Shingles on the face
General
Usually one occurs Shingles on the Skin on the chest or abdomen on.
In some cases, however, symptoms may increase also in the face to make noticable. In this case the Varicella zoster infection as 'Face rose " designated. The varicella zoster viruses then persist in the Cranial nerves. That is particularly common fifth cranial nerve, of the Trigeminal nerve, infected by the virus.
Cause of shingles on the face
The trigeminal nerve is that largest sensitive facial nerve, which one forehead, nose, Cheeks, eyes, chin and Scalp provided.
Spring from him all sensitive nerves of the face, whereby if a branch of the trigeminal nerve is affected the Symptoms of the eyes, nose, forehead and hairy scalp may occur.
If the eye is infected by the virus, shingles is also called Zoster ophthalmicus designated. (Involvement of the ophthalmic nerve from the trigeminal nerve). The ophthalmic nerve is a branch of the trigeminal nerve, which innervates the eye sensitively and can cause massive complications if it is affected.
In some cases, the zoster can innervate the nerves Ear (Herpes zoster oticus) affect. In most cases it is Facial nerve, as the motor nerve of the face, also affected.
Symptoms
As with the rest of the body, symptoms of facial rose start with pain in the affected nerves.
In addition, general fatigue, fever and tiredness can occur. After two to three days, severe, burning pain and sensory disturbances develop on one half of the face.
Shortly thereafter, the affected facial skin swells up reddish and small nodules form, which are arranged in groups.
In the further course of this, fluid-filled bubbles, the size of a pinhead, develop.
Also read our article about Burning in the face!
Swelling as a symptom of shingles
Swelling is a common symptom of shingles. The blistering of the skin is often accompanied by swelling of the subcutaneous tissue in the same place.
The puffiness, especially on the face, can be an uncomfortable symptom.
With a so-called "Zoster ophtalmicus"affecting the eyes, there may be severe swelling around the eyes and eyelids. They go hand in hand with increased tears and a fear of light. The swelling, along with the pain and reddening, is a typical sign of inflammation.
Nerve pain as a symptom of shingles
In the case of shingles of the face, one speaks of nerve pain because the nerves themselves are affected by the inflammation. The pain occurs at the nerve endings and is more likely to occur in older patients. The treatment of shingles and the containment of the inflammation are in the foreground of the treatment of nerve pain.
However, around one in ten patients may experience prolonged pain. This is referred to as "post-zoster neuralgia".
In most cases, the pain persists for a few weeks. However, there is also the risk of becoming chronic over several months. In these cases, extensive pain therapy consisting of several components must be carried out. This includes drug and psychological treatment.
Read more on the topic: Post-zoster neuralgia
Duration of shingles on the face
The duration of shingles can vary and depends greatly on the type and timing of treatment. It is a viral disease that manifests itself a few days after the virus is activated and on average takes at least 14 days for the symptoms to subside.
Blistering occurs on the face about 2 days after the onset of the disease. This is where the malaise sets in. If the 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 onset of therapy, healing can be delayed for several weeks. With 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 on the face can lead to long-term damage and lifelong restrictions. If the eye is affected, the eyesight can be permanently impaired without any prospect of improvement. Long-term damage such as paralysis of the facial muscles can also occur if the facial nerve is affected.
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Signs / initial stage
Will be a Varicella zoster virus-Infection reactivated, for example if the immune system is weakened, then the viruses that have remained in the body since the first infection multiply again.
In the case of shingles of the face, the viruses usually spread along the Trigeminal nerve out. This nerve is responsible for the sensitive innervation of the facial skin.
Before the typical rash occurs, symptoms of the early stage appear in most cases (so-called prodromal stage). These symptoms are general fatigue, tiredness and fever. This initial stage lasts about three to five days. Burning, paresthesia ("tingle“) Or pain in the area of the affected nerve.
In the case of shingles of the face, these complaints occur along one of the branches of the trigeminal nerve, i.e. in the area of the Eye and the forehead, the cheek or the lower jaw. Another localization when the Facial nerve can be the ear and the external ear canal. These pains that occurred before or at the same time as the skin rash occur is called zoster-associated pain.
A few days after the initial stage, painful and reddened swellings of the skin develop on one side in the affected area. These ultimately develop into the bulging zoster vesicles.
Therapy of shingles on the face
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 on the face, rapid and effective therapy must be initiated.
If the eye is affected, it is always advisable to also consult an ophthalmologist. The doctor then usually prescribes eye drops containing cortisone to inhibit the inflammatory reaction in the eye. In addition, systemic antivirals (e.g. acyclovir) are used, which inhibit the virus and alleviate the symptoms. If the itching or pain is severe, additional medication may be prescribed.
The patient himself should take it easy and rest.
Also read our article about Shingles medication!
Complications
The shingles can anywhere on the body lead to complications. However, these are in the face area particularly serious.
in case of an Zoster ophthalmicuswhich that eye concerns, the Cornea affected by the vesicles be. Because here too after healing scar can form this too severe visual disturbances up to blindness to lead. If the zoster is that ear infested (Herpes zoster oticus), is the in 60% of cases Facial nerve also affected. This is the large facial motor nerve, which may cause a lifelong facial paralysis on the affected side can result. Since the nerve for taste sensation arises from the facial nerve, the Sense of taste affected and in some cases may be irreversible.
