Increased Density of Cutaneous Nerve Fibres in the Affected Dermatomes After Herpes Zoster Therapy

Herpes zoster neural injury was assessed by determining cutaneous nerve density in skin biopsies from the affected dermatomes of 35 adult patients with herpes zoster in the acute phase and 3 months post-treatment, using protein gene product 9.5 immunohistochemistry. In contrast to the significant increase in subepidermal nerve fibre density (11.77 +/- 4.88/mm vs. 13.29 +/- 5.74/mm, p= 0.045) after 3 months, no differences were found in epidermal free nerve endings (2.43 +/- 2.35/mm and 2.8 +/- 2.86/mm, p= 0.168). Patients with post-herpetic neuralgia had significantly lower subepidermal nerve fibre densities (9.7 +/- 2.05/mm vs. 14.72 +/- 6.13/mm, p= 0.011) compared to with non-post-herpetic neuralgia patients. No differences in cutaneous nerve density were found in relation to antiviral therapy. In conclusion, 3 months after acute infection, no sign of epidermal innervation recovery is observed, while the increased subepidermal nerve fibre density in the affected dermatomes probably reflects nerve regeneration that is not affected by antiviral agent type. Subepidermal nerve fibre density is decreased in patients with post-herpetic neuralgia 3-months post-acute herpes zoster infection.