Optimizing Early Clinical Management of Herpes Zoster to Prevent Postherpetic Neuralgia: An Evidence-Based Narrative Review.

Abstract

Herpes zoster (HZ), caused by the reactivation of latent varicella-zoster virus, is a common neurocutaneous disorder that predominantly affects older adults and immunocompromised populations. Postherpetic neuralgia (PHN), the most frequent and debilitating complication of HZ, is characterized by persistent neuropathic pain and is associated with substantial impairment in quality of life, functional decline, and increased healthcare utilization. Despite advances in antiviral therapy and vaccination strategies, PHN remains a major clinical challenge. Accumulating mechanistic and clinical evidence indicates that events occurring during the acute phase of HZ, including virus-induced neural injury, persistent inflammation, and central sensitization, play a critical role in the subsequent development of PHN. This evidence-based narrative review summarizes current data on early clinical management as a potential disease-modifying strategy to reduce PHN risk. It examines the pathophysiological continuum from acute HZ to chronic neuropathic pain, evaluates the effectiveness of early antiviral therapy and optimized pain management, and discusses the role of multimodal and supportive interventions during the acute phase. In addition, this review highlights the preventive value of recombinant zoster vaccination and its integration with early clinical management across the HZ-PHN continuum. Overall, current evidence supports a proactive, risk-stratified approach to HZ management that emphasizes early diagnosis, timely antiviral therapy, mechanism-based pain management, structured follow-up, and widespread vaccination. Optimizing early clinical care represents an important opportunity to reduce the incidence, severity, and long-term burden of PHN, particularly in high-risk populations.