As an infection of the cranial nerves can lead to serious complications such as persistent paralysis, blindness or loss of taste, a doctor should be consulted at the first signs of shingles on the face.
Is shingles on the face contagious?
Varicella („chickenpox"), I.e. the initial infection caused by the varicella virus, are very contagious and are"airborne“Transmitted, that is, by inhaling droplets containing virus, which an infected person spreads, for example by coughing.
Smear infections through contact with virus-containing vesicle contents are also possible.
The risk of infection with shingles (Herpes zoster) however is lower. It is not transmitted aerogenically, but only through a smear infection, i.e. only when it comes into contact with the contagious liquid from the zoster vesicles. Because it contains the viruses. In this way, non-immunized children or adults (in other words, people who have not come into contact with the virus before) with the varicella zoster virus and get sick with the primary infection, the "chickenpox". It is not possible to suffer from shingles immediately after infection, as the shingles is always preceded by the primary infection “chickenpox”.
People who have had a varicella-zoster virus infection in their life, i.e. who have had chickenpox, or who have been vaccinated against it, usually have enough antibodies to fight off the virus.
How dangerous can shingles be on the face?
Most of the shingles occurs on the trunk. Here it is painful and uncomfortable, but it is rarely associated with complications.
In the face, on the other hand, sensitive and important structures can be affected and damaged. The nerve that shingles often affects on the face is that Trigeminal nerve.
The eye can also be affected - this can lead to scarring of the cornea, which can limit vision to different degrees.
If the inflammation moves towards the ear, the likelihood that the facial nerve is affected by the inflammation increases. This supplies a large part of the facial muscles. A dangerous complication of inflammation of this nerve is permanent unilateral paralysis of the facial muscles.
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What does the initial stage look like?
The reason for the activation of the offending virus is often a slight weakening of the immune system. This could be due to stress, other illnesses or other factors.
In most cases, it is not possible to determine an exact trigger. First of all, those affected notice small blisters that form on the face. These hurt to varying degrees and are often ignored in the first few days. This goes hand in hand with increasing fatigue, malaise and fever. At this stage, the vesicles are often mistaken for a common rash.
After about three days, the blisters typical of shingles appear. These are arranged in a certain line on the face as they follow the supply areas of the affected nerve.
In particular, contact with pregnant women should be avoided if they have shingles or chickenpox. If the pregnant woman is not vaccinated or does not have enough antibodies against the varicella-zoster virus in her body despite the infection, an infection with the virus of the pregnant woman can lead to developmental disorders in the child. If the pregnant woman becomes infected with the varicella zoster virus shortly before or shortly after the birth, this also poses a risk to the newborn.
Shingles of the eye
The virus spreads along the first branch of the Trigeminal nerve from the Nevus ophthalmicus, it can infest the forehead, of Eye and the Cornea come.
In this case one speaks of "Zoster ophthalmicus“, A complication of facial shingles. The first symptoms can be photophobia, tearing, redness and swelling of the eyes. As the disease progresses, painful blisters can form on the cornea. Once these vesicles have healed, irreversible scarring can occur, which can lead to impaired vision or even blindness.
Long-term effects of shingles
The acute inflammation of the nerves (neuritis) shingles can be very painful.
But even after the zoster has healed, severe pain in the area of the affected nerve can persist - in some cases even for life.
As the zoster heals, the nervous system is likely to be over-sensitive to pain-conducting fibers. This pain is called post-therapeutic neuralgia. Typically it is dull, burning pain. They occur more often in shingles of the face than in comparison to shingles in other parts of the body. In addition, the likelihood of suffering from persistent pain increases with age.
Read more on the topic: Shingles pain
To prevent post-therapeutic neuralgia, early treatment of shingles with antiviral therapy (e.g. acyclovir) is extremely important.
There is a vaccination against herpes zoster for people aged 50 and over. It lowers the likelihood of developing shingles. If a vaccinated person falls ill anyway, the vaccination at least means that the probability of later suffering from post-therapeutic neuralgia is lower than for non-vaccinated people.
You might also be interested in this: Zostavax® vaccination against shingles
Summary
The shingles on the face is true less oftenthan in the area of the chest or abdominal skin, however, goes with numerous serious complications hand in hand.
The cause is often one Reactivation of viruses in the trigeminal nervewhich that entire face sensitive provided. The infestation can do that in particular Eye, ear and the facial motor nerve (Facial nerve) may be affected. In this case you can Blindness, facial paralysis, or loss of taste Be a consequence of the infection.
Due to the serious complications should be at the first sign an infection on the face Consulted a doctor become. If the eye is affected, an ophthalmologist should also be contacted. By early therapy with virus-inhibiting drugs, as well as pain and itch-relieving agents, the facial rose can usually also be treated well. Permanent paralysis or pain can still occur and may require lifelong pain relieving therapy.
