and healthcare utilization and costs in Thailand. Int J Dermatol 2011;50:428-35.

Cohen JI. Herpes zoster. N Engl J Med 2013;369:1766-7.

Antoniolli L, Rodrigues C, Borges R, Goldani LZ. Epidemiology and clinical characteristics of herpes zoster in a tertiary care hospital in Brazil. Braz J Infect Dis 2019;23:143-5.

Kantaria SM. Bilateral asymmetrical herpes zoster. Indian Dermatol Online J 2015;6:236.

Dayan RR, Peleg R. Herpes zoster - typical and atypical presentations. Postgrad Med 2017;129:567-71.

Yoo KH, Park JH, Kim BJ, Kim MN, Song KY. Herpes Zoster Duplex Bilateralis in a Patient with Breast Cancer. Cancer Res Treat 2009;41:50-2.

Vijay A, Dalela G. Herpes Zoster Duplex Bilateralis in Immuno-Competent Patients: Report of Two Cases. J Clin Diagn Res 2015;9:WR01-3.

Mallick-Searle T, Snodgrass B, Brant JM. Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology. J Multidiscip Healthc 2016;9:447-54.

Zeevaert R, Thiry N, Maertens de Noordhout C, Roberfroid D. Efficacy and safety of the recombinant zoster vaccine: A systematic review and meta-analysis. Vaccine X 2023;15:100397.