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

## TL;DR

This study examines the clinical features and risk factors of disseminated herpes zoster in adults, emphasizing the importance of early management and vaccination in high-risk groups.

## Contribution

The study identifies specific risk factors and outcomes for disseminated herpes zoster, offering insights for targeted prevention and treatment strategies.

## Key findings

- Advanced age, cardiovascular disease, and chronic inflammation are independent risk factors for disseminated herpes zoster.
- Hypertension, diabetes, and severe initial pain are associated with postherpetic neuralgia in patients with disseminated herpes zoster.
- Cancer is an independent risk factor for prolonged disease duration in disseminated herpes zoster patients.

## Abstract

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.

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.

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).

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.