Disseminated herpes zoster (DHZ) is defined by the involvement of more than two non-contiguous dermatomes or the presence of at least 20 lesions beyond the primary dermatome. The study retrospectively analyzed 109 patients at a single center from January 2019 to January 2025, with a male predominance (65 patients, 59.63%) and a mean age of 68.6 years. Advanced age (≥ 65 years) was the most common demographic risk factor. Comorbidities such as hypertension, diabetes, and cancer along with severe pain (VAS score 7–10) were significantly associated with an increased risk of postherpetic neuralgia in univariate analysis. Multivariate logistic regression analysis identified cancer as an independent risk factor for prolonged disease duration (OR = 4.271, p = 0.002). Factors such as hypertension, diabetes, and severe initial pain were associated with postherpetic neuralgia in univariate analysis. The study emphasizes the importance of early recognition and targeted preventive vaccination with a non-live recombinant vaccine in risk groups, including cancer patients.