Patients at risk for developing postherpetic neuralgia following acute herpes zoster can be identified by the presence of acute pain and the results of a simple prognostic score.
The first step in the evaluation is to determine if the patient developed acute pain at the first visit in association with the zoster
• If acute pain is absent at the first visit, then the risk of postherpetic neuralgia is rare.
• If acute pain is present, then a prognostic score using 6 parameters can be used to identify those at risk.
Parameters associated with postherpetic neuralgia in those with acute pain, using multivariate analysis:
(1) gender
(2) age
(3) number of lesions
(4) distribution of the lesions
(5) presence of hemorrhagic skin lesions
(6) dermatomal pain in the prodromal period
|
Parameter |
Finding |
Points |
|---|---|---|
|
gender |
female |
8 |
|
|
male |
0 |
|
age |
> 50 years |
9 |
|
|
<= 50 |
0 |
|
number of lesions |
>= 50 |
8 |
|
|
< 50 |
0 |
|
localization |
high risk areas (cranial, sacral) |
6 |
|
|
other areas |
0 |
|
lesions |
hemorrhagic |
8 |
|
|
nonhemorrhagic |
0 |
|
dermatomal pain in the prodromal phase |
present |
9 |
|
|
absent |
0 |
prognostic score =
= SUM(points for parameters present)
Interpretation:
• minimum score: 0
• maximum score: 48
|
Score |
Risk of Postherpetic Neuralgia (in patients with acute pain) |
Percent |
|
0 - 9 |
nil |
< 10% |
|
10 - 18 |
small |
10 - 20% |
|
19 - 26 |
moderate |
20 - 33% |
|
27 - 34 |
marked |
33 - 50% |
|
35 - 48 |
high |
50 - 80%å |
after Figure 2, page 362
Purpose: To predict the risk of developing postherpetic neuralgia in a patient with acute herpes zoster by using a simple prognostic score.
Specialty: Neurology
Objective: risk factors, severity, prognosis, stage
ICD-10: G53.0,
