Disseminated herpes zoster in adults: a single-center retrospective study on clinical spectrum and risk factors for adverse outcomes.

BACKGROUND

Disseminated herpes zoster (DHZ) is defined by the involvement of more than two non-contiguous dermatomes or the presence of at least 20 lesions beyond the primary affected dermatome. The varicella-zoster virus (VZV) can lead to disseminated infection when the host's immune response is insufficient to halt cell-associated viremia. This study aimed to summarize the clinical characteristics and potential risk factors associated with DHZ and to identify and assess factors related to prognosis to enhance the prevention and management strategies for DHZ patients.

METHODS

The demographic information of DHZ patients who presented to our department between January 2019 and January 2025 was retrospectively collected. Patients with a confirmed diagnosis of DHZ were monitored to identify morbidity risk factors and the incidence of postherpetic neuralgia.

RESULTS

A total of 109 patients were diagnosed with DHZ, with a male predominance (65 patients, 59.63%) and 44 female patients (40.37%). The mean age of the patients was 68.6 years. Advanced age (≥65 years) was the most prevalent demographic risk factor. In the assessment of prognostic outcomes, concomitant conditions including hypertension, diabetes, and cancer, along with severe pain (VAS score 7-10), were significantly associated with an increased risk of postherpetic neuralgia in a univariate analysis. Furthermore, a multivariable logistic regression analysis identified cancer as an independent risk factor for prolonged disease duration (OR = 4.271, p = 0.002).

CONCLUSION

This study identified advanced age, cardiovascular disease, and chronic inflammation as independent risk factors for DHZ, highlighting potential target groups for vaccination. Moreover, factors such as hypertension, diabetes, and severe initial pain were associated with postherpetic neuralgia (PHN) in a univariate analysis, suggesting avenues for early attention. These findings highlight the importance of early recognition, aggressive management, and, most importantly, targeted preventive vaccination with the non-live recombinant vaccine in high-risk populations, including cancer patients, to reduce the substantial morbidity associated with disseminated herpes zoster.