Facial Pain And Eye Damage
Between 10% and 15% of the time, shingles affects the trigeminal gangliona triple-branched nerve that provides sensation to structures in the face. The medical term for head or facial pain due to shingles is “painful trigeminal neuropathy attributed to herpes zoster.”
Specifically, the trigeminal ganglion involves the eye the cheek and the mandibular branch . Of these, the ophthalmic branch is the one most commonly affected by herpes zoster.
According to the American Academy of Ophthalmology , 25% of the 300,000 to 500,000 cases of shingles that occur each year are herpes zoster ophthalmicus .
HZO can affect any part of the eye, from the optic nerve to the conjunctiva . Without antiviral treatment, almost half of people who have shingles near the eye will experience eye damage or even lose an eye, so it’s vital to see an ophthalmologist immediately.
First Signs And Symptoms Of Shingles
Among the systemic symptoms that may appear in the first few days of the prodromal stage of shingles are:
- Pain in a specific, localized area of the body
- Sensitivity to light
The most telling first symptom of shingles typically is the pain. Often excruciating, the discomfort has been described as burning, stinging, tingly, prickly, itchy, numbing, achy, or shooting. It can be persistent or intermittent, but will always be limited to one side of the body.
Because the pain from shingles is localized, it can be mistaken for other conditions depending on where it’s focused.
For example, a stabbing or persistent pain on one side of the lower back may mistakenly be attributed to sciatica or a kidney problem. Shingles pain around the lips could suggest a cold sore coming on, while pain focused on the eye or ear might seem like the start of a migraine.
What Does A Mild Case Of Shingles Look Like
Not everyone with shingles will develop a blistering rash. A mild case of shingles may include a red rash without blisters. The shingles rash and blisters are distinct characteristics of the illness. Mild cases of shingles do not usually cause headaches, fever, or fatigue.
Whether mild or severe, pain is the most common symptom of shingles. Most people describe a deep burning, throbbing, or stabbing sensation. The pain usually subsides within 30 days.
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Dont Shrug Off Shingles
- By Matthew Solan, Executive Editor, Harvard Men’s Health Watch
ARCHIVED CONTENT: As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date each article was posted or last reviewed. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
If you had chickenpox as a kid, there is a good chance you may develop shingles later in life. In fact, one in three is predicted to get shingles during their lifetime, says Dr. Anne Louise Oaklander, director of the Nerve Unit at Harvard-affiliated Massachusetts General Hospital.
The same varicella-zoster virus that causes chickenpox also causes shingles. After the telltale spots of chickenpox vanish, the virus lies dormant in your nerve cells near the spinal cord and brain. When your immunity weakens from normal aging or from illnesses or medications, the virus can re-emerge. It then travels along a nerve to trigger a rash in the skin connected to that nerve. The rash often appears on only one side of your body. The most common locations are the chest, back, or stomach, or above one eye.
How Can I Take Care Of Myself
- Take a pain-relief medicine such as acetaminophen. Take other medicine as prescribed by your healthcare provider.
- Put cool, moist washcloths on the rash.
- Rest in bed during the early stages if you have fever and other symptoms.
- Try not to let clothing or bed linens rub against the rash and irritate it.
- You develop worsening pain or fever.
- You develop a severe headache, stiff neck, hearing loss, or changes in your ability to think.
- The blisters show signs of bacterial infection, such as increasing pain or redness, or milky yellow drainage from the blister sites.
- The blisters are close to the eyes or you have pain in your eyes or trouble seeing.
- You have trouble walking.
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What Does The Shingles Vaccine Do
The shingles vaccine can prevent shingles. Every year, about 1 million people in the United States get shingles. Anyone whos had chickenpox can get shingles. Thats because the varicella-zoster virus lives silently in your nervous system after you’ve had chickenpox. The virus can reactivate later in your life if your immune system is weakened. Your risk of getting shingles goes up as you get older. In the United States, 1 in 3 people will get shingles in their lifetime.
How Is It Treated
It is best to start treatment as soon as possible after you notice the rash. See your healthcare provider to discuss treatment with antiviral medicine, such as acyclovir. This medicine is most effective if you start taking it within the first 3 days of the rash. Antiviral medicine may speed your recovery and lessen the chance that the pain will last for a long time.
Your provider may also recommend or prescribe:
- medicine for pain
- antibacterial salves or lotions to help prevent bacterial infection of the blisters
- corticosteroids
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First Signs: Burning Tingling Or Numbness Of The Skin
Usually, a small area of skin may burn, tingle, itch or simply feel very sensitive before any rash occurs, says Alina G. Bridges, D.O., an associate professor of dermatology at the Mayo Clinic in Rochester, MN. This sensation can last roughly one to three days prior to skin lesions appearingand the discomfort can be intense. Its often mistaken for appendicitis, a heart attack or severe headache, says Dr. Bridges.
