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Shingles Complications

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Updated May 27, 2014

Shingles is a painful rash that is caused by a reactivation of the same virus that causes chicken pox. Not only is shingles a painful condition, but several complications can occur. These possible complications are different for people with normal immune systems compared to those with compromised immune systems. The incidence of complications in people with a normal immune system are:

Risk of Developing Complications from Shingles

The main risk factors for developing complications from shingles are older age and other serious medical problems such as diabetes, cancer, HIV, and receiving a transplant.

Postherpetic Neuralgia

Postherpetic neuralgia is a potentially debilitating condition causing burning pain that lasts for at least six months after the start of the shingles rash. A full discussion of this condition can be found here.

Bacterial Skin Infection

Because the shingles rash causes blisters that pop and leave open sores, the risk of a subsequent bacterial infection in the area is high. Examples of common bacterial infections that can occur are:

Eye Damage

If the shingles virus affects the forehead or nose, it can permanently affect the eye. The symptoms include pain and rash on one side of the forehead, eye, and nose. Without antiviral treatment, almost half of these people will experience permanent eye damage. Anyone who has shingles near the eye should be seen by an eye doctor.

Motor Neuropathy - Paralysis

Motor neuropathy is paralysis of the muscles affected by the shingles virus. Normally the virus only affects the sensation of the skin, but in rare cases it can spread to the muscles. Approximately 75% of people with this complication notice a gradual recovery of motor function.

Meningitis

Meningitis is an infection of the fluid surrounding the brain and spinal cord, the cerebrospinal fluid. The symptoms of meningitis include severe headache, sensitivity to light, achy muscles, and fever. Because this meningitis is caused by a virus, not a bacteria, it cannot be treated with antibiotics (viruses are resistant to antibiotics). It essentially has to run its course and sometimes pain medication is needed to treat the headache.

Ramsay Hunt Syndrome

Ramsay Hunt syndrome, otherwise known as herpes zoster oticus, is inflammation of several of the nerves that come out of the brain. The symptoms of Ramsay Hunt syndrome are facial paralysis, ear pain and vesicles inside the ear canal. Some people can also experience dizziness. The chance that this paralysis will resolve depends on how severe the symptoms are. A recent study showed that only 10% of people with complete paralysis fully recovered motor function, while about 66% of people with partial paralysis were able to fully recover.

Suppressed Immune System

People with a compromised immune system, especially those with HIV and transplant recipients, are at higher risk of developing all the above complications except postherpetic neuralgia. Spread of the infection to other areas of the skin and even inside the body is more common in this group. Inflammation of the lungs can cause death even with early treatment with antiviral medications. People with HIV are at risk for developing recurrent shingles infections.

Prevention of Shingles Complications

Prevention of complications is aimed at prompt treatment with appropriate medications. Vaccination with the shingles vaccine reduces the risk of shingles and the risk of post-herpetic neuralgia, although it does not treat shingles once it develops.

Sources:

Bowsher, D. "Pathophysiology of postherpetic neuralgia: towards a rational treatment." Neurology 45(1995): S56.

Devriese, PP and WH Moesker. "The Natural History of Facial Paralysis in Herpes Zoster." Clinical Otolaryngology 13(1988): 289.

Dworkin, RH, and RK Portenoy. "Pain and its persistence in herpes zoster." Pain 67(1996): 241-51.

Finch, Roger, Dennis Maki, Allan Ronald. "Varicella-Zoster Virus Infections." Infectious Diseases, 2nd edition. Ed. Jonathan Cohen, et al. New York: Mosby, 2004. 125-9.

Gnann, John, and Richard Whitley. "Herpes Zoster." The New England Journal of Medicine 347(2002): 340-6.

Jung, Beth, et al. "Risk Factors for Postherpetic Neuralgia in Patients with Herpes Zoster." Neurology 62(2004): 1545-51.

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