14. Postherpetic neuralgia
Patients can be left off with pain in the dermatome even after the skin rash is gone. This pain is known as postherpetic neuralgia, and it is a nerve-related pain with no skin changes. Postherpetic neuralgia can linger in these patients for weeks or months. In some cases, patients can still have the symptom after years of the initial manifestation of herpes zoster. The pain tends to be severe and does not respond to the usual pain medications because it is a nerve-related pain and not associated with inflammation. Patients with severe pain in the eruptive phase of the disease and a higher density of herpetic eruptions are more likely to endure postherpetic neuralgia after the skin rash is resolved.