Objective To investigate the expression change of serum antioxidant markers in cranofacial herpes zoster and its relationship with clinical severity and postherpetic neuralgia(PHN).Methods Totally 109 cases of cranofacial herpes zoster(cranofacial group)and 169 cases of non-cranofacial herpes zoster(non-cranofacial grlup)hospitalized in the Department of Dermatology in the Second Affiliated Hospital of Nanjing Medical University and 200 cases of health check-ups without underlying diseases(healthy control group)from January 2022 to December 2023 were selected,and the serum antioxidant markers including uric acid(UA),total bilirubin(TBIL),and albumin(ALB)of the patients in the three groups group were compared.Meanwhile,the relationship between these markers and clinical severity and PHN of cranofacial herpes zoster was assessed.Results The serum levels of UA,TBIL and ALB in the cranofacial group and non-cranofacial were significantly lower than those in the healthy control group(P＜0.05).Serum UA,TBIL and ALB levels in cranofacial group were significantly lower than those in non-cranofacial group(P＜0.05),and were nega-tively correlated with disease severity(P＜0.05).Serum UA,TBIL and ALB levels in cranofacial group were independent influencing factors for the occurrence of PHN(P＜0.05),and had predictive value for PHN in cranofacial herpes zoster(P＜0.05).Conclusion Reactivation of cranofacial herpes zoster virus,acute nerve injury and PHN may all be related to the low antioxidant status of the body,and the antioxidant biomarkers UA,TBIL and ALB may be protective factors for herpes zoster,but more studies are needed to clarify the un-derlying mechanisms.