Week One: Stroke And Heart Attack Risk
While the risk of a post-shingles stroke is highest amongst those whose shingles outbreak impacted their eyes, overall, people with shingles have a 2.4-fold increased risk of stroke and 1.7-fold increased chance of heart attack during the first week after getting diagnosed, found a report featured in the journal PLOS Medicine. While ones risk gradually lessened after that, it takes about 27 weeks to completely roll the risk back to baseline. Its thought that shingles-induced inflammation may lead to blood clots that could then, in turn, cause a stroke or heart attack. Adding to the risk: A spike in blood pressure due to pain and stress associated with shingles.
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Who Should Not Get The Shingles Vaccine
Some people shouldnt get the shingles vaccine. These people include those:
- Who currently have shingles.
- Who have had a severe allergic reaction to the shingles vaccine in the past.
- Who have tested negative for immunity to the varicella-zoster virus, meaning youve never had chickenpox. If youve never had chickenpox, you should get the chickenpox vaccine.
- Who are ill. You should wait until your illness has passed before receiving the shingles vaccine.
- Who are pregnant or breastfeeding.
Am I At Risk For Shingles
Everyone who has had chickenpox is at risk for developing shingles. Researchers do not fully understand what makes the virus become active and cause shingles. But some things make it more likely:
- Older age. The risk of developing shingles increases as you age. About half of all shingles cases are in adults age 60 or older. The chance of getting shingles becomes much greater by age 70.
- Trouble fighting infections. Your immune system is the part of your body that responds to infections. Age can affect your immune system. So can HIV, cancer, cancer treatments, too much sun, and organ transplant drugs. Even stress or a cold can weaken your immune system for a short time. These all can put you at risk for shingles.
Most people only have shingles one time. However, it is possible to have it more than once.
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Month Two To Three: Lingering Itch
The lasting itch one can experience once the shingles rash clears is called postherpetic itch and it most commonly develops on the face and on skin thats already suffered sensory loss. Translations: Your skin is likely already feeling numb there. And since individuals are more likely to scratch numb skin too long and too vigorously, its important to turn to your healthcare provider for advice. He or she will likely suggest topical local anesthetics to help quell the urge to itch.
Can Shingles Be Spread To Others
A person with a shingles rash can pass the virus to someone, usually a child, who has never had chickenpox, but the child will develop chickenpox, not shingles. The child must come into direct contact with the open sores of the shingles rash during the blistering phase. Once the rash has developed crusts, the person is no longer contagious.
Merely being in the same room with a shingles patient will not cause the child to catch chickenpox because during a shingles infection the virus is not normally in the lungs and therefore cant be spread through the air.
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The Sting Of Shingles
If youve ever had chickenpox, you may be at risk for a painful disease called shingles as you grow older. Shingles is a sometimes-agonizing skin rash and nerve disease thats caused by a virus. Fortunately, you can take steps to prevent shingles or ease its serious effects.
Shingles usually affects adults after age 50, although it can strike at any age. In the U.S., the incidence of shingles is actually increasing, says Dr. Jeffrey Cohen, an infectious disease researcher at NIH. If you live to be 85 years old, you have a 50% chance of getting shingles.
Shingles is caused by the varicella-zoster virusthe same virus that causes chickenpox. Once youve had chickenpox, the virus stays with you for life, hidden and inactive in your nerve cells. Your immune systemThe system that protects your body from viruses and other microscopic threats. helps keep chickenpox from returning. But later in life, the virus can re-emerge and cause shingles .
You cant catch shingles from someone else. But it is possible for a person with a blistery shingles rash to pass on the varicella-zoster virus to someone whos never had chickenpox or a chickenpox vaccine. If that happens, the other person would get chickenpox, not shingles.
To help prevent these problems, see your doctor at the first sign of shingles. Early treatment can shorten the length of infection and reduce the risk of serious complications.
Seek Treatment Right Away
Many people have the mistaken impression that, like poison ivy, shingles is a nuisance rash that fades on its own. But in fact a shingles rash should alert people, especially in middle or old age, to seek immediate medical help, says Dr. Oaklander.
Rapid treatment with one of three antiviral drugs, acyclovir , valacyclovir , or famciclovir , can shorten a shingles attack and reduce the risk of serious damage, such as:
- Long-term pain. Pain that lingers in the area of a healed shingles rash is called postherpetic neuralgia. This often-disabling pain can last several months to a year.
- Prolonged itching. Many people are left with an itchy area from their shingles, which can be as disabling as chronic pain. It is most common on the head or neck.
- Damage to vision and hearing. Pain and rash near an eye can cause permanent eye damage and requires an urgent ophthalmological exam. When the nerve to the ear is affected, it can permanently damage hearing or balance.
- Strokes and heart attacks. A PLOS Medicinestudy that tracked about 67,000 people ages 65 and older who were newly diagnosed with shingles found that stroke risk more than doubled in the first week after the shingles diagnosis. The same study reported an increased risk for heart attacks in the three months after shingles, but the additional risk dissipated after six months.
