Prevalence of postherpetic neuralgia after a first episode of herpes zoster: prospective study with long term follow up.
OBJECTIVE
To estimate the frequency, duration, and clinical importance of postherpetic neuralgia after a single episode of herpes zoster.


METHODS
Prospective cohort study with long term follow up.


METHODS
Primary health care in Iceland.


METHODS
421 patients with a single episode of herpes zoster.


METHODS
Age and sex distribution of patients with herpes zoster, point prevalence of postherpetic neuralgia, and severity of pain at 1, 3, 6, and 12 months and up to 7.6 years after the outbreak of zoster.


RESULTS
Among patients younger than 60 years, the risk of postherpetic neuralgia three months after the start of the zoster rash was 1.8% (95% confidence interval 0.59% to 4.18%) and pain was mild in all cases. In patients 60 years and older, the risk of postherpetic neuralgia increased but the pain was usually mild or moderate. After three months severe pain was recorded in two patients older than 60 years (1.7%, 2.14% to 6.15%). After 12 months no patient reported severe pain and 14 patients (3.3%) had mild or moderate pain. Seven of these became pain free within two to seven years, and five reported mild pain and one moderate pain after 7.6 years of follow up. Sex was not a predictor of postherpetic neuralgia. Possible immunomodulating comorbidity (such as malignancy, systemic steroid use, diabetes) was present in 17 patients.


CONCLUSIONS
The probability of longstanding pain of clinical importance after herpes zoster is low in an unselected population of primary care patients essentially untreated with antiviral drugs.
Helgason
S
S
Arbaer Health Care Centre, IS-110 Reykjavik, Iceland. S.Helgason sh@centrum.is
Petursson
G
G
Gudmundsson
S
S
Sigurdsson
J A
JA
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006562:Herpes Zoster / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D007223:Infant; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology*; D015995:Prevalence; D011446:Prospective Studies; D012008:Recurrence; D017678:Sex Distribution
D000998:Antiviral Agents