Common Complications of Shingles

The problems can last well after the rash disappears

Girl with shingles
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Shingles (herpes zoster) is a painful rash caused by a reactivation of the same virus that causes chickenpox (varicella-zoster). Not only can an outbreak of shingles be incredibly distressing, there can be complications that extend well beyond the appearance of the rash.

The complications are different for people with normal (intact) immune systems compared to those with compromised immune systems (such as people living with HIV).

Among those with intact immune function, the rate of complication are as follows:

  • postherpetic neuralgia (nerve pain after the rash has healed) - 7.9%
  • bacterial skin infection - 2.3%
  • eye pain and infections - 1.6%
  • motor neuropathy (weakness or atrophy of the muscles) - 0.9%
  • meningitis - 0.5%
  • Ramsey Hunt syndrome (shingles of the nerves central to hearing and balance) - 0.2%

The main risk factors for developing complications are older age, receiving an organ transplant, and having a serious medical condition such as diabetes, cancer, or HIV.

Postherpetic Neuralgia

Postherpetic neuralgia is a potentially debilitating condition causing burning pain that lasts for at least six months following a shingles outbreak. Symptoms include:

  • burning sensation in the area where the rash has already healed
  • pain brought on by normally non-painful contact such as a light touch
  • itching, often persistent
  • areas of numbness
  • difficulty sensing temperature and vibration

Bacterial Skin Infections

Because the shingles rash causes blisters that leave open sores, the risk of a bacterial infection is high. Examples of common bacterial infections include:

  • impetigo (usually caused by staphylococcal or streptococcal bacteria)
  • erysipelas (also known as St. Elmo's Fire)
  • folliculitis (the bacterial inflammation of hair follicles)

Shingles-Related Eye Damage

If the shingles virus affects parts of the face around forehead or nose, it can permanently affect the eye. This sort of outbreak appears on one side of the face along what is known as a dermatome (the area of skin serviced by a single spinal nerve). Without antiviral treatment, almost half of those affected will experience permanent eye loss or damage. Anyone who has shingles near the eye should be seen by an ophthalmologist immediately.

Motor Neuropathy

Motor neuropathy is paralysis of the muscles caused by the shingles virus. Normally the virus only affects the sensation of the skin, but, in rare cases, it can go deeper into muscle tissue. Approximately 75 percent of those experiencing motor neuropathy will regain motor function.

Meningitis

Meningitis is an infection of the fluid surrounding the brain and spinal cord called the cerebrospinal fluid. The symptoms include fever, severe headache, sensitivity to light, and achy muscles. Because this type of meningitis is caused by a virus, and not a bacteria, it cannot be treated with antibiotics. It essentially has to run its course, although pain medication may be prescribed treat the headache.

Ramsay Hunt Syndrome

Ramsay Hunt syndrome (otherwise known as herpes zoster oticus) is the inflammation of a facial nerve near one of the ears. The symptoms include facial paralysis, ear pain, and small, fluid-filled blisters (called vesicles) inside the ear canal. People with Ramsay Hunt can often experience dizziness or lack of balance. A recent study showed that only 10 percent of people with complete paralysis fully recovered their motor function, while 66 percent with partial paralysis experience full recovery.

Risk in People With Immune Suppression

People with a compromised immune system, especially people with advanced HIV infection and organ transplant recipients, are at increased risk of developing all of the above-listed complications (with the exception of postherpetic neuralgia).

Among these high-risk individuals, the spread of shingles to other areas of skin (and even inside the body) is known to happen. More concerning is the fact that shingles-associated lung inflammation can cause death even with early antiviral treatment. Recurrent shingles infections are not uncommon among people with HIV.

A Word From Verywell

The prompt treatment of a shingles outbreak is the most effective way to prevent both short- and long-term complications. An even better way to prevent an outbreak before it even occurs.

A vaccine called Zostavax is now available which can significantly reduce the risk of a shingles outbreak. While approved by the Food and Drug Administration (FDA) for use in adults 50 years of age or under, the Centers for Disease Control and Prevention (CDC) recommends vaccination for adults 60 years or under.  

Sources:

Volpi, A. "Severe complications of herpes zoster." Herpes. 2007; 2(Supplement 14):35-39.

Finch, R.; Maki, D.; and Ronald, A. "Varicella-Zoster Virus Infections." Infectious Diseases, 2nd edition. Ed. Jonathan Cohen, et al. New York: Mosby, 2004; pp 125-129.

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