Background/Objectives: Persistent pain after acute herpes zoster (HZ) carries substantial functional burden, but early markers of pain persistence remain uncertain. In an exploratory analysis, we examined whether baseline clinical features and a simple affected-to-contralateral pressure-pain threshold (PPT) ratio were associated with persistent zoster-associated pain approximately one month after rash onset. Methods: In this prospective multicenter observational cohort, 117 adults with acute HZ (mean age 58.7 ± 14.7 years, 60.7% women, 18.8% with diabetes mellitus, 16.2% immunosuppressed, 58.1% thoracic dermatome) were assessed 1–7 days after rash onset with clinical variables, the Douleur Neuropathique 4 (DN4) questionnaire, bedside sensory examination and standardized pressure algometry. Two equally reported outcome definitions were applied at follow-up: average and worst 24 h numerical rating scale (NRS) pain ≥ 3. Firth penalized logistic regression was used, with bootstrap internal validation that repeated the predictor-selection step within each resample. Results: Of 117 participants, 109 (93.2%) completed follow-up at a mean of 29.8 ± 3.3 days. Average 24 h NRS ≥ 3 occurred in 25/109 (22.9%) and worst 24 h NRS ≥ 3 in 42/109 (38.5%). Under the average-pain definition, age per 10 years (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.03–2.59), baseline NRS per point (OR 1.43, 1.11–2.06) and PPT ratio per 0.1 increase (OR 0.69, 0.50–0.92) were associated with the outcome; under the worst-pain definition only baseline NRS remained associated (OR 1.18, 1.02–1.39), with attenuation of both age (OR 1.34, 0.98–1.86) and PPT ratio (OR 0.86, 0.68–1.08). Apparent areas under the receiver operating characteristic curve (AUCs) were 0.863 and 0.740, respectively; the optimism-corrected AUC for the average-pain model was 0.831. The PPT ratio was strongly correlated with bedside allodynia (Spearman ρ = −0.82). Conclusions: PPT asymmetry was associated with one-month pain persistence under one of two outcome definitions but overlapped substantially with clinically assessed allodynia. These exploratory associations require prespecified confirmation before any clinical application.

Background and Objectives: While associations between attachment styles and certain dermatologic conditions have been documented, their role in chronic pruritus remains unexplored. Given the significant psychosomatic component in the etiology of chronic pruritus, this study aimed to assess attachment styles in patients with chronic pruritus in the absence of organic or psychiatric disorders and to examine their potential contribution to its development. Methods: Sixty patients with chronic pruritus were compared with a healthy control group (n = 60). Socio-demographic data, the duration of the disease, and the itch severity were noted. Additionally, assessments performed via the Questionnaire of Relation Scale, Questionnaire of Relation, Hospital Anxiety and Depression Scale, General Health Questionnaire, and Dermatology Life Quality Index (DLQI). Results: Statistically higher scores of fearful, dismissive, and preoccupied attachment styles were observed in the patient group compared to the control group. Among patients, those with moderate to high itch severity had higher mean scores of anxiety and preoccupied attachment than those with low itch severity. In contrast, secure attachment scores were significantly higher in the control group than in the patient group. Limitations: Attachment styles were examined with a self-report instrument without stimulated recall procedures. Conclusions: Our findings clearly demonstrate that patients with chronic pruritus exhibit significantly higher levels of insecure attachment styles alongside elevated anxiety, depression, and psychosocial burden. Notably, the association between preoccupied attachment and greater itch severity highlights how emotional dysregulation may intensify pruritus symptoms. Due to limited research directly examining attachment in chronic pruritus, our study provides novel insight and supports a biopsychosocial approach to care.