A Clinical Study of the Nature of Pain Associated with Herpes Zoster / 대한피부과학회지

ABSTRACT

BACKGROUND: Pain and paresthesia often precede the eruption of herpes zoster and vary from itching to stabbing. The preeruptive pain may simulate other diseases and may lead to misdiagnosis and misdirected interventions. OBJECTIVE: The aim of this study was to elucidate the clinical characteristics of herpes zoster and its nature of pain. METHODS: Three hundred and thirty three patients who were admitted with herpes zoster during a 10-year period from 1995 to 2004 were evaluated in regard to age, sex, dermatomal distribution, associated diseases, and complications. Patients were further assessed concerning the nature of the pain and its relationship to age, sex, dermatomal distribution, and postherpetic neuralgia. RESULTS: Herpes zoster was seen most frequently in the 70~79 year-old age group (30.9%), and the ratio of male to female patients was 1 : 2.2. The most common dermatomal distribution was thoracic dermatome (39.6%), followed by trigeminal (30.9%), cervical (11.7%), lumbar (7.2%), sacral (2.7%), and multiple dermatomal involvement (4.5%). Associated diseases to herpes zoster were observed in 180 patients (54.1%) which included hypertension (18.6%), diabetes mellitus (8.7%), gastritis and gastric ulcer (6.0%), fatty liver and hepatitis (5.1%), pulmonary tuberculosis (3.3%), malignancy (2.7%), rheumatoid arthritis (1.8%), and various other conditions (7.9%). The most common complication of herpes zoster was postherpetic neuralgia (15.6%), followed by ocular complications (6.9%), secondary infection (1.5%), scar formation (0.9%), Ramsay-Hunt syndrome (0.6%), and a neurogenic bladder (0.3%). The most common nature of pain associated with herpes zoster was pricking or stabbing (68%), followed by a dull ache (8.1%), tingling (7.2%), burning (4.2%), numbness (3.9%), throbbing (2.1%), a water trickling sensation (1.5%), itching (1.5%), formication (1.2%), soreness (0.9%), bursting (0.6%), sensation of being pulled down (0.3%), and sensation of cold water being poured on the skin (0.3%). Paresthesia was observed in 11 patients (3.3%), and 8 of these complained of this in the trigeminal dermatome (72.7%). CONCLUSION: Higher incidences of herpes zoster were observed in female and in the 70~79 year-old age group. The nature of pain associated with herpes zoster varied from a superficial itching to severe stabbing or bursting, and paresthesia occurred most frequently in the trigeminal dermatome.