Treating Shingles on the Face

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Shingles, or herpes zoster, is caused by the varicella-zoster virus—the same virus that causes chickenpox, and anyone who has previously had chickenpox can develop shingles, often decades later. Shingles usually appears on the side of the chest and back, but it can also occur on the face.

On the face, shingles rash and blisters will appear on one side, extending to the scalp, the eye, and/or the ear.

Doctor and woman who has shingles on face

Terry Vine / Getty Images

According to the Centers for Disease Control and Prevention (CDC), one in three American adults will develop shingles during their lifetime.

Shingles is a painful condition that can have long-term effects. Prompt diagnosis and early treatment are vital for reducing the risk of serious or life-threatening complications.

Symptoms

Signs and symptoms of shingles are usually seen on one side of the face. Common symptoms in the affected area of the face might include:

  • Pain that varies in its intensity, as an early sign
  • A burning sensation
  • Numbness or tingling 
  • Itching
  • Multiple blisters that appear in a stripe-like pattern
  • Fluid-filled blisters that can break open and crust over

Symptoms you may feel generally include:

Shingles on the face can sometimes cause weakness on one side, causing the face to appear droopy.

Symptoms can appear in different areas of the face, including around the eyes or over the eyelid, near the ear and facial nerve, at the mouth, on the scalp, and at the forehead:

  • Eye: A shingles rash might appear around the eye and over the eyelid. Also called ophthalmic herpes zoster, eye involvement can lead to burning, swelling, and pain in the eye, eye watering, and blurred vision. Shingles of the eye accounts for 10%–20% of shingles cases.
  • Ear: When shingles affects the ear, it is called herpes zoster oticus. It can affect the inner, middle, and external ear, and it can cause hearing and balance problems. Symptoms include a painful red rash with fluid-filled blisters in and around the ear.
  • Facial nerve: When herpes zoster oticus affects the facial nerve, it may cause facial paralysis. This infection is called Ramsay Hunt syndrome. Facial weakness or paralysis is usually on the same side as the affected ear.
  • Mouth: At the mouth, rash and blisters can be very painful. Rashes and blisters can make eating and chewing painful, and numbness can affect taste. The rash may also cause mouth sensitivity and increase your risk for oral infections.
  • Scalp: On the scalp, shingles can cause pain with combing or brushing and lead to hair loss. In addition to a painful rash and blisters, shingles of the scalp can cause headaches and weakness on one side of the face.
  • Forehead: When a shingles rash appears on the forehead, it will extend to the tip of the nose. There might be facial pain, numbness, and tingling.

Causes

Shingles is caused by the varicella-zoster virus. Anyone who has had chickenpox can develop shingles. This is because after you recover from chickenpox, the virus will enter the nervous system and lay dormant for years or decades. It may eventually reactivate and travel to the skin’s nerve pathways, causing shingles.

Researchers don’t know exactly what causes shingles. But they speculate it may have to do with the body’s lowered immunity as people get older. Shingles is also more common in people who are immunosuppressed (have weakened immune systems).

There is no research explaining why shingles might affect the face, or why it affects some people’s faces and not those of others.

Complications

Shingles on the face may cause complications depending on where the rash and blisters appear.

Eye Problems

Ophthalmic herpes zoster can be a very serious condition. Shingles can affect any of the parts of the outer and inner eye. This might include the cornea (the transparent part of the eye covering the front part) and nerve cells that respond to light.

Swelling of the cornea from shingles can be so severe it leads to permanent scarring.

Shingles can also cause increased eye pressure and swelling that might eventually lead to glaucoma—an eye condition that causes damage to the optic nerve. In rare cases, shingles of the eye can lead to permanent vision loss.

Hearing Loss and Facial Weakness

Complications of herpes zoster oticus and Ramsay Hunt syndrome might include hearing loss and facial weakness. For most people, these are temporary symptoms, but it is possible for the damage to become permanent, especially if shingles is left untreated.

Ramsay Hunt syndrome accounts for up to 12% of facial paralysis. In some cases, it has a worse outcome than Bell’s palsy—a condition that causes temporary weakness in the muscles of the face.

Postherpetic Neuralgia

Postherpetic neuralgia (PHN) is a painful condition that results when shingles damages nerves. Because of the damage, the nerves will continue to send pain signals to the brain. Up to 20% of people with shingles will develop this complication.

On the face, PHN might affect one or more branches of the trigeminal nerve. This is the nerve that allows for feeling and movement to the face. PHN pain in the face can vary in intensity and might include burning or sharp pain that is triggered by touch.

