Treating Shingles on the Scalp

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Shingles, also known as herpes zoster, is an infection caused by the same virus that causes chickenpox. According to the Centers for Disease Control and Prevention (CDC), 1 out of 3 Americans will develop shingles in their lifetime. The risk of getting it becomes more common with age. Fortunately, it's rare to get shingles more than once.

Shingles causes blistery, itchy, and painful rashes to develop anywhere on the body. These rashes are much more painful and challenging to treat and manage when they appear on the scalp. This is because the scalp is very sensitive, and any pressure, such as from scratching or brushing your hair, can cause blisters to burst and bleed.

Keep reading to learn about shingles on the scalp, including symptoms, causes, complications, diagnosis, and treatment.

Itchy scalp

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Symptoms

The earliest signs of shingles are burning, tingling, numbness, and sharp pain on the skin on one side of the body or the face. The most common sites for shingles blisters are the waistline, face, neck, chest, abdomen, and back.

Additional early symptoms of shingles may include:

Symptoms that appear a few days after initial symptoms include:

  • Itching, tingling, or burning in the affected area of skin
  • Redness
  • Raised rash
  • Blisters that are filled with fluid. These will break open and then scab.
  • Mild to severe pain in the affected area of the skin

Shingles rashes usually affect nerve paths, and blisters are typically found in a line. Rashes might also appear on one side of the face or the scalp. On the face, the rash can appear near your eye or on your ear. 

In addition to painful blisters, shingles of the scalp might also cause headaches or weakness on one side of the face. This weakness can cause the affected side of the face to look droopy.

Causes

Shingles is caused by a reactivation of the varicella-zoster virus, the virus that causes chickenpox. After a person recovers from chickenpox, the virus might travel into nerve tissues, where it will remain dormant for decades. Shingles will result when the virus reawakens and travels back up the nerve pathways and into the skin.

Anyone who has ever had chickenpox is at risk of shingles later in life, usually as an older adult. Shingles is more common in people older than age 50, and the risk increases with age.

Additional risk factors include:

  • Having an illness that weakens your immune system, such as HIV/AIDS
  • Undergoing cancer treatments: Radiation or chemotherapy can lower your immune defenses and may trigger shingles.
  • Taking certain medicines: Taking immunosuppressive drugs after an organ transplant or prolonged use of steroids like prednisone can increase the risk of shingles. 
  • Prolonged stress or infection: The immune system can be weaker if you are experiencing high levels of stress or have an infection, which can increase your risk of shingles.

If you are not immune to chickenpox—either from having had chickenpox or after being vaccinated against it—it is possible to contract the varicella-zoster virus from someone else. This often happens if there is direct contact with open sores from a shingles rash.

While you may not develop shingles right away, you might become infected with the varicella-zoster virus. If you are not immune to chickenpox, you will develop chickenpox instead.

Once you have had chickenpox, you are at risk of shingles later down the road. While this means that shingles isn’t highly contagious, you should still exercise caution when caring for someone with open sores.

Complications

Shingles pain can last for weeks, months, or even years—often long after skin symptoms have healed. This long-term pain is called postherpetic neuralgia (PHN). PHN occurs in the places where the shingles rash was, even after the skin has cleared. This pain can sometimes be so severe that it affects a person's quality of life.

According to the CDC, up to 18% of people who get shingles will experience PHN. The risk of PHN increases with age, and older adults are more likely to develop PHN and have long-lasting and more severe pain than a younger person would. PHN is rare in people under 40.

Shingles of the scalp can lead to hair loss from scratching or combing too hard during an outbreak. It can also lead to a condition called cicatricial alopecia or scarring alopecia. The hair loss occurs because the shingles rash destroys cells in hair follicles responsible for new hair growth. Once those cells are destroyed, the balding is permanent.

Shingles might lead to other serious complications, including those of the eyes, such as vision loss. In rare cases, shingles can lead to pneumonia, hearing problems, encephalitis (brain inflammation), or death.

When Should You See a Healthcare Provider?

