Brief overview
- Causes and risk factors: Infection with varicella zoster virus, outbreak of the disease after surviving chickenpox infection
- Symptoms: pain, skin rash, inflammation, disruption or damage to eye and ear functions
- Diagnosis: Based on appearance and physical examination, PCR test or cell culture if necessary
- Treatment: Skin care ointments for rashes, painkillers, antiviral medication, antibiotics if necessary
- Course and prognosis: Usually heals well. Unsightly scarring possible, sometimes persistent pain in the context of post-zosteric neuralgia
- Prevention: Vaccination against shingles
What is shingles on the face?
Shingles on the face, also known as facial shingles, is caused by an infection with the varicella zoster virus (VZV), just like regular shingles. As a “remnant” of a chickenpox infection that has already been overcome, the viruses remain in the body and sometimes cause shingles (herpes zoster) many years later.
The special feature of this manifestation is that it may carry a higher risk of serious complications, as shingles on the face also threatens the visual and auditory nerves.
Is shingles on the face contagious?
Further information on infection, causes and risk factors can be found in the main article on shingles.
How does shingles manifest itself on the face?
As with other forms of zoster, shingles usually causes pain and the typical skin rash on the head. This appears, for example, on the hairy scalp, on the forehead and nose or on the neck. However, there are also cases of shingles without a rash.
Because of the many sensitive structures in the head area, shingles on the face can lead to serious secondary problems. This is especially true if the patient’s immune system is weakened. Herpes zoster on the face is particularly problematic if it affects the eye or ear:
Shingles of the eye (zoster ophthalmicus)
The eye is a very sensitive organ and therefore susceptible to herpes zoster. In principle, it is possible for shingles on the face to affect any structure of the eye. Possible consequences are, for example
- Inflammation of the conjunctiva (conjunctivitis)
- Inflammation of the sclera of the eye (scleritis): The porcelain-white sclera forms the outermost wall layer of the eyeball (outer skin of the eye).
- Inflammation of the cornea of the eye (keratitis): The translucent cornea is the part of the outer skin of the eye that lies above the pupil.
- Secondary glaucoma: Dangerous increase in intraocular pressure (glaucoma) as a result of uveitis.
- Damage to the retina and/or optic nerve: In severe cases, this complication leads to permanent blindness.
Shingles on the ear (zoster oticus)
Shingles on the face sometimes also affects the ear or its nerve structures. Possible symptoms here are
- Hearing disorders if the acustic nerve is affected
- Balance disorders if the vestibular nerve is affected
- Facial paralysis in the event of inflammation of the facial nerve: This nerve supplies the muscles in the face, among other things, and runs in sections in the area of the middle and inner ear. The paralysis of the facial nerve is called facial nerve palsy.
How is shingles on the face diagnosed?
If shingles on the face is suspected, the family doctor or, if the eye is also affected, the ophthalmologist is the right person to contact, as is the ear, nose and throat specialist in the case of ear problems. They can recognize facial herpes zoster by its typical characteristics and possible consequences, such as inflammation of the eye and ear.
In order to diagnose herpes zoster beyond doubt, a PCR test or a cell culture, which are carried out or created on the basis of a wound swab, help after the physical examination.
How is shingles on the face treated?
In the event that complications such as inflammation of the ear and eyes develop as a result of shingles on the face, these are also treated, for example with antibiotics.
Detailed information on the treatment of herpes zoster can be found in the article Shingles – treatment.
How does shingles on the face progress?
In most cases, shingles on the face disappears once the infection has been overcome. However, there is a risk of complications and consequential damage.
In general, shingles on the head increases the risk of developing post-zosteric neuralgia. This means that the pain persists even after the rash has subsided, sometimes even for years. In the case of shingles on the face, the trigeminal nerve is usually responsible for this persistent pain. This is also referred to as trigeminal neuralgia.
Scars also occasionally form as a result of shingles. The face and neck are particularly unfavorable regions for this. In contrast to chickenpox, zoster scars develop even without scratching the skin blisters. They can therefore often not be prevented. However, the earlier shingles on the face is treated professionally, the lower the risk of scars.
How can shingles on the face be prevented?
For more information on vaccination against herpes zoster, read the article on shingles vaccination.