Oral Nerve Damage

In addition to affecting the facial structures, the trigeminal nerve supplies feeling to the teeth. Any of the parts of the trigeminal nerve can be affected by shingles in the face or mouth. Oral shingles can cause long-lasting and burning pain on the right side of the face, with dental pain along the trigeminal nerve.

Scalp Pain and Hair Loss

Shingles of the scalp can lead to PHN pain in the areas of the scalp where the rash was, and long after the skin has cleared. It can also cause hair loss from scratching or combing too hard during a shingles attack, leading to a condition called cicatricial alopecia or scarring alopecia.

Hair loss occurs when the shingles rash destroys hair follicle cells responsible for new hair growth. With these cells damaged, the hair loss is permanent.

Other Complications

Shingles is associated with other complications, though much more rare. These can include pneumonia, encephalitis (brain inflammation), bacterial infections, and stroke. Left untreated, these complications can be life threatening or fatal.

When Should You See a Doctor for Shingles?

If you experience persistent pain or a widespread itchy rash on the body or face, you should reach out to your doctor. The National Institute of Aging recommends that you see your doctor no later than three days after the rash or skin pain has appeared.

Early diagnosis and treatment are vital to reducing your risk for complications, helping you to heal quicker and reduce the potential for scarring.

Diagnosis

If you have symptoms of shingles, especially on your face, it is vital to see your doctor right away. A diagnosis of shingles can be made with a physical exam. Your doctor might take a sample of the skin or fluid from a blister for testing.

Your doctor will also ask about other symptoms you might be experiencing, such as fever, chills, headache, and fatigue.

If you have a shingles rash or blisters in or around the eyes, you should see an ophthalmologist. They can examine your eyes and treat eye symptoms before they worsen and lead to permanent eye damage.

Early diagnosis and treatment are vital to avoid serious complications. This is especially important for people who have weak or compromised immune systems.

Treatment

Treatment for shingles is the same regardless of where the rash appears on the body. Prompt treatment with medications and self-care is necessary to speed up your recovery and reduce the risk for complications.

Medication

Medicinal treatment for shingles includes antiviral drugs, steroids, and pain medicines.

  • Antiviral therapies, including acyclovir, famciclovir, or valacyclovir, can help manage pain, treat the rash and blisters, speed up healing, and reduce your risk for complications.
  • Pain relievers, including numbing medications like lidocaine, over-the-counter (OTC) and prescription pain relievers, capsaicin cream, and steroid injections can help to manage shingles pain.
  • Oral corticosteroids might help to reduce swelling and pain from the shingles rash and potentially speed your recovery. Your doctor might prescribe a short course of prednisolone in addition to antiviral therapy and as an alternative to injection. Some research suggests that corticosteroid therapy might help to prevent PHN in higher-risk groups.
  • Prednisolone eye drops might be prescribed when shingles affects the eye. Eye drops can be helpful for soothing and cooling down eye symptoms, including pain.
  • Tricyclic antidepressants might also be prescribed to ease skin pain that lingers after the rash has cleared.

At-Home Care

There are ways to relieve pain and itching, as well as soothe a shingles rash and blisters. At-home treatments to try include:

  • Applying a cold compress to the affected areas of the face: Apply an ice pack wrapped in a towel or a washcloth that has been run under cold water. Place the ice pack or washcloth on the blisters for about 20 minutes at a time. This can help relieve itching and keep the area clean. Placed over closed eyes, it can relieve eye pain and discomfort. 
  • Using calamine lotion: Calamine lotion can cool and soothe your skin. If your doctor OKs it, you can use the lotion on your face, forehead, or scalp. Calamine lotion should only be used externally—it should not be used on or near the eyes, or inside the mouth, nose, or ears.
  • Keeping the face clean: While you may want to conceal the rash and blisters on your face, it is much wiser to keep your face clean to avoid infection or irritation of blisters. Don’t put anything on your face (such as makeup or lotion) that could inflame the rash or cause the blisters to worsen.

Prognosis

For most people, the rash and pain of shingles will heal within three to five weeks, and there will not be any scarring from the blisters. However, shingles can be serious and life threatening for older adults and immunosuppressed people.

Shingles can be a very painful condition. The best way to improve your outlook is with early diagnosis and early treatment.

Another option is prevention. Ask your doctor about the shingles vaccine. It can be given as a two-dose injection in the upper arm.

A Word From Verywell

Shingles can be a very painful condition, especially if it is left untreated. On the face, it can cause a visible rash and blisters, which can lead to discomfort and embarrassment. Fortunately, for most people, shingles is a temporary condition that will go away with time.

If you think you have shingles, you should reach out to your doctor right away. Proper treatment can prevent scarring to the face and long-term or life-threatening complications.

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