Postherpetic Neuralgia: An Overview of the Pathophysiology, Presentation, and Management

Acute herpes zoster can recur with activation of the varicella zoster virus (VZV) that has laid dormant in the sensory ganglia. VZV is initially transmitted via direct contact with or inhalation of aerosolized droplets. In the United States alone, 90% of people are susceptible to the reactivation of the VZV that they harbor. Furthermore, there is approximately a 10% to 20% lifetime risk for herpes zoster reactivation. PHN is preceded by the characteristic neuropathic dermatomal pain and rash (Figure 1), although there have been instances of PHN without this prodrome (as in zoster sine herpete, where diagnosis is confirmed with serologic studies). A commonly used definition of delineating PHN is suggested by Dworkin as a “significant pain or abnormal sensation 120 days or more after the presence of the initial rash.” It generally affects the thoracic dermatomes, although cervical and thoracic dermatomes also