Contact your healthcare provider right away if you suspect you might have shingles, especially if you are older than age 60.

You should also seek out medical attention for:

  • Pain and/or a rash near the eye. Left untreated, shingles could lead to permanent eye damage.
  • Pain, redness, or rash on the face
  • A very painful and widespread rash
  • A high fever or feeling very sick in addition to a rash
  • Blister spread to other parts of the body
  • A severe headache with a rash on the scalp or head
  • Weakness on one side of the face

The National Institute on Aging recommends seeing your healthcare provider no later than three days after the start of the shingles rash.

Diagnosis

One of the first things your healthcare provider will do in making a diagnosis is to examine the rash that has appeared on the skin or scalp. The shingles rash is the main sign, and your healthcare provider can often tell you have shingles just from the appearance and feel of the rash.

Your healthcare provider will also want to know about other symptoms you might be experiencing. Symptoms that are common when a shingles rash is present are fever, chills, nausea, and headache.

Tests for shingles usually aren’t done unless the rash alone isn’t enough to confirm a diagnosis. Your healthcare provider may want to do a shingles test if you are at a higher risk of complications.

A shingles test can check to see if you have been infected with the varicella-zoster virus. This test can be done in two different ways. The first involves taking a blood sample from a vein, and the second samples fluid from a blister. Both tests check for virus antibodies. The blister test can also check for the virus.

Treatment

There is no cure for shingles, but treatment with antiviral medications and self-care can speed up healing and reduce the risk of complications.

Medications

Antiviral drugs can slow down the progression of shingles rashes. These drugs need to be taken within the first 72 hours of showing signs of shingles. They can keep the rash from spreading or getting worse, and they might help to lower the chance of complications. 

Antiviral treatments that your healthcare provider might prescribe include acyclovir, famciclovir, or valacyclovir. Talk to your healthcare provider about the side effects connected to these medicines.

You can take over-the-counter (OTC) pain relievers to relieve mild pain and swelling from the shingles rash and blisters. OTC pain relievers that might help include ibuprofen, naproxen, and acetaminophen.

If you continue to have severe pain after the rash and the infection clear, your healthcare provider can prescribe treatments to help. This might include:

  • Capsaicin cream to reduce skin pain and swelling
  • A numbing medication like lidocaine
  • Antibiotics to treat skin bacteria
  • Tricyclic antidepressants to ease skin pain that lingers after the shingles rash has healed

At-Home Care

If you have shingles blisters on the scalp, combing or brushing your hair can cause the skin to feel sensitive. Be careful when brushing or combing to avoid scaping the rash or popping a blister. Scratching the scalp too hard can cause scars that destroy hair follicles.  

Other ways to manage scalp pain and itching and prevent permanent damage include:

  • Applying cold compresses to the affected part of the scalp
  • Applying calamine or menthol lotion on the head to soothe the pain and itching
  • Avoiding harsh or scented shampoos on the hair. Instead, use gentle, unscented cleansers.
  • Avoiding scrubbing when washing your hair
  • Patting hair dry with a towel after washing it
  • Using lukewarm water when washing hair
  • Avoiding hairspray and other hair styling products

Ask your healthcare provider about other creams that can help soothe the shingles rash on your scalp and to reduce itching.

Prognosis

Shingles with a rash—regardless of where the rash is located—can take up to five weeks to completely heal. Even without a rash, symptoms can still take up to five weeks to heal.

For most people, the lesions will heal, the pain will subside, and the blisters won’t leave scarring. However, people who have compromised immune systems are at a higher risk of complications and might find that it takes longer to heal or might have lingering pain long after the rash has cleared.

Shingles can be very painful. The best way to improve your prognosis is to seek out diagnosis and treatment as soon as you experience symptoms.

A better option is to do what you can to reduce your risk of shingles. If you have had chickenpox in the past, ask your healthcare provider about getting the shingles vaccine. If you have not had chickenpox, ask your healthcare provider about the chickenpox vaccine.

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