Herpes Zoster Complications

If you are basically healthy, shingles usually resolves without complications. You are not likely to ever get it again! However, in certain instances, some individuals do encounter complications:

If shingles appears on your face, it can lead to complications in your hearing and vision. People with "optical" shingles (where the virus has invaded an ophthalmic nerve) may suffer painful eye inflammations that leave them temporarily blind or impair their vision. Individuals with this type of shingles should see an ophthalmologist immediately. If shingles appears on the face and affects the auditory nerves, it can also lead to complications in hearing. Infections of facial nerves can lead to temporary paralysis.

Bacterial infection of the open sores can lead to scarring. In a small number of cases, bacteria can cause more serious conditions, including toxic shock syndrome or necrotizing fasciitis, a severe infection that destroys the soft tissue under the skin.

The constant pain, loss of sleep, and interference with even basic life activities can cause serious depression.

Postherpetic Neuralgia

Another complication of the virus is postherpetic neuralgia (PHN), a condition where the pain from shingles persists for months, sometimes years, after the shingles rash has healed. The pain can be truly debilitating, and unfortunately, it is common in people over 60.

Sometimes, particularly in older people, symptoms of shingles persist long after the rash is healed. In these cases, facial paralysis, headache, and persistent pain can be the aftermath. Possibly because the nerve cells conveying pain sensations are hardest hit, or are exquisitely sensitized by the virus attack, pain is the principal persistent complication of shingles. This pain, called postherpetic neuralgia, is among the most devastating known to mankind — the kind of pain that leads to insomnia, weight loss, depression, and that total preoccupation with unrelenting torment that characterizes the chronic pain sufferer.

Although it can be extraordinarily painful, postherpetic neuralgia is not life-threatening. Doctors treating the pain currently employ a variety of medications. Powerful narcotic pain relievers can offer relief but, because they can have serious side effects, doctors often prescribe newer nonaddictive but potent painkillers. Ointments containing capsaicin, the heat-producing ingredient found in hot chili peppers, are effective in relieving pain from postherpetic neuralgia, as well as pain from other disorders such as arthritis. Such ointments are currently available by prescription. Although these creams contain less than 1 percent capsaicin, new research suggests that patients may be able to tolerate creams containing 5 to 10 percent of this active ingredient if used in combination with other pain killers. More research is needed before these higher dose ointments will be available to patients with postherpetic neuralgia (see section entitled "What Research is Being Done?").

In 1999, the Food and Drug Administration approved a new method of treating the pain of postherpetic neuralgia. The product is an adhesive patch containing lidocaine, a commonly used local anesthetic. The patch allows lidocaine to be released into the top layers of the skin, reducing pain from the damaged nerves. Because it delivers the drug via the skin, it does not produce any significant levels of the drug in the blood and, therefore, does not cause serious systemic side effects if used appropriately.

Studies have also shown that some anticonvulsant drugs used to treat epilepsy, such as carbamazepine, are sometimes effective in relieving the pain of postherpetic neuralgia. Antidepressants can help also. In addition to their effects on mood, the antidepressants appear to relieve pain. Some doctors report that patients occasionally benefit from alternative treatments for pain, such as acupuncture and electrical stimulation of nerve endings.

It is important to realize that individuals with postherpetic neuralgia no longer have shingles: their infection is over. Instead, they are suffering from damage to the nervous system. Scientists believe that the virus attack has led to scarring or other lesions affecting the cells in sensory ganglia and associated nerves. Even in such severe cases, however, the paralysis, headaches, and pain generally subside, although it may take time.

Herpes Zoster Oticus

Herpes zoster oticus, also called Ramsay Hunt Syndrome or Ramsay Hunt Syndrome type II, is a common complication of shingles. Herpes zoster oticus, which is caused by the spread of the varicella-zoster virus to facial nerves, is characterized by intense ear pain, a rash around the ear, mouth, face, neck, and scalp, and paralysis of facial nerves. Other symptoms may include hearing loss, vertigo (abnormal sensation of movement), and tinnitus (abnormal sounds). Taste loss in the tongue and dry mouth and eyes may also occur.

Some cases of herpes zoster oticus do not require treatment. When treatment is needed, medications such as antiviral drugs or corticosteroids may be prescribed. Vertigo may be treated with the drug diazepam.

Generally, the prognosis of herpes zoster oticus is good. However, in some cases, hearing loss may be permanent. Vertigo may last for days or weeks. Facial paralysis may be temporary or permanent.

Immunosuppressed Individuals

In patients with immune deficiency, the rash can be much more extensive and the illness can be complicated by pneumonia. These cases are more serious, but they are rarely fatal except in extraordinary situations.

Shingles is a serious threat to life in immunosuppressed individuals — for example, those with HIV infection or patients with cancer who are receiving treatments that can weaken their immune systems. These treatments destroy cancerous tissue but unfortunately they also have the potential to damage cells of the immune system that normally fight invading organisms. Patients who receive organ transplants (for kidney disease, for example) are also vulnerable to shingles. To prevent the body from rejecting the foreign tissue of the transplant, these patients are given drugs that suppress the immune system. Should any of these patients contract shingles, there is a possibility that the zoster virus will spread throughout the body, reaching vital organs like the lungs. If unchecked, such disseminated zoster can lead to death from viral pneumonia or secondary bacterial infection.

Source: NIH