Initial presentation sites as predictors of herpes zoster complications: A nationwide cohort study

Herpes zoster (HZ) is associated with complications such as postherpetic neuralgia (PHN) and HZ ophthalmicus (HZO). However, few studies have focused on identifying patients having a high risk of PHN and HZO according to the initial presentation sites. The current study investigated these factors in a nationwide population-based cohort derived from Taiwan's Longitudinal Health Insurance Database. The results indicate that the initial presentation sites can predict the complication site of HZ. In this study, elderly patients were found to be more susceptible to HZ and were the first to present with neurological signs (HZN). Furthermore, compared with patients with HZO and other signs (HZT), those with HZN had a higher comorbidity risk. Patients with HZN showed a significantly higher visceral complication risk than did those with HZO (adjusted hazard ratio [HR] = 1.47, 95% confidence interval [CI] = 1.27-1.71). In addition, patients with HZT showed lower risks of ocular and neurological complications than did those with HZN after stratification by age and sex (adjusted HR = 0.46, 95% CI = 0.31-0.68 and HR = 0.73, 95% CI = 0.59-0.91, respectively).