Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ). The aim of the present study was to compare the nutritional status of PHN patients with that of healthy controls, and then to identify risk factors for PHN using multivariate multiple logistic regressions. In the present cross-sectional study, we prospectively enrolled fifty PHN patients for at least 3 months and fifty healthy controls. We selected nine circulating nutrients including ionised Ca, Zn, retinol, folic acid, vitamin B 12 , vitamin C, a-tocopherol, g-tocopherol and lycopene associated with both immunity and the modulation of neuropathic pain, and measured their concentrations in plasma/serum. Concentrations of ionised Ca, Zn, vitamin C and vitamin B 12 were significantly lower in PHN patients than in controls after excluding those patients receiving supplements since the outbreak of HZ. The prevalence of either mild/marginal or severe deficiencies for any of the nine selected circulating nutrients in PHN patients (92 %) was much higher than that in controls (46 %) (P, 0·001). Lower concentrations of vitamin C (#45·0 mmol/l), ionised Ca (#1·05 mmol/l) and Zn (#0·91 g/l) were found to increase independently the risk of PHN using binary variable (dichotomy) analyses with both PHN patients and controls in a multivariate logistic regression analysis. No significant correlations existed between the risks of PHN and the concentrations of retinol, folic acid, vitamin B 12 , lycopene or a:g-tocopherol ratios. Thus, lower concentrations of circulating nutrients, namely vitamin C, ionised Ca or Zn, are probably a risk factor in Taiwanese patients with PHN.Key words: Nutritional status: Herpes zoster: Postherpetic neuralgia: Nutrient deficiencies: Risk factors Postherpetic neuralgia (PHN), a peripheral neuropathic pain syndrome, is the most common complication of herpes zoster (HZ) (1) . PHN can lead to long-term psychological distress, physical disability and tremendous use of health care resources (2) . Therefore, to identify risk factors for PHN and to effectively improve preventive strategies are clinically meaningful. Although old age, female sex, presence of a prodrome, greater acute pain severity, presence of severe rash (3) and immunocompromised patients (1) have been identified as independent predictors of PHN, discovering additional risk factors is still needed to prevent developing PHN with respect to HZ management (3) .An outbreak of HZ caused by a reactivation of latent varicella zoster virus (VZV) is primarily attributed to a reduction in host cellular immunity (1) . Additionally, two non-mutually exclusive theories of PHN are an alteration in the excitability of central neurons and a chronic active VZV ganglionitis caused by ongoing viral activity in patients developing PHN compared with HZ patients who do not (1,4) . Thus, reduced cellular immunity plays a critical factor in both zoster risk and the persistence of PHN (1,4) . Diminished cellular immunity has been advocated to be closely associated with def...