Shingles On the Face: Complications and Treatment

Potential for serious complications is very real.

The red rash and lesions associated with shingles (herpes zoster) can erupt anywhere on the human body. It all depends on which nerves are affected by the reactivation of the varicella zoster virus (VZV) that remained in the body after an earlier case of chickenpox.

Although the front and back of the torso are the usual sites of the rash, the face will be affected when the virus reactivates in the trigeminal nerve, which handles face and motor functions. When this happens, the patient is at risk for potentially serious complications like facial pain, numbness, tingling, or paralysis; damage to the eyes, and hair loss.

The shingles rash generally appears on just 1 side of the affected body part, and the face is no exception. The fluid-filled blisters can extend to cover the mouth, eye, ear, forehead, nose, and scalp. Early diagnosis and treatment can help limit the length of the infection and its complications, including postherpetic neuralgia.

Two of the most serious threats from shingles on the face are herpes zoster ophthalmicus (affecting the outer and inner eye) and herpes zoster oticus, which involves the ear.

Herpes zoster ophthalmicus (HZO), or ocular shingles, is a growing health risk in the United States, according to an article published in the American Academy of Ophthalmology’s (AAO) EyeNet Magazine.1 It reports that cases are on the rise and account for approximately 10% of all shingles cases.1

Fever, headache, and tingling forehead and scalp are all early symptoms of shingles of the eye that emerge ahead of the rash. Subsequently, the patient experiences eye redness and pain, eyelid swelling, and sensitivity to light. Complications include chronic pain, increased pressure within the eye, and loss of vision. In addition to seeing a health care provider to diagnose and treat shingles, HZO warrants a visit to an ophthalmologist to help prevent permanent damage to the eye.

Additionally, HZO is associated with cerebral stroke, according to the AAO article. “Within one year of a patient’s initial episode, those with HZO have a risk of stroke 4.3 times higher than that of all HZ patients (whose risk is 1.3 times that of controls),” the authors wrote.1

When VZV reactivates in one of the facial nerves near the ear, the result is herpes zoster oticus, also known as Ramsay Hunt syndrome. The rash covers the outer part of the ear and the external ear canal, causing facial weakness, palsy, or paralysis on the same side of the face. It can also spread to the mouth, soft palate, and upper throat. Patients may have trouble speaking, smiling, and closing the eye on the affected side. Tinnitus, hearing loss, and vertigo may develop and become permanent if the condition is left untreated.

Another area of concern is oral shingles involving the mouth and gums. Blisters in the mouth make chewing very painful, cause nerve damage that results in sensitivity and numbness affecting the ability to taste, and increase the risk of oral infections.

Shingles on the face is treated with antiviral drugs, preferably within the first 72 hours after the rash appears. Immediate attention is required to prevent a worsening of symptoms as well as scarring and damage to the face.

The only way to prevent shingles once VZV is in the body is through vaccination. Shingrix is a 2-dose vaccine that has been proven to be effective in both clinical trials and real-world applications. The FDA recommends Shingrix for the prevention of shingles in healthy adults aged 50 years and older.

Reference

1. Lewis K, Palileo B, Pophal C, et al. Herpes zoster ophthalmicus. EyeNet Magazine. 2020. https://www.aao.org/eyenet/article/herpes-zoster-ophthalmicus-pearls