Current advances in the epidemiology, risk factors, prevention, management, and long-term outcomes of herpes zoster and post-herpetic neuralgia.

BACKGROUND: Herpes zoster (HZ) results from reactivation of latent varicella-zoster virus and is a major cause of morbidity, particularly among older adults and immunocompromised individuals. Post-herpetic neuralgia (PHN), the most common chronic complication of HZ, is characterized by persistent neuropathic pain that can substantially impair quality of life. Despite advances in antiviral therapy and vaccination, PHN remains a significant clinical challenge. This review presents current evidence on the epidemiology, risk factors, pathophysiology, clinical manifestations, prevention, and management of HZ and PHN, with emphasis on factors associated with PHN development and contemporary therapeutic approaches. METHODS: A narrative review of the literature was conducted using publications indexed in PubMed, Scopus, Web of Science, and Google Scholar from January 2010 to June 2026. Peer-reviewed studies, systematic reviews, meta-analyses, randomized controlled trials, cohort studies, and clinical guidelines addressing HZ, PHN, and related management strategies were included. Findings were synthesized narratively. RESULTS: Advanced age, severe acute zoster pain, extensive rash involvement, prodromal pain, and immunocompromised status were consistently identified as major predictors of PHN. Early initiation of antiviral therapy within 72 h of rash onset was associated with reduced acute disease severity and may decrease the risk of prolonged pain. Evidence supports the use of gabapentinoids, tricyclic antidepressants, topical lidocaine, and capsaicin for PHN management, while multidisciplinary approaches incorporating non-pharmacologic interventions may further improve outcomes. Recombinant zoster vaccination demonstrates high effectiveness in preventing HZ and PHN in older adults. CONCLUSION: PHN remains a substantial source of long-term morbidity following HZ, particularly in aging populations. Early recognition of high-risk patients, prompt antiviral treatment, evidence-based pain management, and wider uptake of recombinant zoster vaccination are key strategies for reducing disease burden and improving patient outcomes.