“I have patients that can have this pain for years and years and years.”
Even without complications, shingles (herpes zoster) can be a very painful infection. It’s caused by the same virus—the varicella-zoster virus—that causes chickenpox, but instead of causing relentless itching, it causes a burning, stinging rash of pus-filled blisters called a dermatome.
Unfortunately, for many people who develop shingles, the symptoms don’t stop there. “Even after [shingles] resolves—because of the robust inflammation of the nerve—you can have a period of pain that we call postherpetic neuralgia after having an episode of shingles,” says Michelle Henry, MD, dermatologist in New York City and clinical instructor at Weill Cornell Medical College.
Long-term nerve pain that lasts longer than three months after the onset of shingles symptoms is known as postherpetic neuralgia, and it’s the most common complication of shingles. “That can be a really deep burning, uncomfortable, crippling pain,” says Dr. Henry. “I have patients [who] have this pain for years and years and years, [and it] can disturb their sleep. It can disturb their daily activities.”
The risk of shingles increases with age, and so does the risk of postherpetic neuralgia. For example, someone who gets shingles in their 70s is more likely to experience postherpetic neuralgia than someone who gets shingles in their 50s. It rarely affects people under the age of 40.
The pain of postherpetic neuralgia typically occurs where the shingles rash was, and it affects around 10 to 18 percent of people who get shingles, according to the Centers for Disease Control and Prevention.
Other Complications of Shingles
“If you do not have the pain or the postherpetic neuralgia, you can still have other side effects post-shingles,” says Dr. Henry.
Due to the effect shingles has on the skin, you may have visual complications, such as scarring and hyperpigmentation. Shingles rashes often occur on the back, but they can sometimes occur elsewhere, such as on the face. “Depending on where you had the shingles—if it’s in the sensitive cosmetic area—it can be really upsetting for patients,” says Dr. Henry.
Shingles rashes on the face are not just a cosmetic concern. “It can be an emergency,” says Dr. Henry. “If you have shingles [near] the upper forehead, the eye, and sometimes even the nose, this is what we call an ophthalmologic emergency, because that inflammation can really compromise the vision.”
Anyone who experiences shingles symptoms near the eyes is encouraged to see an ophthalmologist—a physician who specializes in diseases of the eyes. This doctor can help monitor your condition and make sure you get the appropriate treatment to prevent eye problems or blindness.
Other potential complications include pneumonia, hearing problems, encephalitis (brain inflammation and swelling), and in some cases, death.
Preventing Shingles Complications
One way to prevent complications of shingles is by preventing shingles altogether. This can be accomplished by the zoster vaccine, or by getting the chickenpox vaccine as a child. The zoster vaccine doesn’t completely eliminate the risk of shingles, unfortunately, but those who get the vaccine for shingles and still develop the infection tend to have less severe symptoms and a lower risk of complications.
Whether you’ve received the zoster vaccine or not, once you’ve developed shingles, the best way to reduce the risk of complications is by seeking treatment—immediately. “If you treat your shingles outbreak early, you’re at a lower risk of having the most negative sequelae of shingles, which is postherpetic neuralgia,” says Dr. Henry.
“If you know you’re prone to shingles,” that is, if you’ve had chickenpox before, “the minute you see that vesicle, see your primary care doctor [or] your dermatologist, so you can have treatment, so you can reduce your risk of having long-term pain,” says Dr. Henry.
Dr. Henry is a board-certified dermatologist and dermatologic surgeon in New York City, and a clinical instructor at Weill Cornell Medical College.
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Shingles is the reactivation of the chickenpox virus.
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It can be quite painful, and even after it resolves,
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because of the robust inflammation in the nerve,
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you can have a period of pain that we call
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postherpetic neuralgia after having an episode of shingles.
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The most concerning complication of shingles
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is postherpetic neuralgia.
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That can be a really deep, burning, uncomfortable,
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crippling pain, depending on the location.
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That can require oral medications that affect the nerves.
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I have patients that can have this pain for years
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and years and years.
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That can disturb their sleep, disturb their daily activities.
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The risk of having postherpetic neuralgia
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or this long-standing pain after having a shingles outbreak
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increases with age, so older patients are more at risk
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for having that crippling, long-standing pain.
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If you do not have the pain or the postherpetic neuralgia,
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you can still have other side effects post-shingles.
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Because you're having this robust, vesicular eruption,
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you can have scarring, you can have hyperpigmentation,
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and depending on where you had the shingles,
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if it's in a sensitive cosmetic area,
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it can be really upsetting for patients.
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Depending on the dermatome, or the pattern
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that you have your shingles, it can be an emergency.
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Shingles in a dermatome that includes the upper forehead,
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the eye, and sometimes even the nose,
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this is what we call an ophthalmologic emergency.
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That inflammation can really compromise the vision,
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so if you're noticing that you have shingles
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and it involves that dermatome, make sure that you see
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an ophthalmologist quickly so that your eye can have
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the appropriate monitoring and you can have
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the appropriate treatment.
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What we do know is that if you treat your shingles outbreak early,
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you're at a lower risk of having the most negative sequelae
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of shingles, which is postherpetic neuralgia,
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so what's critical is that if you know that you're prone
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to shingles, the minute you see that vesicle,
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see your primary care doctor, see your dermatologist,
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so you can have treatment, so you can reduce your risk
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of having long-term pain.
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Patient education: shingles (beyond the basics). Waltham, MA: UpToDate, 2020. (Accessed on February 26, 2020 at https://www.uptodate.com/contents/shingles-beyond-the-basics.)
Shingles (herpes zoster). Atlanta, GA: Centers for Disease Control and Prevention. (Accessed on February 26, 200 at https://www.cdc.gov/shingles/about/index.html.)
Shingles (herpes zoster): complications. Atlanta, GA: Centers for Disease Control and Prevention. (Accessed on February 26, 2020 at https://www.cdc.gov/shingles/about/complications.html.)
Shingles (herpes zoster): vaccination. Atlanta, GA: Centers for Disease Control and Prevention. (Accessed on February 26, 2020 at https://www.cdc.gov/shingles/vaccination.html.)
Shingles information page. Bethesda, MD: National Institute of Neurological Disorders and Stroke. (Accessed on February 26, 2020 at https://www.ninds.nih.gov/Disorders/All-Disorders/Shingles-Information-Page.)