Shingles (cont.)

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What are the complications of shingles?

Generally, shingles heals well and problems are few. However, on occasion, the blisters can become infected with bacteria, causing cellulitis, a bacterial infection of the skin. If this occurs, the area will become reddened, warm, firm, and tender. You might notice red streaks forming around the wound. If you notice any of these symptoms, contact your health care professional. Antibiotics can be used to treat these complications.

A more worrisome complication occurs when shingles affects the face, specifically the forehead and nose. In this situation, it is possible, although not likely, that shingles can affect the eye (known as herpes zoster ophthalmicus), leading to loss of vision. If you have shingles on your forehead or nose, your eyes should be evaluated by a health care professional.

A rare complication of shingles is known as Ramsay Hunt syndrome. In this case, the cranial nerves (cranial nerves V, IX, and X) are involved. Symptoms may include peripheral facial nerve weakness and deafness. The typical rash is often observed around the ear and ear canal.

Picture: The Varicella zoster virus can cause shingles and postherpetic neuralgia.
Picture: How the varicella zoster virus causes shingles and postherpetic neuralgia

What is postherpetic neuralgia?

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The most common complication of shingles is postherpetic neuralgia. This occurs when the nerve pain associated with shingles persists beyond one month, even after the rash is gone. It is a result of irritation of the nerves of sensation by the virus. The pain can be severe and debilitating. Postherpetic neuralgia occurs primarily in people over the age of 50 and affects 10%-15% of people with shingles. There is evidence that treating shingles with antiviral agents can reduce the duration and occurrence of postherpetic neuralgia.

The pain of postherpetic neuralgia can be reduced by a number of medications. Tricyclic antidepressant medications (amitriptyline [Elavil] and others), as well as antiseizure medications (gabapentin [Neurontin], carbamazepine [Tegretol], and pregabalin [Lyrica]), have all been used to relieve the pain associated with postherpetic neuralgia. In 2012, the FDA approved the use of gabapentin enacarbil (Horizant), previously used for the management of restless legs syndrome, for the treatment of postherpetic neuralgia. Capsaicin cream (Zostrix), a derivative of hot chili peppers, can be used topically on the area after all the blisters have healed, to reduce the pain. Lidocaine pain patches (Lidoderm) applied directly to the skin can also be helpful in relieving nerve pains by numbing the nerves with local lidocaine anesthetic. These pain-relief options should be discussed with your health care professional.

Medically Reviewed by a Doctor on 8/28/2013

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