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Year Five: Chronic Or Recurrent Eye Disease
When shingles impacts the eyes its called herpes zoster ophthalmicus, or HZO. And according to a report in the journal Ophthalmology, 25% of patients experience chronic or recurrent eye disease within five years of HZO. Although most patients with HZO do not experience recurrence, it is important for patients to remain vigilant for recurrences due to potential for long-term damage to their eyes, says Dr. Shekhawat. Recurrent HZO can cause severe dry eye, corneal nerve damage and inflammation and scarring on the inside of the eye, which can damage vision and cause elevation of intraocular pressure leading to glaucoma, says Dr. Shekhawat.
The Stages Before And After Rash Development
The most well-known symptom of shingles is a severe skin rash. However, before any signs of blisters, you may feel as if you’re only coming down with the flu.
You may experience chills and fever, as well as intense pain. It’s not until a few days later that a rash finally joins these shingles symptoms, with clusters of tiny, pimple-like blisters progressing quickly once they appear.
If you’re familiar with the signs and symptoms of shingles, you’ll be able to recognize what’s going on, get a diagnosis quickly, and deal with it without delay. Doing so makes you less likely to develop complications, such as nerve issues or bacterial skin infections.
This article reviews the symptoms of shingles and what you need to know about potential complications.
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Who Is At Risk For Getting Shingles
About 25% of all adults, mostly otherwise healthy, will get shingles during their lifetimes, usually after age 40. The incidence increases with age so that shingles is 10 times more likely to occur in adults over 60 than in children under 10.
People with compromised immune systems from the use of immunosuppressive medications or serious illnesses, such as cancer or HIV, are at special risk of developing shingles. These individuals also can have recurrent shingles and may have shingles that never heal. Most people who get shingles strenghen their immunity to the chickepox virus and will not get the disease for another few decades.
Week Three: More Blisters
If your blisters persist for more than two weeks, this is a red flag that your immune system is not functioning as it should. You should visit your healthcare professional again. And remember, if your blisters appear on your face at any time, quickly see a healthcare professional. Just like the rash, when blisters develop near or in the eye or the ear, it can cause lasting damage, such as hearing loss, blindness, facial paralysis and brain swelling, according to The National Institute on Aging.
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Is There A Treatment For Shingles
Several antiviral medicines, acyclovir , valacyclovir , and famciclovir , are available to treat shingles. These medications should be started as soon as possible after the rash appears and will help shorten the illness and decrease how severe the illness is. Pain medicine may also help with pain caused by shingles. Call your provider as soon as possible to discuss treatment options.
Shingles Symptoms Before Rash
Shingles develops in two stages. The first is called the prodromal period.
Shingles is a reactivation of the varicella virus, which is what causes chickenpox. After an initial infection, the virus lays dormant in the body. Once reactivated, which can happen years down the line, shingles results.
Often, the earliest signs this is occurring are similar to what you’d expect at the start of any infection. These symptoms sometimes occur at times when you’re feeling stressed or run down. They are also systemic, meaning they affect the whole body.
You may assume you’re just overtired or coming down with a cold when you actually have shingles.
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What Are Some Common Treatments For Shingles
The CDC recommends that adults 50 years or older receive two doses of the shingles vaccine. Additionally, several antiviral medicines like acyclovir, valacyclovir, and famciclovir are available to treat shingles and shorten the length and severity of the illness. These medicines are most effective when taken immediately after the rash appears.
How Is Shingles Diagnosed And Treated
If you think you might have shingles, talk to your doctor as soon as possible. Its important to see your doctor no later than three days after the rash starts. The doctor will confirm whether you have shingles and can make a treatment plan. Most cases can be diagnosed from a visual examination. If you have a condition that weakens the immune system, your doctor may order a shingles test. Although there is no cure for shingles, early treatment with antiviral medications can help the blisters clear up faster and limit severe pain. Shingles can often be treated at home.
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When Should I Get The Shingles Vaccine
The current shingles vaccine is a safe, easy, and more effective way to prevent shingles than the previous vaccine. In fact, it is over 90% effective at preventing shingles. Most adults age 50 and older should get vaccinated with the shingles vaccine, which is given in two doses. You can get the shingles vaccine at your doctors office and at some pharmacies.
You should get the shingles vaccine if you:
- Have already had chickenpox, the chickenpox vaccine, or shingles
- Received the prior shingles vaccine called Zostavax
- Dont remember having had chickenpox
Medicare Part D and private health insurance plans may cover some or all of the cost. Check with Medicare or your health plan to find out if it is covered.
You should not get vaccinated if you:
- Currently have shingles
- Are sick or have a fever
- Had an allergic reaction to a previous dose of the shingles vaccine
If you are unsure about the above criteria or have other health concerns, talk with your doctor before getting the vaccine.