Shingles usually occurs on the skin of the chest or abdomen. In some cases, however, the symptoms can also be felt on the face. In this case, the varicella zoster infection is called “facial rose”.
The varicella zoster viruses then persist in the cranial nerves. The fifth cranial nerve, the trigeminal nerve, is particularly often affected by the virus. The trigeminal nerve is the largest sensitive facial nerve, which supplies the forehead, nose, cheeks, eyes, chin and scalp.
It is the source of all the sensitive nerves in the face, which means that if one branch of the trigeminal nerve is affected, symptoms can occur in the eyes, nose, forehead and hairy scalp. If the eye is affected by the virus, shingles is also called zoster ophthalmicus. (Infestation of the ophthalmic nerve from the trigeminal nerve).
The ophthalmic nerve is a branch of the trigeminal nerve, which sensitively innervates the eye and can lead to massive complications. In some cases, the zoster may affect the nerves that innervate the ear (otic zoster). In most cases, the facial nerve, the motor nerve of the face, is also affected.
As in the rest of the body, the symptoms of facial erysipelas begin with pain in the area of the affected nerves. In addition, general fatigue, fever and tiredness can occur. After two to three days, sometimes severe, burning pain and sensory disturbances develop on one side of the face.
Shortly afterwards the affected facial skin swells reddish and small nodules form, which are arranged in groups. In the further course of the disease, pinhead-sized, fluid-filled blisters develop. Swelling is a common symptom of shingles.
The blistering of the skin is often accompanied by swelling of the subcutaneous tissue at the same location. Especially in the face, the swelling can be an unpleasant symptom. In the case of a so-called “zoster ophtalmicus”, in which the eyes are affected, there may be severe swelling around the eyes and the eyelids.
They are accompanied by increased lacrimation and light aversion. The swelling is a typical sign of inflammation together with the pain and redness. In the case of shingles on the face, one speaks of nerve pain, since the nerves themselves are affected by the inflammation.
The pain occurs at the nerve endings and is more common in older patients. The treatment of nerve pain is initially focused on the therapy of shingles and the containment of the inflammation. However, in about one in ten patients, pain can last longer.
This is known as “post-zoster neuralgia“. In most cases, the pain persists for a few weeks. However, there is also the risk of chronicity over several months.
In these cases, an extensive pain therapy must be carried out, which consists of several components. These include drug therapy and psychological treatment. The duration of shingles can vary and is highly dependent on the type and timing of treatment.
It is a viral disease that manifests itself a few days after the virus is activated and takes at least 14 days on average until the symptoms subside. About 2 days after the beginning of the disease, blisters appear on the face. This is when the malaise sets in.
If therapy is started immediately, the blisters dry out within a week and after about 14 days the patient usually feels much better. Depending on the start of therapy, healing may be delayed by further weeks. In the case of shingles on the face, however, there are often after-effects that can still be felt after weeks and months.
In older people in particular, pain at the nerve endings can still be felt after a few months. Complications and difficult courses of shingles in the face can lead to long-term damage and lifelong limitations. If the eye is affected, vision can be permanently reduced without any prospect of improvement.
Even if the facial nerve is affected, long-term damage such as paralysis of the facial muscles can occur. If a varicella zoster virus infection is reactivated, for example if the immune system is weakened, the viruses that have remained in the body since the first infection will multiply again. In the case of shingles in the face, the viruses usually spread along the trigeminal nerve.This nerve is responsible for the sensitive innervation of the facial skin.
Before the typical rash appears, the symptoms of the early stage (so-called prodromal stage) occur in most cases. These symptoms are general fatigue, tiredness and fever. This early stage lasts about three to five days.
There may also already be a burning, paraesthesia (“tingling”) or pain in the area of the affected nerve. In the case of shingles on the face, these symptoms occur along one of the branches of the trigeminal nerve, i.e. in the area of the eye and the forehead, cheek or lower jaw. A further localization in the case of an affection of the facial nerve can be the ear and the external auditory canal.
This pain, which occurs before or at the same time as the skin rash, is called zoster-associated pain. A few days after the initial stage, painful and reddened swellings of the skin form on one side in the affected area. These eventually develop into bulging zoster blisters.
If the initial symptoms, such as severe pain in the face and general malaise, become noticeable, a doctor should be consulted immediately. Due to the numerous serious complications of shingles in the face, a quick and effective therapy must be initiated. If the eye is also affected, it is always advisable to consult an ophthalmologist as well.
The ophthalmologist will usually prescribe cortisone-containing eye drops to inhibit the inflammatory reaction in the eye. In addition, systemically acting virustatics (e.g. Aciclovir) are used to inhibit the virus and alleviate the symptoms. In case of severe itching or pain, additional medication can be prescribed.
The patient himself should take it easy and rest. Shingles can lead to complications in any part of the body. In the area of the face, however, these are particularly serious.
In case of zoster ophthalmicus, which affects the eye, the cornea may be affected by the blisters. Since scars can form here as well after healing, this can lead to severe visual disturbances up to blindness. If the zoster affects the ear (Zoster oticus), the facial nerve is also affected in 60% of cases.
This is the large motor facial nerve, which can result in a possible life-long facial paralysis of the affected side. Since the nerve for taste sensation originates from the facial nerve, the sense of taste can also be affected and in some cases can be irreversibly lost. Since infection of the cranial nerves can lead to serious complications such as persistent paralysis, blindness or loss of the sense of taste, a doctor should be consulted at the first signs of shingles on the face.
All articles in this series:
