What to know about shingles in the face

Shingles in the face can occur when the varicella-zoster virus (which also causes chickenpox) reactivates in the body along nerves connected to the face. It can affect the eyes and, in severe cases, may even cause vision loss.

For most people, symptoms typically get better within 2–4 weeks, which may be shortened with the use of antiviral medications.

Seeing a doctor quickly and receiving treatment can help prevent long-term complications like nerve pain and vision loss.

Symptoms of shingles in the face

Shingles can cause a rash to form on the face that can sometimes blister and cause severe pain. A shingles rash usually affects only one side of the face. Some areas where shingles in the face might occur include:

• forehead and scalp
• upper eyelid
• inside the eye (zoster ophthalmicus)
• side of the nose
• cheek and ears
• inside the mouth (oral shingles)

There are three phases of shingles in the face, each with distinct symptoms:

• Before the rash: You might feel pain, burning, or electrical sensations on your face for a few days before you notice the rash. You might also experience a headache, light sensitivity, or generally feel unwell.
• As the rash starts: You might develop a painful rash on one side of your face. The rash may cause blisters and color changes. This can also lead to further blisters before the rash starts to heal. Typically, this phase lasts 2–4 weeks.
• As the rash goes away: As the shingles rash starts to clear up, the blisters on your face might open, bleed, and scab over. 

If you have shingles in the eye, you might also have:

• vision problems
• eye redness
• tearing
• eye pressure
• skin lesions at the tip, side, or root of your nose

Some people also experience a chronic shingles infection. This is where symptoms such as pain last longer than 4 weeks. This is called postherpetic neuralgia. 

Postherpetic neuralgia can significantly affect your life, causing severe pain, shock-like sensations, burning, prickling, tingling, or numbness in the area of the face where you had the shingles rash.

Causes of shingles in the face

The varicella-zoster virus causes shingles. It’s the same virus that causes chickenpox. After someone has chickenpox, the virus stays dormant in the body. If it reactivates, it’s called shingles.

No one knows why the virus reactivates in some people, but researchers think it has to do with the immune system. As the immune system naturally weakens with age, it’s less able to keep the virus in check. You’re at greater risk of shingles if you:

• are age 50 years or older
• have had a bone marrow or organ transplant
• have had human immunodeficiency virus (HIV)
• take immunosuppressive medications

Shingles appears on the face when the varicella-zoster virus reactivates in a nerve root, which is connected to areas of skin called dermatomes. The location of the rash is the dermatome connected to where the virus became active. 

One possible cause for shingles in the face is the reactivation of the varicella-zoster virus in the trigeminal nerve, which is responsible for sensory information to the eyes, nose, and mouth.

Treatment options for shingles

Shingles treatment typically includes antiviral medications and home remedies. A healthcare professional can recommend a treatment plan that’s suited to your needs.

Medication options

The antivirals used for shingles treatment are:

• acyclovir (Zovirax)
• valacyclovir (Valtrex)
• famciclovir (Famvir)

Need a refill for valacyclovir (Valtrex)? You may be able to get an online prescription through Optum Perks in as little as 15 minutes. Learn more here.

Depending on the antiviral, a doctor will usually recommend you take a dose 3–5 times a day for 5–7 days.

Antiviral medications can help reduce the amount of time it takes for the shingles rash to heal.

Starting treatment with antiviral medications within 3 days of developing a shingles rash on the face can help prevent complications like postherpetic neuralgia.

If you have shingles of the eye, an ophthalmologist might also recommend prescription eye drops such as prednisolone acetate (Pred Forte) or timolol (Timoptic), depending on your eye symptoms. These treatments are in addition to antiviral medications.

At-home treatment options

Home treatment for shingles of the face includes over-the-counter pain medications such as ibuprofen (Advil) and acetaminophen (Tylenol). 

You can take these additional steps to help ease your experience with shingles. 

• Wash the rash daily with a mild cleanser.
• Apply petroleum jelly to the rash.
• Cover the rash with a sterile nonstick bandage.
• Apply a wet, cool washcloth to uncomfortable skin.
• Use calamine lotion to help relieve itch once scabs form.

It’s also important to follow a primary care doctor’s or ophthalmologist’s recommendations about home treatment near the eye to help avoid getting unsafe substances inside the eye. 

Resting and avoiding stress can also help you manage a shingles infection.

If you need help covering the cost of medications, the free Optum Perks Discount Card could help you save up to 80% on prescription drugs. Follow the links on drug names for savings on that medication, or search for a specific drug here.

When should you speak with a doctor?

If you have symptoms of shingles on the face, it’s recommended that you speak with a doctor or ophthalmologist as soon as possible.

While shingles is healing, it can also be helpful to speak with a doctor if there are signs of the following:

• an infection, such as swelling or pus
• persistent pain
• inflammation

If shingles affects your eye, it might lead to inflammation that causes permanent vision loss. Early diagnosis and beginning antiviral treatment right away can help prevent these complications.

Summary

Shingles can occur when the dormant varicella-zoster virus becomes active again in the body. If the virus reactivates in the nerves connected to the dermatomes of the face, you may develop a rash in the following areas:

• forehead
• cheek
• ears
• eyelid
• side of the nose

Antiviral medications help clear up the shingles rash more quickly and can help prevent a chronic shingles infection. Home treatment includes over-the-counter pain medication, keeping the skin clean and cool, and avoiding stress.

If you believe you have a shingles infection, it’s important that you speak with a healthcare professional immediately.

Download the free Optum Perks Discount Card to save up to 80% on some prescription medications.